Adoption of coronary artery disease - Reporting and Data System (CAD-RADS™) and observed impact on medical therapy and systolic blood pressure control

• Published in: Journal of cardiovascular computed tomography 2020-09, Vol.14 (5), p.421-427
• Main Authors: Hull, Robert A., Berger, Jeremy M., Boster, Joshua M., Williams, Michael U., Sharp, Alec J., Fentanes, Emilio, Maroules, Christopher D., Cury, Ricardo C., Thomas, Dustin M.
• Format: Article
• Language: English
• ISSN: 1934-5925; 1876-861X
• DOI: 10.1016/j.jcct.2020.01.005

CAD-RADS was developed to standardize communication of per-patient maximal stenosis on coronary CT angiography (CCTA) and provide treatment recommendations and may impact primary prevention care and resource utilization. The authors sought to evaluate CAD-RADS adoption on preventive medical therapy and risk factor control amongst a mixed provider population. Statins, aspirin (ASA), systolic blood pressure and, when available, lipid panel changes were abstracted for 1796 total patients undergoing CCTA in the 12 months before (non-standard reporting, NSR, cohort) and after adoption of the CAD-RADS reporting template. Only initiation of a medication in a treatment naïve patient, escalation from baseline dose, or transition to a higher potency was considered an escalation/initiation in lipid therapy. The CAD-RADS reporting template was utilized in 83.7% (751/897) of CCTAs after the CAD-RADS adoption period. After adjusting for any coronary artery disease (CAD) on CCTA, statin initiation/escalation was more commonly observed in the CAD-RADS cohort (aOR 1.46; 95%CI 1.12–1.90, p = 0.005), driven by higher rates of new statin initiation (aOR 1.79; 95%CI 1.23–2.58, p = 0.002). This resulted in a higher observed rates of total cholesterol improvement in the CAD-RADS cohort (58% vs 49%, p = 0.016). New ASA initiation was similar between reporting templates after adjustment for CAD on CCTA (aOR 1.40; 95%CI 0.97–2.02, p = 0.069). The ordering provider's specialty (cardiology vs non-cardiology) did not significantly impact the observed differences in initiation/escalation of statins and ASA (pinteraction = NS). Adoption of CAD-RADS reporting was associated with increased utilization of preventive medications, regardless of ordering provider specialty.