ASCVD, Coronary Artery Calcification
Conditions
Brief summary
Estimate the impact of notifying both patients and their clinicians of the presence of incidental coronary artery calcium (CAC) on initiation of lipid-lowering therapy in patients with ASCVD who are not receiving lipid-lowering therapy.
Detailed description
This is a randomized quality improvement (QI) project evaluating the impact of notifying patients and their clinicians (primary care, cardiologists, neurologists, or vascular surgeon) of incidental CAC detected on a prior chest CT scan. Patients will be identified by screening previous non-gated chest CT scans and electronic health records. The presence of CAC will be confirmed by a radiologist. Eligible patients will be randomized to: 1) notification of presence of CAC with a CT scan image; 2) notification of presence of CAC without a CT scan image; 3) or usual care.
Interventions
OTHERNotification of patients and clinicians
Notification Patients randomized to notification will receive a message sent by either the electronic health record (EHR) patient portal or US mail that will inform them of the CAC identified on their previous chest CT scan (with or without an image) and a recommendation that they discuss this finding and initiation of lipid-lowering therapy with their clinician. The clinicians will be notified of these findings by an earlier EHR message that will be sent 2 weeks before the patient notification. Two months after the initial notification, patients and their clinicians who are randomized to notification arms will receive a second message similar to the initial notification.
Sponsors
Stanford University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Caregiver)
Masking description
In the usual care arm, patients or clinicians will not be notified.
Intervention model description
Eligible patients will be randomized to: 1) notification of presence of CAC with a CT scan image; 2) notification of presence of CAC without a CT scan image; 3) or usual care.
Eligibility
Sex/Gender
ALL
Age
18 Years to 84 Years
Healthy volunteers
No
Inclusion criteria
1. Presence of CAC on non-gated chest CT scans performed from 2021 to 2025 2. Age \<85 years 3. Diagnosis of ASCVD(coronary artery disease, peripheral artery disease, or cerebrovascular disease) 4. Visit to Stanford affiliated clinician since 2022 at one of the following Stanford clinics including University affiliated clinics: 1. Internal Medicine 2. Family Medicine 3. Cardiology 4. Neurology 5. Vascular surgery 5. Primary language is English or Spanish
Exclusion criteria
1. No diagnosis of ASCVD 2. Patients receiving lipid-lowering therapy 3. Dementia 4. Metastatic cancer or active cancer undergoing chemotherapy 5. Hospice
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Initiation of lipid-lowering therapy | Month 6 | Number of patients who had initiation of lipid-lowering therapy |
Countries
United States
Outcome results
None listed