In terms of identifying and intervening in heart disease, waiting for a patient to develop chest pain is similar to waiting for someone to develop advanced cancer, rather than identifying it early when the treatment may be more effective. Although waiting for advanced disease is not an ideal preventive method, this method has represented the historical standard of heart disease care for decades.
Our treatment of heart disease has been ineffective. One person dies of heart disease every 1.7 seconds, and more than half of heart attacks occur in people who had no symptoms before the catastrophic event. To some extent, this failure stems from attention to indirect surrogate markers of heart disease—such as risk factors (for example, cholesterol, blood pressure, etc.), symptoms, and stress tests—rather than simply examining the disease itself. The main disease process is atherosclerotic plaque, which has accumulated silently in the walls of the arteries of the heart for many years.
In order to improve the prevention of heart attacks, there is an urgent need to modernize our methods, from late-stage symptom-driven care to directly based disease care. This is a care paradigm that can address heart attacks in all patients within the entire range of heart attack severity. Risk. We can achieve this by using non-invasive coronary computed tomography angiography (CCTA), which is a fast, safe and accurate method of heart disease assessment. Unlike other assessment methods, CCTA can identify the accumulation of atherosclerotic plaque in all heart arteries and their branches, which has been shown in previous landmark clinical trials as the strongest predictor of the likelihood of a patient’s heart attack.
Before I was Professor of Radiology and Medicine (Cardiology) at Weill Cornell Medical College and Director of the Dalio Cardiovascular Imaging Institute at New York Presbyterian Hospital, I spent more than 15 years trying to better understand and The information enabled by the integration is transformed by CCTA into a method that can identify individuals at risk of heart attack and treat them effectively. The results of a series of clinical trials support CCTA as an effective first-line tool for evaluating patients with suspected heart disease. For some time, CCTA has been recognized as the leading method for heart disease evaluation in Europe, Japan and Korea.
The 2021 clinical practice guidelines recently updated by the American College of Cardiology (ACC), American Heart Association (AHA) and other American professional sub-professional associations now support CCTA as a first-line test for doctors to better evaluate symptomatic suspected heart disease Patients. With CCTA as the new standard of care, we can now advance the diagnosis process, identify patients earlier, more accurately and accurately, and treat cardiovascular diseases more effectively to improve the prognosis of patients.
What the AHA/ACC guidelines mean for patients
As part of the AHA/ACC guidelines, CCTA received the highest scientific evidence-based designation-Level 1A. This allows CCTA to be used not only for stable chest pain in the outpatient setting, but also for acute chest pain in the emergency department. CCTA is the only way to achieve the highest designation through the strong and modern scientific evidence base of large-scale multicenter and randomized controlled trials. As the only diagnostic method to achieve this goal, it replaces the recommendations of all other testing methods, including historical methods such as stress testing.
In addition, these new clinical practice guidelines represent the first AHA/ACC recommendation to assess atherosclerotic plaque to assess risk and guide treatment decisions over time, which is contrary to traditional speculation methods using indirect heart disease markers or substitutes. The new AHA/ACC clinical practice guidelines emphasize the unparalleled value of CCTA in guiding invasive and medical treatment.
Changing the paradigm of heart disease care
The use of imaging to guide interventional cardiac therapy is based on a lot of strong evidence, which proves the effectiveness of this method in relieving chest pain and improving the quality of life. But these same clinical trials have shown that image-guided invasive therapies are ineffective in reducing heart attacks and extending lifespan. As a field, we must separate two questions that we have mistakenly conflated: (1) Is my patient’s symptoms related to heart disease? (2) Is my patient at risk of heart attack, can I effectively treat it with medication and lifestyle interventions (such as diet and exercise)? In fact, most people who have a heart attack or sudden coronary heart disease death did not show symptoms before the event. The new AHA/ACC guidelines are an important step forward on this road. By prioritizing direct imaging of atherosclerotic diseases over more abstract measures, we can fundamentally change the paradigm of heart disease care and eradicate heart attacks from the planet. We have no treatment problems because there are a series of medical and lifestyle interventions that can reduce heart attacks. We have an identification problem. We have not accurately identified those high-risk groups that require medication and lifestyle changes.
There is no doubt that we will see stress testing transform into a first-line method of diagnosing heart disease using CCTA-based methods. Given the wealth of information embedded in any individual CCTA study, we also urgently need innovative tools that can take advanced imaging science and turn it into actionable clinical insights to improve non-imaging clinicians (e.g., primary care physicians, Ordinary cardiologists) diagnosis certainty, etc.) and provide patients with knowledge by improving health literacy. Based on the evidence so far, targeting every stakeholder in the care paradigm—imaging physicians, treating clinicians, and patients—will significantly reduce overall care costs and improve clinical outcomes. Ultimately, this approach can improve workflow, reduce costs, increase literacy, and save lives.
Through the CCTA-supported disease-based approach, the early quantification and characterization of heart disease will enable earlier and more effective treatment, which can prevent heart attacks and deaths in millions of patients.
Photo: BrianAJackson, Getty Images
