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Coronary artery calcium testing: A call for universal coverage
Morteza Naghavi1, David J Maron2, Robert A Kloner3
1Society for Heart Attack Prevention and Eradication (SHAPE), Palo Alto, CA, United States of America.
Insights
Early detection of high-risk individuals for heart attacks is crucial. Coronary artery calcium (CAC) testing offers a more accurate and cost-effective screening method than current practices, saving lives and resources.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Economics
Background:
- Heart attacks are a leading cause of death, surpassing all cancers combined.
- Current screening for atherosclerotic cardiovascular disease (ASCVD) focuses on risk factors, often missing high-risk individuals and over-treating low-risk ones.
- Existing methods like treadmill stress tests are frequently misleading and resource-intensive for asymptomatic individuals.
Purpose of the Study:
- To highlight the need for improved early detection of asymptomatic individuals at high risk for heart attacks.
- To advocate for the adoption and coverage of coronary artery calcium (CAC) testing as a superior screening tool.
- To emphasize the cost-effectiveness and accuracy of CAC testing compared to current screening paradigms.
Main Methods:
- Review of current screening practices for ASCVD and cancer.
- Comparison of the diagnostic accuracy and cost of CAC testing versus traditional risk factor screening and treadmill stress tests.
- Analysis of the implications of current payer policies on ASCVD screening.
Main Results:
- Coronary artery calcium (CAC) testing is a non-invasive, 5-minute CT scan costing under $200, significantly less than cancer screenings.
- CAC testing provides more accurate risk assessment for ASCVD compared to traditional methods.
- Despite ACC/AHA guideline adoption, CAC testing is not widely covered by payers, unlike less cost-effective cancer screenings.
Conclusions:
- CAC testing represents a significant advancement in identifying high-risk individuals for heart attacks, enabling timely intervention.
- Increased coverage of CAC testing for appropriate individuals can lead to substantial savings in healthcare costs and, more importantly, save lives.
- Policy changes, such as Texas's HB1290, are necessary to mandate CAC coverage and improve public health outcomes.
Abstract:
Heart attacks kill more Americans than all cancers combined. Fatal heart attack victims have no symptoms until minutes before they die, hence early detection of high-risk asymptomatic individuals is needed. Even though heart attacks kill and cost more than cancers, as a nation we spend over 20 times more on screening for asymptomatic cancer than for asymptomatic atherosclerotic cardiovascular disease (ASCVD), the underlying cause of heart attacks. Currently, payers only cover screening for risk factors of ASCVD such as blood pressure and blood cholesterol. This approach tends to miss high-risk and over-treat low-risk individuals. Although treadmill stress testing with ECG is not indicated for ASCVD detection in asymptomatic individuals, it is done often, and frequently leads to misleading conclusions or unnecessary downstream diagnostic procedures. For example, former President Clinton had passed his treadmill stress tests for several years during his presidential annual checkup but had a heart attack shortly after his presidency. This common practice is a waste of our limited resources. Instead, a more accurate risk assessment using coronary artery calcium (CAC) testing is available; and has just been adopted by ACC/AHA guidelines, however payers do not cover it. CAC is measured non-invasively with a 5-minute CT-scan of the heart, and costs less than $200, whereas cancer screening with colonoscopy and mammography costs over $3000. There is an opportunity to save lives and dollars if CAC testing is covered for appropriately selected individuals. Texas has already passed HB1290 to mandate CAC coverage. Other states must step up and take actions.
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