HeartFlow, Inc. is highlighting a recent publication in the Journal of the American College of Cardiology (JACC) which advocates for the use of coronary computed tomography angiography (CTA) as the default diagnostic test for evaluating patients with stable chest pain. The article was authored by prominent healthcare stakeholders representing physician societies, provider institutions and government and commercial health plans.
Evidence from several clinical trials has demonstrated the value of adopting a coronary “CTA-first” strategy. In the SCOT-HEART randomized controlled trial of more than 4,100 patients, the utilization of a CTA-first diagnostic approach led to a 41% reduction in cardiac death and myocardial infarction over five years and a significant increase in initiation of preventative therapy1. Citing results of these trials, the authors conclude that the diagnosis of stable chest pain in patients must change from detection of a perfusion abnormality to detection of atherosclerosis using a coronary CTA-first strategy.
“Transitioning to coronary CTA is essential in the U.S., and we need to remove the barriers that are impeding adoption,” noted Michael Poon, M.D., Chief, Non-Invasive Cardiac Imaging, and System Director of Research, Cardiac Imaging and Clinical Transformation, Lenox Hill Hospital-Northwell Health and lead author of the JACC publication. “Among the barriers are the overwhelming use of SPECT myocardial perfusion imaging as compared to coronary CTA testing and ‘perverse economic incentives’ which underlie this pattern. Such incentives reward use of established, less effective practices as opposed to innovative technologies offering improved medical outcomes with long-term cost reduction. Despite these challenges, I remain strongly optimistic about widespread adoption, in light of the impressive clinical trial results showing the clear benefits of a CTA-first pathway for patients.”
The Need for Improved Coronary Artery Disease Testing
In the U.S., cardiologists typically turn to established non-invasive tests such as stress echocardiography and nuclear single-photon emission computed tomography (SPECT) to detect perfusion abnormalities in the heart, seeking to determine which patients have coronary artery disease (CAD) and to identify who may benefit from revascularization – an invasive procedure.
As a result of the widespread use of these tools, several studies point to the need for a non-invasive test that more accurately determines who may benefit from invasive evaluation:
About 60% of patients sent to invasive coronary angiography (ICA) do not have significant CAD.4
Stress test results are not predictive of which patients had significant CAD and provided no predictive value beyond traditional cardiovascular risk factors such as high blood pressure or a history of smoking.5
Patients with positive stress test results are less likely to undergo revascularization (35.2%) than patients with negative results (47.9%) or no stress test at all (40.3%).6
Overcoming Barriers to Adoption of Coronary CTA-first Strategy
Physicians and clinical societies in the UK, EU and Japan have already updated guidelines and implemented clinical programs, reimbursement and education to enable the switch to a coronary CTA-first strategy.
HeartFlow has seen significant adoption of the CTA-first strategy in recent years, including at 75% of the top 50 heart hospitals in the U.S. as ranked by U.S. News and World Report.8 The adoption of the CTA-HeartFlow Analysis pathway has led to reduced waiting times and improved patient care, which are all critical factors especially during the pandemic when physicians and hospitals are doing everything they can to minimize the number of patients who are required to be in a hospital setting.
“We welcome this CTA-first approach which has broad support within the healthcare ecosystem globally,” said Campbell Rogers, M.D., FACC, Chief Medical Officer, HeartFlow. “The benefits of coronary CTA are undeniable. Our PLATFORM trial comparing conventional strategies to coronary CTA paired with the HeartFlow Analysis found that across 584 patients there was an 83% reduction in unnecessary invasive angiograms. More recently, results from the FORECAST trial show a significant reduction in unnecessary invasive cardiac testing, an increase in catheterization lab efficiency to higher levels than have been reported previously, and a large reduction in repeat non-invasive testing9. Combined with study results cited in the JACC publication, the evidence for adopting a coronary CTA-first treatment pathway, and for the added value of the HeartFlow Analysis, is compelling.”