ABSTRACT
Individuals eligible for lung cancer screening (LCS) are at risk for atherosclerotic cardiovascular disease (ASCVD) due to smoking history. Coronary artery calcifications (CAC), a common incidental finding on low-dose CT (LDCT) for LCS, is a predictor of cardiovascular events. Despite findings of high ASCVD risk and CAC, a substantial proportion of LCS patients are not prescribed primary preventive statin therapy for ASCVD. We assessed the frequency of statin prescription in LCS patients with moderate levels of CAC. Among 259 individuals with moderate CAC, 95% had ASCVD risk ≥ 7.5%. Despite this, 27% of patients were statin-free prior to LDCT and 21.2% remained statin-free after LDCT showing moderate CAC. Illustratively, while a substantial proportion of LCS patients are statin-eligible, many lack a statin prescription, even after findings of CAC burden. CAC reporting should be standardized, and interdisciplinary communication should be optimized to ensure that LCS patients are placed on appropriate preventive therapy.
Subject(s)
Atherosclerosis , Coronary Artery Disease , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Lung Neoplasms , Vascular Calcification , Atherosclerosis/drug therapy , Atherosclerosis/prevention & control , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/drug therapy , Coronary Artery Disease/prevention & control , Early Detection of Cancer , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/drug therapy , Prescriptions , Risk Assessment , Risk Factors , Vascular Calcification/diagnostic imaging , Vascular Calcification/drug therapyABSTRACT
PURPOSE: To report on the clinical utility of implantable loop recorders (ILRs) in a large academic hospital setting over a 4-year period. METHODS: Retrospective study (2013-2016) of patients receiving ILRs for any indication including syncope, cryptogenic stroke (CrS), atrial fibrillation (AF) burden, palpitations, ventricular arrhythmias (VA), and other. Remote checks, symptomatic transmissions, and in-person checks were reviewed. Time to diagnosis was documented. RESULTS: A total of 263 patients (54% male, mean age 63 ± 15 years, mean follow-up 601 (range 9-1714) days) received ILRs for 324 indications; multiple indications were noted in 53/263 (20.2%) patients. ILR indications were 126 (39%) syncope, 81 (25%) CrS, 46 (14%) AF, 37 (11%) palpitations, 10 (3%) VA, and 24 (7%) other. Diagnostic yield for each indication was compared to the overall yield for all other indications. Three indications showed a significantly higher yield: AF (65% vs. 22%, p < 0.002), palpitations (60% vs. 24%, p < 0.001), and VA (70% vs. 28%, p < 0.004). For all other indications, there were no significant differences. Syncope had nearly half the diagnostic yield of previously published trials (28% vs. 43-56%). We observed a fourfold increase in ILR implant rate over the study duration. CONCLUSIONS: In a "real-world" academic hospital setting, the diagnostic rate of ILRs was highest for AF, palpitations, and VA; however, these high yield indications comprised only 29% of all indications. The diagnostic yield for the commonest indication (syncope) was approximately half that reported in the previously published trials. With increasing implantation rates, additional studies are required to refine guideline-based indications for ILR implantation to improve diagnostic yield.
