Coronary Artery Calcification
Conditions
Brief summary
This is a prospective randomized controlled trial assessing the impact of notifying patients and their clinicians of an incidental finding of coronary artery calcification (CAC) indicating increased cardiovascular risk. Patients will be identified through completed radiology orders for non-gated, non-contrast chest CT in the appropriate clinical context and then will have an EHR screen for inclusion criteria. The presence of CAC will be confirmed by a radiologist. Eligible patients will be randomized to CAC notification or usual care using a 1:1 stratified block randomization method based on baseline ASCVD.
Interventions
OTHERNotification
For patients randomized to notification, the affiliated non-EP cardiologist, if present, or if patient does not have one, the PCP will be notified and will receive an electronic health record (EHR) message notifying them of the presence of CAC (with images) and the ACC/AHA guideline recommendation to consider starting statin therapy. Simultaneously, the patient will be notified via a MyHealth message describing the presence of CAC with personalized scan images, its significance, and the recommendation that statin therapy should be considered. For the notification arm, we will check for either statin prescription or a documented discussion in the EHR at 2 months. For those not prescribed a statin and without a documented discussion in Epic at 2 months follow-up, we will send a repeat notification to their home address and to their affiliated clinician.
Sponsors
Stanford University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 84 Years
Healthy volunteers
No
Inclusion criteria
* Age 18 and above and \<85 * Non-gated chest CT with CAC * An encounter after July 1, 2021 with a Stanford-affiliated clinician from one of the following clinics: * Stanford Internal Medicine (includes University affiliated clinics) * Stanford Family Medicine (includes University affiliated clinics) * Non-EP cardiologist
Exclusion criteria
* Advanced or poor-prognostic cancer * No active primary care or cardiology care at Stanford Health Care * Primary language other than English, Spanish, Vietnamese, Cantonese, or Mandarin * Baseline statin or non-statin lipid lowering therapy * Allergy to statin medication or identification of statin-associated muscle symptom
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of new statin prescriptions | Baseline through Month 6 | 6-month new statin prescription rate |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of participants using statin medication | Month 6 | 6-month assessment of statin prescription rates |
| Change in Low-density lipoprotein (LDL) cholesterol | Baseline and Month 6 | — |
| Change in 10-Year Atherosclerotic Cardiovascular Disease (ASCVD) Pooled Cohort Equation | Baseline and Month 6 | This outcome measures the 10 year risk of ASCVD events. |
| Number of events requiring primary care intervention, cardiology referrals, or cardiac testing | Baseline through Month 6 | This outcome assesses healthcare resource use (primary care clinical encounters, cardiology referrals, cardiac testing). |
Countries
United States
Outcome results
None listed