How has the COVID-19 pandemic affected CT Coronary Artery Calcium testing?

How has the COVID-19 pandemic affected CT CAC testing?

By Kate Madden Yee, staff writer

July 20, 2021 — The COVID-19 pandemic caused a significant dip in heart disease screening with CT coronary artery calcium (CAC) scoring, particularly between March and May of last year, according to a poster presentation at the virtual 2021 Society of Cardiovascular Computed Tomography (SCCT) meeting.

A team led by Dr. Mrinali Shetty of the University of Chicago in Evanston found a dramatic decrease in CT CAC testing during that time period, although the group did discover that patients at highest risk of heart disease still received statin therapy during the acute phase of the pandemic.

The most current cholesterol management guideline from the American College of Cardiology and the American Heart Association recommends that intermediate-risk patients undergo CT CAC testing when the decision about whether to begin statin therapy is unclear, the group wrote. Statin therapy tends to be the first line of treatment for preventing heart disease in patients with a CAC score of more than 100.

Shetty and colleagues used electronic medical record data from a four-hospital, community-based health system. They tracked patients’ CAC scores, monthly volume of studies between January 2019 and February 2021, and start of statin therapy within six months of a patient undergoing CAC scoring (the system had instituted a $50 CAC test in June 2019 to boost uptake, and it saw a significant increase in the number of these tests ordered). The study included orders for 2,806 CAC score tests.

The pandemic hit Illinois in March 2020, the authors noted. They found a 7.7 percentage point decrease in CAC tests after that time, although the number of CAC scans began to bounce back later in the year, and the rate of statin initiation actually hit a higher level further into the pandemic than the pre-COVID-19 time frame.

Effect of COVID-19 pandemic on rates of statin therapy initiation in patients at risk of heart disease
Measure Before March 2020 March to May 2020 June 2020 to February 2021
Rate of statin therapy initiation 30.6% 22.9% 32.1%

Despite the dip in the initiation of statin therapy during the pandemic’s acute phase, the group did find that patients with CAC scores higher than 100 had high rates of statin prescription. In fact, more than three-quarters of patients with high CAC scores received a prescription for statins in February 2021.

“[For patients with CAC [scores greater than] 100, rate of initiation of statin therapy was not affected by the COVID-19 pandemic,” the group wrote. “It is reassuring that despite the pandemic, the highest-risk individuals based on CAC [scores] still received statin therapy.”