Cardiac CT — Not enough of a good thing

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Cardiac CT — Not enough of a good thing

by Sean Ruck, Contributing Editor | March 13, 2020
Cardiology CT X-Ray
From the March 2020 issue of HealthCare Business News magazine

Low or no reimbursement is also unfortunate when considering something else cardiac CT has going for it: patients benefit and learn so much more than whether they have ischemia or not. “The really unique feature to coronary CT angiography for patients who have symptoms concerning for heart disease is that you see non-obstructive plaque or no plaque at all. These are important distinctions for predicting their cardiovascular risk and are much more common than finding a blocked artery,” says Villines. “Most patients who have chest pain don’t have significant heart artery disease. Stress tests just tell you whether you might have a coronary narrowing, whereas cardiac CT allows you to say, ‘OK, not only do you have a narrowing, or not, but do you have plaque and if so, how much?” Clinical trials have shown that seeing, quantifying, and characterizing coronary plaque leads to more appropriate use of preventative therapies (e.g., statins) and discussions with patients on how to improve healthy lifestyle choices. It improves outcomes and better informs patients and their providers. Functional stress tests simply do not visualize coronary atherosclerosis, the most powerful predictor of patient short and long-term risk.”

Todd Villines, M.D.
Cardiac CT’s safety has also improved since its introduction. “When I started in the early to mid-2000s, radiation and contrast doses were much, much higher.” He says the drop has been dramatic. According to the PROTECTION VI study, doses for coronary CTA have decreased by 78% since 2007 with the procedure typically delivering about half the radiation dose of SPECT imaging, for example. “Patient radiation dose exposure for modern coronary CTA is often similar to a mammogram.”

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He hopes in the near future that patients will have broader access to this important test. A big step to improving access will be improving reimbursement. For that, it’s imperative that cardiac CT providers work closely with their hospitals to make sure they’re reporting the true costs of the study to Medicare most accurately.

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