Atherosclerotic Cardiovascular Disease, Coronary Artery Disease
Conditions
Keywords
Coronary Calcium, Statin, Non-gated Chest CT
Brief summary
This is a multi-center, randomized quality improvement project. At least 200 statin-naïve patients without a history of atherosclerotic cardiovascular disease with incidental coronary artery calcium (CAC) on a prior non-gated chest CT will be enrolled across the Stanford Healthcare System and the Palo Alto Veteran's Affairs Healthcare System. Patients will be randomized in a 1:1 fashion to notification or usual care arms. The primary aim of this project is to estimate the increase in 6-month statin prescription among statin-naïve patients without a history of atherosclerotic cardiovascular disease with incidental CAC on a non-gated chest CT who are randomized to receive notification of their findings vs. usual care.
Interventions
OTHERNotification
Notification of coronary calcium to the patient and their clinician
Sponsors
Stanford University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Non-gated chest CT between 2014-2019 * The presence of CAC confirmed by manual review by an experienced radiologist * Stanford affiliated primary care provider or endocrinologist for Stanford healthcare system patients and VA primary care provider for VA patients with at least 1 encounter since 2018
Exclusion criteria
* Current or prior statin or PCSK9 inhibitor therapy * Prior diagnosis of ASCVD (coronary artery disease, peripheral arterial disease, cerebrovascular disease, coronary/peripheral revascularization) * Prior coronary imaging (cardiac CT, invasive coronary angiography) * Dementia * Metastatic cancer or active cancer undergoing chemotherapy * History of medical nonadherence
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rate of Statin Prescription | Within 6 months | Proportion of patients prescribed a statin |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Statin Intensity | 6 months | Proportion of patients prescribed a high intensity, intermediate intensity, and low intensity statin |
| Total Cholesterol Level | 6 months | — |
| LDL Cholesterol Level | 6 months | — |
| HDL Cholesterol Level | 6 months | — |
| Triglyceride Level | 6 months | — |
| Systolic Blood Pressure | 6 months | — |
| Number of Hypertension Medications | 6 months | — |
| Hemoglobin A1c Level | 6 months | — |
| Body Mass Index | 6 months | — |
| Pooled cohort equations estimated 10-year risk of atherosclerotic cardiovascular disease | 6 months | — |
| Rate of Aspirin Prescription | 6 months | Proportion of patients prescribed aspirin |
| Number of primary Care Clinical Encounters | 6 months | — |
| Number of Cardiology Referrals | 6 months | — |
| Number of Cardiovascular Diagnostic Tests | 6 months | — |
Countries
United States
Outcome results
None listed