Case Studies

Putting CAD into Focus

A Collaborative Approach

This case study highlights a Northern California based healthcare system, which includes more than 24 acute care hospitals and 200 clinics. Like many systems, optimal patient care is a priority; however, their approach is unique in its focus on an integrated, team-based approach bolstered by the adoption of innovative technologies.

There’s no better benefit than being right."
- Brad Angeja, MD, Cardiologist

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Cardiologist & Radiologist Perspectives

Case Reviews with Dr. Brad Angeja

The Mainstream Approach

The traditional approach guiding coronary artery disease (CAD) diagnosis and management relies primarily on stress testing—despite widely recognized shortcomings—costing billions of dollars globally every year due to missed diagnoses and unnecessary diagnostic testing. Diagnosing CAD is often subject to interpretation, highly variable, and particularly vulnerable to snap judgement decisions when made during an invasive procedure.

20% to 30% false negatives from stress tests1

55% false positives from CT tests, often resulting in unnecessary diagnostic angiograms2

Incomplete information results in layered testing, repeat patient visits and overuse of resources

We joke that nuclear medicine is unclear medicine, because the images are blurry. CT with the HeartFlow Analysis brings the diagnosis into focus. I feel like I’m putting on glasses and seeing better, and it’s a great feeling.”

- Brad Angeja, MD, Cardiologist

A Clearer Path - CTA + HeartFlow

Realization of a successful CTA + HeartFlow program impacts not only patient outcomes, but also operational efficiency and program success. Patients and staff benefit from a “one stop, closed loop test” that encourages dialogue between specialties, improves overall CT quality and interpretation, and beyond making a more accurate diagnosis, provides powerful risk stratification and prognostic information that helps guide medical therapy strategies.

  • Higher diagnostic accuracy using a CTA + HeartFlow pathway3
  • 98% negative predictive value from CTA4
  • Physiology information that improves anatomic data accuracy
  • Impact of blockages on blood flow
  • Less time, risk, radiation/COVID-19 exposure for patients/staff

We’ve seen literally hundreds of studies that prove that coronary CT is not just a problem solving tool but really is the most powerful firstline diagnostic test for the workup of coronary artery disease. What the HeartFlow Analysis brings to coronary CT is the ability to understand what a blockage means."

- Eric Flagg, MD, Radiologist

Availability of the HeartFlow Analysis

One of the striking differences between the HeartFlow Analysis compared to other tests is the quality and clarity of data provided in a simple-to-read, interactive 3D model of a patient’s coronary arteries. Interpretation is simplified and impact to patient education is transformed.

Keys to Success

Leading with a focus on “what’s right for the patient” sets an important standard. With this goal in mind, identifying and trusting in a new, yet proven pathway is essential, as well as taking a multi-disciplinary, collaborative approach to adoption.

  • Establish a quality CTA program, in partnership with HeartFlow
  • Engage the entire clinical team to prioritize high quality CTA scans for the betterment of patient care
  • Prioritize sending CTA scans with a stenosis of 30-90%
  • Leverage the HeartFlow mobile app to see results right away while on the go

The key point where HeartFlow comes in is that it enhances the dialogue after the scan. The more robust the communication between specialties taking care of patients, the better the patient care that'll be achieved.”

- Eric Flagg, MD, Radiologist

A Focus on Patient Care

With competing tests to choose from, deciding which one to use has historically been confusing. Shifting to a CTA + HeartFlow frontline strategy for patients presenting with symptoms of coronary artery disease, streamlines diagnosis, provides clarity and gives confidence to physicians and patients of the final treatment plan.

A Clearer Roadmap
to PCI

A Safer Deferral
with OMT

This is a common case in which an abnormal stress test would have resulted in a diagnostic angiogram to view the coronary arteries for the first time during the procedure. In contrast, CTA and HeartFlow provide precise anatomic and physiologic information indicating the impact blockages have on blood flow, which allows the interventionalist to pinpoint problem areas and plan a procedure in advance of the cath lab.

Patient History

68-year-old-man with high blood pressure, high cholesterol, and squeezing chest tightness while walking, starting 2 months prior.

The Results

  • LAD blockage confirmed
  • 1 stent placed
  • Angina resolved
HeartFlow Analysis

I’ve had people come to me, excited about hearing that they can get a heart scan and have the ability to see their arteries and see the colors of the HeartFlow Analysis. From the standpoint of patient understanding, education, consent, adherence to therapy, I think they are much more engaged. It’s more clear for the patient, and we can achieve that without a half a day in the office or overnight stay, which provides a much better patient experience."

- Brad Angeja, MD, Cardiologist

Doctors Angeja and Flagg are co-leads of the CT + HeartFlow program and are responsible for the expansion of the CTA program across numerous sites throughout their system.

Brad Angeja, M.D.

Eric Flagg, M.D.


  1. Arbab-Zadeh, Heart Int 2012. Yokota, et al. Neth Heart J 2018. Nakanishi, et al. J Nucl Cardiol 2016.
  2. Patel, et al. N Engl J Med 2010. Patel, et al. AHJ 2014. Danad, et al. JAMA Cardiology 2017.
  3. Driessen, et al. J Am Coll Cardiol 2019.
  4. Hoffmann, et al. J Am Coll Cardiol. 2009.

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