Adoption of coronary artery disease - Reporting and Data System (CAD-RADS™) and observed impact on medical therapy and systolic blood pressure control.

Autor: Hull RA; Department of Medicine, Cardiology Division, Brooke Army Medical Center, San Antonio, TX, USA., Berger JM; Department of Flight Medicine, Little Rock Air Force Base, AR, USA., Boster JM; Department of Medicine, Internal Medicine Residency, Brooke Army Medical Center, San Antonio, TX, USA., Williams MU; Department of Medicine, Division of Cardiology, Warren Alpert School of Medicine, Brown University, Providence, RI, USA., Sharp AJ; Department of Medicine, Cardiology Division, Brooke Army Medical Center, San Antonio, TX, USA., Fentanes E; Department of Medicine, Division of Cardiology, Tripler Army Medical Center, Honolulu, HI, USA. Electronic address: Emilio.fentanes.mil@mail.mil., Maroules CD; Department of Radiology, Naval Medical Center, Portsmouth, VA, USA. Electronic address: christopher.maroules@gmail.com., Cury RC; Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA. Electronic address: RCury@baptisthealth.net., Thomas DM; Department of Medicine, Cardiology Division, Brooke Army Medical Center, San Antonio, TX, USA. Electronic address: dustin.thomas@parkview.com.
Jazyk: angličtina
Zdroj: Journal of cardiovascular computed tomography [J Cardiovasc Comput Tomogr] 2020 Sep - Oct; Vol. 14 (5), pp. 421-427. Date of Electronic Publication: 2020 Jan 22.
DOI: 10.1016/j.jcct.2020.01.005
Abstrakt: Background: CAD-RADS was developed to standardize communication of per-patient maximal stenosis on coronary CT angiography (CCTA) and provide treatment recommendations and may impact primary prevention care and resource utilization. The authors sought to evaluate CAD-RADS adoption on preventive medical therapy and risk factor control amongst a mixed provider population.
Methods: Statins, aspirin (ASA), systolic blood pressure and, when available, lipid panel changes were abstracted for 1796 total patients undergoing CCTA in the 12 months before (non-standard reporting, NSR, cohort) and after adoption of the CAD-RADS reporting template. Only initiation of a medication in a treatment naïve patient, escalation from baseline dose, or transition to a higher potency was considered an escalation/initiation in lipid therapy.
Results: The CAD-RADS reporting template was utilized in 83.7% (751/897) of CCTAs after the CAD-RADS adoption period. After adjusting for any coronary artery disease (CAD) on CCTA, statin initiation/escalation was more commonly observed in the CAD-RADS cohort (aOR 1.46; 95%CI 1.12-1.90, p = 0.005), driven by higher rates of new statin initiation (aOR 1.79; 95%CI 1.23-2.58, p = 0.002). This resulted in a higher observed rates of total cholesterol improvement in the CAD-RADS cohort (58% vs 49%, p = 0.016). New ASA initiation was similar between reporting templates after adjustment for CAD on CCTA (aOR 1.40; 95%CI 0.97-2.02, p = 0.069). The ordering provider's specialty (cardiology vs non-cardiology) did not significantly impact the observed differences in initiation/escalation of statins and ASA (pinteraction = NS).
Conclusions: Adoption of CAD-RADS reporting was associated with increased utilization of preventive medications, regardless of ordering provider specialty.
(Copyright © 2020 Society of Cardiovascular Computed Tomography. All rights reserved.)
Databáze: MEDLINE
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