Self- vs provider-referral differences for coronary artery calcium testing

Abstract

Study objectives: The objectives of this study were to identify independent predictors for moderate/accentuated coronary artery calcium (CAC) score and compare patients who self-referred for CAC Computed Tomography (CT) testing to those who were provider-referred. Design: Patients underwent CAC between January to July 2019. The analysis was divided into self-referred patients influenced by a CAC community campaign who identified themselves as having cardiovascular risk factors compared to provider-referred intermediate-risk patients who were asymptomatic. SAS version 9.4 (SAS Institute, Inc., Cary, NC) was used for all analyses. Setting: Seven southwest Ohio hospitals from a single network. Participants: 2124 adult patients who received CAC CT (163 self and 1961 provider-referred). Interventions: CAC CT. Main outcome measures: Demographics, risk factors, lab values, prescriptions, and referral status were used to compare CAC score differences between self- and provider-referred patients. Results: For 2124 patients, three predictors for moderate/accentuated CAC score remained significant after multiple logistic regression: CKD (OR 0.24, CI 0.008–0.68, p < 0.05), COPD (OR 0.39, CI 0.19–0.80, p < 0.05), and CAD (OR 0.46, CI 0.22–0.98, p < 0.05). There were four differences between referred groups: history of PVD (OR 0.21, CI 0.05–0.86, p < 0.05), higher triglyceride (OR 1.004, CI 1.00–1.01, p < 0.05), higher LDL levels (OR 0.991, CI 0.98–1.00, p < 0.05), and beta blocker prescription (OR 4.38, CI 1.49–12.85, p < 0.05) in self-referred patients. Conclusions: CAC CT testing is associated with independent risk predictors and can be used to clarify cardiovascular risk in self- and provider-referred patients with statistical similarity. Patients reliably self-refer for CAC CT when risk is present during a community initiative. Such initiatives may have a preventive benefit and lead to earlier pursuit and optimization of anti-lipid therapies.

Keywords

• Coronary
• Calcification
• Statin
• Hyperlipidemia
• CAC
• ASCVD