ERIK STERTMAN: Implementation of Coronary CT angiography in Swedish primary care

Project description

Background

In obstructive coronary artery disease there is atherosclerotic narrowing of the coronary arteries and insufficient supply of oxygen-rich blood to the heart muscle. This condition becomes more prevalent after mid-age and is commonly known as angina pectoris. Given that angina has existential dimensions and implicates multiple life-long drug treatments, precision in diagnosing the condition is critical. In patients with chest pain or dyspnea, the European Society of Cardiology recommends using coronary CT angiography as the initial diagnostic test over exercise stress testing for individuals with a low disease risk. Coronary CT angiography can more safely rule out disease and is more strongly associated with prognosis. The clinical likelihood can be estimated from the main symptom, age and sex. Updated in 2024, European guidelines now advocate for a model weighting in cardiovascular risk factors to improve estimation of disease risk.

Purpose

The project aims to increase knowledge on how the investigation of chest pain and/or breathing difficulties can be effectively conducted in primary care with risk assessment and coronary CT angiography.

Method

A database was established by including the first 731 patients referred to coronary CT angiography from the primary care in Östergötland after its implementation in 2021 as a first-line investigation. The database includes the referrals with risk assessments, the angiography results, and registry data on cardiovascular risk factors. Additionally, 18 qualitative interviews were conducted with primary care physicians about views on investigating chronic coronary syndrome after introductory seminar to the revised recommendations. Transcripts will be subjected to conventional content analysis.