The Physician’s Weekly #PWChat series continued with another insightful discussion on Wednesday, July 25, focusing on “Personalizing Coronary Artery Disease Diagnosis & Care.”
It was co-hosted by Andrew Waxler, MD, and the chat was inspired by his article Personalizing Coronary Artery Disease Diagnosis.
You can view our upcoming schedule, or read our other #PWChat recaps here.
Below are the highlights from the chat. You can read the full transcript here.
Question 1
OK,
Q1: What do we know about the current status of coronary artery disease (#CAD) in the US?#PWChat— Physician’s Weekly (@physicianswkly) July 27, 2017
#CAD remains one of the largest health threats to American adults, and diagnosis can be challenging. #PWChat
— Andrew Waxler (@arwaxler) July 27, 2017
Question 2
Q2: What makes the diagnosis of #CAD particularly challenging?#PWChat
— Physician’s Weekly (@physicianswkly) July 27, 2017
There are a number of things. For instance, diagnosis is only as good as the tools available to make it. #PWChat #CAD
— Andrew Waxler (@arwaxler) July 27, 2017
Only 1/3 of cardiac caths in patients with stable symptoms actually have obstructive #CAD. #PWChat #CAD
— Andrew Waxler (@arwaxler) July 27, 2017
Patient follow up data suggest only 10% of those presenting with stable chest pain to outpatient have CAD etiology. #PWChat #CAD
— Andrew Waxler (@arwaxler) July 27, 2017
We need accurate means to rule out #CAD before we expose patients to expensive & potentially risky tests. #PWChat
— Andrew Waxler (@arwaxler) July 27, 2017
Question 3
Q3: Why else is an accurate means for ruling out CAD in PTs w/ possible symptoms particularly important?#PWChat
— Physician’s Weekly (@physicianswkly) July 27, 2017
Because for patients we can rule out #CAD early, they will be saved exposure to more expensive and potentially risky tests. #PWChat
— Andrew Waxler (@arwaxler) July 27, 2017
All available tests have their uses. We want to be judicious in our use of them. Knowing when to use each test… #PWChat #CAD
— Andrew Waxler (@arwaxler) July 27, 2017
will bring more benefit to patients both in terms of saving $ as well as avoiding risks associated w/ tests when not needed. #PWChat #CAD
— Andrew Waxler (@arwaxler) July 27, 2017
Question 4
Q4: If diagnosis is so difficult, how can clinicians choose appropriate cardiac care pathways for patients w/ #CAD?#PWChat
— Physician’s Weekly (@physicianswkly) July 27, 2017
I think it’s important to be able to identify not only those with #CAD, but those without very quickly. #PWChat #CAD
— Andrew Waxler (@arwaxler) July 27, 2017
There is a relatively new test that helps us do that just. It’s a simple blood test called Corus CAD. #PWChat #CAD
— Andrew Waxler (@arwaxler) July 27, 2017
Corus CAD provides an easy-to-understand age, sex, and gene expression score (ASGES). #PWChat #CAD
— Andrew Waxler (@arwaxler) July 27, 2017
… and thus need for coronary artery revascularization in the near term, is low. #PWChat #CAD
— Andrew Waxler (@arwaxler) July 27, 2017
Question 5
Q5: How confident can clinicians be in ASGES scores?#PWChat
— Physician’s Weekly (@physicianswkly) July 27, 2017
As scores rise above 15, likelihood of obstruction in heart arteries or clinical event increases & is correlated with score. #PWChat #CAD
— Andrew Waxler (@arwaxler) July 27, 2017
On a scale of 1 to 40, scores of 15 or less provide confidence the likelihood of obstructive #CAD… #PWChat
— Andrew Waxler (@arwaxler) July 27, 2017
We can be as confident in a low #Corus CAD scores as we are in normal or negative myocardial perfusion imaging or CTA finding. #PWChat #CAD
— Andrew Waxler (@arwaxler) July 27, 2017
Question 6
Q6: What indications are there that care based on ASGES scores can help improve #CAD patient outcomes?#PWChat
— Physician’s Weekly (@physicianswkly) July 27, 2017
We can be as confident in a low #Corus CAD scores as we are in normal or negative myocardial perfusion imaging or CTA finding. #PWChat #CAD
— Andrew Waxler (@arwaxler) July 27, 2017
The challenge is what to do w/low score. Is evidence-based reassurance enough, or do we need protocol to support no further testing? #PWChat
— Robert Mahoney (@mahoneyr) July 27, 2017
The ability to accurately diagnose #CAD with a simple blood test means patients who rule out are not exposed to risks associated… #PWChat
— Andrew Waxler (@arwaxler) July 27, 2017
Question 7
Q7: What does the future of coronary artery disease care look like?#PWChat#CAD
— Physician’s Weekly (@physicianswkly) July 27, 2017
The future of #CAD care is reliant upon bringing down costs while providing the same quality of care, if not better, and… 1 of 2, #PWChat
— Andrew Waxler (@arwaxler) July 27, 2017
…better adoption of personalized medicine. With PM each person gets care specialized to his or her needs. 2 of 2, #PWChat #CAD
— Andrew Waxler (@arwaxler) July 27, 2017
Question 8
Q8: Switching gears a bit: How can clinicians reduce the impact of #CAD on individual, community & national levels?#PWChat#CAD
— Physician’s Weekly (@physicianswkly) July 27, 2017
Short question with long answer. Need to figure out how to intervene when necessary and not intervene when not necessary. #PWChat https://t.co/wsDvGSRaJW
— Robert Mahoney (@mahoneyr) July 27, 2017
To reduce the impact of #CAD we need to continue to talk about it. Even though we’ve been focused on this for some time… #PWChat
— Andrew Waxler (@arwaxler) July 27, 2017
…people are still presenting with disease. Lack of funds to care for themselves, obtain appropriate healthcare and… #PWChat #CAD
— Andrew Waxler (@arwaxler) July 27, 2017
… a whole host of other reasons means need to continue to deliver the same messages in the hopes they get through. #PWChat #CAD
— Andrew Waxler (@arwaxler) July 27, 2017
We also need to use more efficient diagnostic methods to avoid unnecessary medical testing & complications that… #PWChat #CAD
— Andrew Waxler (@arwaxler) July 27, 2017
… are costly to patients & the health care system. #PWChat #CAD
— Andrew Waxler (@arwaxler) July 27, 2017
Question 9
Q9: What procedures are performed too often in diagnosing #CAD?#PWChat#CoronaryArteryDisease#Cardiology
— Physician’s Weekly (@physicianswkly) July 27, 2017
The more advanced diagnostic test, like cardiac cath, have been historically used in cases they were not needed. #PWChat #CAD
— Andrew Waxler (@arwaxler) July 27, 2017
Question 10
Q10: How can unnecessary diagnostics be reduced in cardiac care?
— Physician’s Weekly (@physicianswkly) July 27, 2017
Unnecessary potentially risky and costly diagnostics can be avoided by utilizing the #CorusCAD blood test. #PWChat #CAD
— Andrew Waxler (@arwaxler) July 27, 2017
The #CorusCAD blood test really is useful in helping me determine the most appropriate next steps in care. #PWChat #CAD
— Andrew Waxler (@arwaxler) July 27, 2017
Question 11
Q11: What role can personalized medicine play in directing cardiac care?
— Physician’s Weekly (@physicianswkly) July 27, 2017
I utilize personalized medicine as a front-line tool. When a symptomatic patient presents & I’m concerned about #CAD… #PWChat
— Andrew Waxler (@arwaxler) July 27, 2017
I often use the #CorusCAD blood test to help me rule out #CAD or determine the most appropriate next steps. #PWChat
— Andrew Waxler (@arwaxler) July 27, 2017
