Unlock the life-saving power of
Cardiac Calcium Scoring
for your at-risk patient population today!

Cardiac Calcium Scoring succeeds where other prevention strategies fail. It individualizes risk. It is not theoretical. It looks at the actual disease process. It is simply the best predictor of a person’s risk of heart attack. It is also cost-effective with essentially no risk.

In order to Champion Coronary Calcium Scoring, one must:

(1) Understand which patients benefit

(2) Convey benefits clearly, when referring for a scan

(3) Learn to interpret results clinically

(4) Translate findings into a care management “pathway”

(5) Capitalize on the motivational aspects of of a high score

Here we describe the unique benefits of coronary calcium scoring. For a more in-depth description of how to integrate this technology into your practice, and prevent heart attacks in your patients — subscribe to our monthly case reports. To consider implementing a new Calcium Scoring Program at your practice, or improving your current Program, contact us to hear about our consultation solutions.

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“Great news, your calcium
score is ZERO !
You have a less than
1-in-1000 chance of having a heart attack this year.”

“I’m concerned, your
calcium score is high for
your age. We need to work at stopping plaque formation
NOW.”

“Your calcium score proves
you are at HIGH RISK
of a heart attack.
I’d like you to have a
stress test.”

“The great news is --
that with a few medications
and some basic changes in
your lifestyle; we’ll cut your
heart attack risk in half!”

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Patient Engagement & Motivation

Cardiac calcium scoring UNIQUELY engages patients in their treatment plans.  It gets their attention.

After a HIGH score, it is not uncommon for patients to ask bluntly, “How are we going to get rid of that plaque? I don’t want to have a heart attack!”

They WANT to hear about exercise, weight loss techniques and smoking cessation strategies. They drop their pre-conceived notions of “statins” and listen to the true risks & benefits discussion.

Cholesterol values and calculated risks don’t get our patients excited about behavioral change — but seeing the actual disease-process that might kill them, certainly does. Putting a number to their plaque and putting a picture in front of them, certainly does.

LOW scores help too. You can stop begging your patient with a calculated ASCVD risk of 8.2% to take a low-dose statin when they have a ZERO score. Not because you’re tired of the fight — but because they are NOT going to have a heart attack, regardless!

Early Detection

All providers should visit the “Individuals” section, to consider who should be referred for testing.  If your home institution needs to initiate a program, or if you want to improve utilization and quality — please also visit our “Consulting Solutions” section.

Consultation with a preventive cardiologist and/or nuclear stress testing for patients with high risk results (generally, total score >400) can be a life-saving intervention.  Starting a “statin” or getting a patient to quit smoking, after a high risk result can be a life-saving intervention.  Coaching a patient through a 30-pound weight loss after a HIGH risk result can be a life-saving intervention.

The DATA supporting Coronary Calcium Scoring

[1] Coronary Calcium Scoring accurately predicts coronary events.

  • Coronary Calcium Scoring is the single best predictor of future heart attack, need for stents/revascularization or sudden cardiac death.
  • Clearly the higher your score the less likely you are to go on living without one of these events occurring (“event free survival”).
  • Hazard Ratios (HR) are striking — where compared with a zero score, people with a score of 400-100 had 7 times the number of coronary events; and people with scores >1000 had 28 times as many!
  • Remember, these people are asymptomatic and un-suspecting — this was requirement of enrolling in the study!
  • Clearly Coronary Calcium Scoring is an opportunity for early detection of CAD before heart attacks occur.
  • The Multi-Ethnic Study of Atherosclerosis (MESA) has validated these results across races.
[2] Coronary Calcium Scoring out-performs carotid ultrasound, CRP, and ABIs for CV risk-stratification. CCS has a unique ability to predict incident coronary disease (revascularization, MI or CV-death).

  • Net Reclassification Index of 66% in Intermediate Risk patients (FRS 10-20%).
  • YHR has tracked and replicated this data — precisely 33% of “Intermediate” risk patients were re-classified as “High” risk, and 33% were re-classified as “Low” risk based on Coronary Calcium Score (CCS).
  • A picture is worth a thousand words. When other “risk factors” are added to FRS, the prediction of heart attack changed minutely (lines on ROC curve are nearly super-imposed). When CCS was added to FRS evaluation, the accuracy for predicting events (the area-under-the-curve) improved dramatically. These are real events — including heart attack and sudden death!
  • In other words, without ordering a calcium score on your “Intermediate” risk patients — you will mis-classify more than half of them! This means starting unnecessary medications or missing the opportunity for early detection.
[3] Patients take statins and follow lifestyle changes more often after Coronary Calcium Scoring.

  • In Your Heart Report data, 35% of cigarette smokers quit after receiving a high risk result (score >400).
  • When assessed more than 3 years after having a CCS done, of those people with scores >400 — 90 percent were compliant with statin therapy [Atherosclerosis 2006; 185:394-9].  High risk patients getting highly effective intervention, looks like success!
  • The higher a person’s risk, the more likely they are to comply with diet recommendation and to exercise regularly [Am J Cardiol 2008; 101: 999-1002].
  • In fact, when people were randomized to undergo CCS (vs. not) — it resulted in significant improvement in: blood pressure, LDL, weight, waist size, and calculated FRS! [JACC 2011; 57: 1622-32]
[4] Coronary Calcium Score determines who needs stress testing.

  • Screening stress tests in asymptomatic patients should generally be avoided. Especially in low risk patients where falsely abnormal results will out-number truly abnormal results more than 2-to-1.
  • Since CCS accurately assesses risk, and looks directly for coronary plaque — it is uniquely able to determine who “deserves” a screening stress test. It has been called the “gatekeeper” for stress testing in asymptomatic, at-risk populations.
  • The ACC/AHA 2010 guidelines for the assessment of cardiovascular risk in adults gave calcium scoring a Class IIa recommendation for asymptomatic, intermediate risk patients.
  • 35% of  asymptomatic people with a score >400 had abnormal nuclear stress test results, whereas only 1% had an abnormal result when their score was <100.
  • Appropriate Use Criteria rated nuclear stress testing for people with CCS > 400 as “Appropriate”, with an overall score of 7-out-of-9.
  • Prevention-focused primary care providers should use calcium scoring in asymptomatic, at-risk patients — and follow through with nuclear stress testing for scores >400.
[5] The “Your Heart Report” Coronary Calcium Scoring Experience…A Proven System

  • YHR validated its results in intermediate risk patients [32% moved to high & 34% to low risk]
  • 85% of people with high-risk results started taking “statins” reliably, if not already taking
  • 35% of smokers quit following a high-risk CCS in our system
  • 3% of our screened population underwent revascularization with stents or bypass
    — for high risk anatomy, usually preceded by high risk stress testing
  • Countless people started exercise regimens and lost weight
  • For Every 1,000 scans, an estimated 75 years of life is added to this population

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