General practice preventive health care in non-obstructive coronary artery disease determined by coronary computed tomography angiography

Rikke Elmose Mols, Bjarne Linde Nørgaard, Peter Vedsted, Dora Körmendiné Farkas, Hans Erik Bøtker, Jesper Møller Jensen

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Abstract

Background: The aim of this study was to compare changes in health service utilization, preventive medical management, and cholesterol levels in patients without coronary artery disease (CAD) or with non-obstructive CAD as determined by coronary computed tomography angiography (CTA). Methods: Single-center five-year observational registry-based cohort study of consecutive patients with chest pain undergoing coronary CTA with subsequent 12 months follow-up in general practice. Results: We included 3032 patients with a normal test result (n = 2179) or a diagnosis of non-obstructive CAD (n = 853) by coronary CTA. Median age was 55 (interquartile range: 47–63) years and 44% were males. After coronary CTA, the probability of a decrease in consultations with general practitioner was higher in patients with no CAD compared to patients with non-obstructive CAD (adjusted OR = 0.81 [95% CI: 0.68–0.96], P = 0.016). Accordingly, patients with non-obstructive CAD more frequently received prescriptions on lipid-lowering medical therapy (adjusted OR = 4.50 [95% CI: 3.31–6.12], P < 0.001) than patients with no CAD after coronary CTA. In patients with non-obstructive CAD, mean total-cholesterol reduction was 0.51 (P < 0.001) compared to 0.13 mmol/L (P < 0.001) in patients without non-obstructive CAD. The relative reduction in low-density lipoprotein was 14% higher (P < 0.001) in patients with compared to patients without non-obstructive CAD after coronary CTA. Conclusions: Coronary CTA with subsequent follow-up in general practice has the potential to align health service utilization that prioritizes high-risk patients and facilitate optimized preventive management.

Original languageEnglish
JournalInternational Journal of Cardiology
Volume278
Pages (from-to)14-21
Number of pages8
ISSN0167-5273
DOIs
Publication statusPublished - 1 Mar 2019

Keywords

  • Atherosclerosis
  • Coronary computed tomography angiography
  • General practice
  • Health service utilization
  • Management
  • Preventive

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