CAC screening, follow-up care lacking among Black patients in small study
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Key takeaways:
- Black patients were less likely to receive treatment after coronary calcium screening vs. white patients, despite greater ASCVD risk.
- The 3-year adverse CV event rate was also higher among Black participants.
Black patients who undergo coronary artery calcium scoring received less post-screening care and had more adverse CV events compared with white patients at a single center, a speaker reported.
The results of the retrospective IMPACT study were presented at the National Lipid Association Scientific Sessions.
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“Atherosclerotic coronary artery disease is the leading cause of death among every racial and ethnic group. Worldwide prevalence is about 5% to 8%, accounting for about 7 million deaths. In the U.S. about 20.1 million adults, or 7.2%, have CAD, with someone having a heart attack every 40 seconds,” Muhammad Umer, MD, of the department of cardiovascular medicine at the University of Louisville, said during a presentation. “Among Black individuals, they are 30% more likely to die from coronary artery disease. We all know South Asians have a higher prevalence of coronary artery disease and it occurs around 10 years earlier.
“We define [disparities] as differences in the quality of health care that are not due to access-related factors or clinical needs, preferences and appropriateness of interventions,” Umer said. “Overall, African Americans have a higher overall CAD mortality rate, and the highest out-of-hospital coronary death rate of any ethnic group, particularly at younger ages.”
Umer and colleagues conducted the present analysis to better understand disparities in the access to CT coronary calcium scoring and downstream CV care among patients from different racial and socioeconomic backgrounds.
The present study was a single-center, retrospective study of data from Cerner, Epic and PACS and included patients who underwent CAC scoring at University of Louisville clinics from 2019 to 2022.
Participants were retrospectively followed up for 3.6 years and assessed for post-CAC score care and adverse events.
Among more than 18,000 patients evaluated at University of Louisville clinics (70.6% white; 25.5% Black; 2% other), 434 underwent CAC screening (91.9% white; 5.4% Black; 2.7% other). Participants classified as “other” were of non-white Hispanic, Asian and Native American race/ethnicities. White participants were more likely to undergo CAC screening compared with Black participants (OR = 4.2; 95% CI, 2.19-8.09).
Within the overall cohort (55.1% women), CAC score distribution was as follows:
- 40.7% with a score of 0;
- 28.7% with a score between 1 and 99;
- 13.7% with a score between 100 and 300; and
- 16.7% with a score greater than 300.
Post-CAC screening CV care, defined as specialty consultation, echocardiography, stress testing, cardiac MRI, angiography, angioplasty, CABG and initiation of aspirin or statins, was initiated in 61.1% of white patients, 38.9% of Black patients and 55.6% of those designated as other.
Post-CAC screening adverse events, defined as cardiac admission, MI/unstable angina, HF, stroke and CV death, occurred in 7.3% of white patients, 16.6% of Black patients and 0% of those designated as other.
Moreover, the 10-year ASCVD risk was distributed as follows among white patients compared with Black patients:
- less than 5% (34% white vs. 15% Black);
- 5% to 7.5% (12% white vs. 7.7% Black);
- 7.5% to 20% (34% white vs. 54% Black); and
- more than 20% (19% white vs. 23% Black).
“The overall number is small for the study, right now. So, we’re going to continue to assess the data for the next 3 years, at least. ... The study, I hope, will help enable cardiovascular clinicians to better understand the racial disparities and help us improve the equitable access to care and minimize adverse events,” Umer said during the presentation. “We are planning on implementing some educational programs to improve our care, which will include educating providers and the public of racial disparities; working on some social and economic barriers to improve access; more effectively implement guidelines; and last but not least, improve patient-physician communication.”
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Umer M, et al. The IMPACT study – Impact of Racial Disparities in Access to CT Coronary Artery Calcium Scoring and Downstream Cardiovascular Care. Presented at: National Lipid Association Scientific Sessions; June 1-4, 2023; Atlanta (hybrid meeting).
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