Prevalence of CAC Scoring in Patients With Known Coronary Artery Disease: A Cohort Study on Choosing Wisely

Background

Coronary artery calcium (CAC) scoring plays a role in risk assessment for presence of atherosclerotic coronary heart disease (CHD). Among patients with known CHD, CAC has little or no value. Performing CAC on CHD patients is discouraged by ACC/AHA guidelines and the Choosing Wisely campaign. The extent to which this occurs in clinical practice is not well described.

Methods

We evaluated all UF Health patients since 2011 with known CHD who later underwent CAC scoring. We used our Integrated Data Repository to identify the cohort based on International Classification of Diseases and Current Procedural Terminology codes. Data from patient demographics, past medical history, CAC scoring results, ordering provider information and subsequent clinical management were recorded into a custom REDCap database for qualitative analysis. No prespecified statistical plan was performed as the investigation was intended as descriptive.

Results

Upon reviewing all patients with known CHD, we found only 19 instances over 12 years where CAC scoring was ordered. Among these, 14 were men and 5 were women. A large percentage had a past medical history of DM (9, 47.4%) and hypertension (15, 78.9%) with a subclinical CHD diagnosis (17, 89.5%). Statin therapy was already initiated for 13 (68.4%). Most of the CAC scoring tests were ordered by cardiology attendings (10, 52.6%), and the justification most frequently provided was for risk stratification in patients with known CHD. Often (78.9%), there was no significant change in patient management or a slight alteration in medication therapy. One case resulted in percutaneous intervention.

Conclusions

CAC scoring was rarely ordered among patients with known CHD over a 12-year span. Professional society efforts towards encouraging high-value care may wish to consider more high-impact recommendations in the future.