Primary care patients' perspectives on CT coronary calcium scoring and exercise electrocardiography

Area of Science:

• Cardiology
• Diagnostic Imaging
• Primary Care Medicine

Background:

• Computed tomography coronary calcium scoring (CT-CCS) demonstrates superior sensitivity for detecting obstructive coronary artery disease (OCAD) compared to exercise electrocardiography (x-ECG).
• The utility of CT-CCS as an initial diagnostic test within primary care settings remains under investigation.

Purpose of the Study:

• To evaluate patient perspectives on CT-CCS versus x-ECG testing.
• To compare diagnostic outcomes, including OCAD diagnosis and initiation of cardiovascular risk management (CVRM), between the two testing modalities.

Main Methods:

• A one-year pilot study involving 38 general practitioner practices, cluster randomized to CT-CCS or x-ECG referrals for patients with atypical angina or non-specific thoracic complaints.
• Patient perspectives were assessed via questionnaire, and clinical data were collected from electronic patient records.
• Outcome measures included patient satisfaction, OCAD diagnosis rates, and CVRM initiation.

Main Results:

• CT-CCS patients reported significantly higher overall satisfaction, ease of undergoing the test, willingness to retest, and better perception of GP information compared to x-ECG patients.
• In the CT-CCS group, 24% of patients with a CT-CCS score ≥100 were diagnosed with OCAD, and 82% initiated CVRM.
• In the x-ECG group, only 4% of patients were included in CVRM, with no OCAD diagnosis.

Conclusions:

• CT-CCS is associated with greater patient satisfaction than x-ECG.
• Coronary calcium scoring emerges as a promising diagnostic tool for OCAD detection in primary care, potentially enhancing cardiovascular risk management strategies.