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. 2023 Jul-Aug;17(4):254-260.
doi: 10.1016/j.jcct.2023.04.003. Epub 2023 May 18.

Early outcomes following integration of computed tomography (CT) coronary angiography service in an established cardiology practice in disease management

David Playford  1 , Nisha Schwarz  2 , Anna E Williamson  2 , MyNgan Duong  2 , Amied Shadmaan  3 , Daneh Turner  3 , Stuart Behncken  2 , Tom Phillips  2 , Leighton Kearney  4
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Free article

Early outcomes following integration of computed tomography (CT) coronary angiography service in an established cardiology practice in disease management

David Playford et al. J Cardiovasc Comput Tomogr. 2023 Jul-Aug.
Free article

Abstract

Background: Computed tomography coronary angiography (CTCA) is an established modality for the diagnosis and assessment of cardiovascular disease. However, price and space pressure have mostly necessitated outsourcing CTCA to external radiology providers. Advara HeartCare has recently integrated CT services within local clinical networks across Australia. This study examined the benefits of the presence (integrated) or absence (pre-integrated) of this "in-house" CTCA service in real-world clinical practice.

Methods: De-identified patient data from electronic medical records were used to create an Advara HeartCare CTCA database. Data analysis included clinical history, demographics, CTCA procedure, and 30-day outcomes post-CTCA from two age-matched cohorts: integrated (n ​= ​495) and pre-integrated (n ​= ​456).

Results: Data capture was more comprehensive and standardised across the integrated cohort. There was a 21% increase in referrals for CTCA from cardiologists observed for the integration cohort vs. pre-integration [n ​= ​332 (72.8%) pre-integration vs. n ​= ​465 (93.9%) post-integration, p ​< ​0.0001] with a parallel increase in diagnostic assessments including blood tests [n ​= ​209 (45.8%) vs. n ​= ​387 (78.1%), respectively, p ​< ​0.0001]. The integrated cohort received lower total dose length product [Median 212 (interquartile range 136-418) mGy∗cm vs. 244 (141.5, 339.3) mGy∗cm, p ​= ​0.004] during the CTCA procedure. 30-days after CTCA scan, there was a significantly higher use of lipid-lowering therapies in the integrated cohort [n ​= ​133 (50.5%) vs. n ​= ​179 (60.6%), p ​= ​0.04], along with a significant decrease in the number of stress echocardiograms performed [n ​= ​14 (10.6%) vs. n ​= ​5 (11.6%), p ​= ​0.01].

Conclusion: Integrated CTCA has salient benefits in patient management, including increased pathology tests, statin usage, and decreased post-CTCA stress echocardiography utilisation. Our ongoing work will examine the effect of integration on cardiovascular outcomes.

Keywords: CTCA; Cardiac CT service; Computed tomography coronary angiography; In-house service; Integrated CT services.

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Conflict of interest statement

Declaration of competing interest Amied Shadmaan and Daneh Turner are employees of GE Healthcare. The remaining authors have no relevant disclosures.

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