Support of a stronger recommendation for coronary artery calcification (CAC) scoring
The U.S. Preventive Services Task Force (USPSTF) recently published a statement that would make it more difficult and expensive to receive the test coronary artery calcium (CAC) score test.
The USPSTF’s draft revision to the “Cardiovascular Disease Risk Assessment with Nontraditional Risk Factors” statement assigns CAC scoring a grade of I, meant to signal that there is insufficient evidence to assess the balance of risks versus benefits. However, this conclusion and recommendation is not supported by the current published data.
You can help change this by sharing how CAC scoring as a nontraditional risk factor test has positively impacted your medical care.
What is the USPSTF?
The U.S. Preventive Services Task Force (USPSTF) is an independent, volunteer panel that makes recommendations about clinical preventive services such as screening, counseling services and preventive medications. Recommendations are assigned a letter grade corresponding to whether the Task Force feels the evidence is strong enough to recommend the particular test or service to everyone.
- Grades A and B — assigned to tests or services deemed to have at least a moderate benefit, and thus should be offered to patients.
- Grade C — assigned when a service is deemed beneficial for a select group of patients.
- Grade D — recommended when a test or service is discouraged from being offered.
- Grade I — given when the USPSTF concludes that there is insufficient evidence to recommend for or against a particular test or service.
Why are USPSTF recommendations important?
USPSTF recommendations are very important as an assigned grade of A or B mandates that commercial insurance providers offer coverage, as well as reimbursement, for a given screening test.
The effect of USPSTF recommendations is more complicated when it comes to Medicare. Medicare is required to reimburse for screening tests assigned a grade of A or B. Coverage under Medicare and its various administrative contractors is based on whether screening tests are considered reasonable and necessary, as outlined in National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs).
Data supporting coronary artery calcium (CAC) scoring
USPSTF published a draft revision to “Cardiovascular Disease Risk Assessment with Nontraditional Risk Factors” statement in January 2018, which includes the screening test coronary artery calcium (CAC) scoring. In this draft recommendation, CAC scoring is assigned a grade of I, meant to signal that there is insufficient evidence to assess the balance of risks versus benefits. However, this conclusion and recommendation is not supported by the current published data.
There are multiple large (several thousand patients), prospective, multi-ethnic studies with long-term follow-up (> 5 and up to 15 years) that have been published over the past 10 - 15 years consistently demonstrating that CAC scoring has the power to identify patients at the highest risk for adverse cardiovascular events, like death, heart attacks and strokes. In addition, CAC scoring is able to “de-risk” patients who have a zero CAC score where traditional risk factors, such as high blood pressure, diabetes, or age, may recommend treating with preventive medications like statins and aspirin.
All of this prognostic information can be obtained from an inexpensive test (Medicare reimbursement: $59) with minimal radiation exposure (approximately the same as a screening mammogram). Importantly, conventional approaches that employ a clinical risk score, which integrates CAD risk factors into an estimate of 10-year CVD risk, poorly estimate risk in non-white patients, women and younger men. Thus, the improved detection of risk with CAC scanning can significantly improve identification of at-risk patients.
The Society of Cardiovascular Computed Tomography (SCCT) feels strongly that the current medical literature strongly supports a higher grade recommendation (either an A or B). As a result, we encourage all individuals who have had a CAC scan to submit comments to the USPSTF.
Your comments can be submitted electronically. The deadline to submit comments is February 12, 2018.
You can use the following sample letter for your comment. We have provided some recommended ways that you can personalize the letter with aspects of your CAC story.
If you would like to become a member of the SCCT patient advocacy committee, email your name and contact information to Claire Johns at firstname.lastname@example.org.
Sample comment letter
My name is (first and last name) and I am leaving this comment in support of a stronger recommendation for coronary artery calcification (CAC) scoring as a nontraditional risk factor test that positively impacted my medical care.
CAC scoring has impacted my life.
Aspects of your personal story to consider including in your letter:
1. What is your personal story of how undergoing CAC testing led to a beneficial change in your health?
2. Why was this test important in your particular scenario?
3. What changes to your medical care (i.e. medication changes) did you and your doctor decide on after your CAC score?
4. What lifestyle changes (i.e. diet, exercise, medication compliance, etc.) have you undertaken and what role did CAC scoring play in that?
5. Do you feel this is a useful test that should be offered to others?
6. Have other friends/family been positively impacted by CAC scoring?