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Int J Cardiol. 2019 Mar 1;278:14-21. doi: 10.1016/j.ijcard.2018.09.094. Epub 2018 Oct 1.

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

Author information

1
Department of Cardiology, Aarhus University Hospital, Denmark. Electronic address: rikkmols@rm.dk.
2
Department of Cardiology, Aarhus University Hospital, Denmark.
3
Section of General Practice, Department of Public Health, Aarhus University, Denmark; Department of Clinical Medicine, Diagnostic Center-Silkeborg, Aarhus University, Denmark.
4
Department of Clinical Epidemiology, Aarhus University Hospital, Denmark.

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.

KEYWORDS:

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

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