For the first time since 2012, the American College of Cardiology (ACC) and American Heart Association (AHA) Guidelines for the Evaluation and Diagnosis of Chest Pain have been updated. The 2021 Guidelines now highlight use of Coronary CTA + FFRCT as a front-line pathway1, a decision that was supported by numerous clinical studies indicating that this pathway provides higher diagnostic accuracy compared to other non-invasive diagnostic tests2, provides long-term outcomes3 and is a "dominant strategy".4
The newly updated ACC/AHA Guidelines reflect the growing support for a Coronary CTA + FFRCT pathway across the world–including in Europe (2019 ESC Guidelines), the UK (2016 NICE Guidelines) and Japan (2018 JCS Guidelines)–suggesting a revolutionary shift in the diagnosis and management of coronary artery disease (CAD) is underway.
Coronary CTA (CCTA) has been elevated to be the only Class I test with Level A evidence for use as a first-line tool to evaluate patients exhibiting symptoms of CAD: "it is effective for diagnosis of CAD, risk stratification, and guiding treatment decisions". It is also appropriate after inconclusive functional tests, such as nuclear tests and stress echos, when considering revascularization strategies.
CCTA provides 98% negative predictive value and is a definitive test to help rule out the possibility of CAD.5
FFRCT is now included in the guidelines to support the further evaluation of patients with a coronary artery disease of uncertain physiologic significance. FFRCT provides actionable information that enables physicians to non-invasively diagnose "vessel-specific ischemia and guide decision-making regarding" revascularization in stenoses of 40-90%.
As the only commercially available FFRCT product, the HeartFlow FFRCT Analysis provides higher diagnostic performance and accuracy than other non-invasive tests.2
To date, more than 170,000 patients have benefited from a HeartFlow Analysis, but this is only a fraction of the 18+ million people living with coronary artery disease (CAD) in the US.6 Together, we can help take the stress out of the diagnosis and management of CAD and help revolutionize precision heart care.
Patients can stress less knowing that the most advanced technology available has been used to determine that either their CAD has been safely ruled out as a possible cause of their symptoms or that they are receiving the optimal treatment if CAD has been identified.
Physicians can stress less knowing that they have the clarity and confidence to precisely diagnose and treat their patients with CAD, benefiting from a single pathway that provides both anatomic and physiologic information in a simple-to-understand 3D model.
Hospital administrators can stress less knowing that their sites are delivering the best guideline-directed care, backed by major societies, payors, CMS and a growing coalition around the world all dedicated to addressing the most prevalent and deadly disease in the world.
The 2021 ACC/AHA Guidelines are built upon extensive evidence demonstrating the value of non-invasive cardiac testing. In particular, this evidence substantiates the long-term benefits of the CT+HeartFlow pathway, including:
High patient and provider confidence to rule out CAD using CTA with a 98% negative predictive value5 and to accurately diagnose the physiologic significance of disease, when paired with the HeartFlow Analysis.
Improved long-term patient outcomes when coronary CTA is used to evaluate patients with suspected or known CAD.3
Adding physiologic insight to anatomy informs treatment and leads to better patient outcomes.8
Clinical decision making and workflow efficiencies improve resulting in long-term improved outcomes and a lower cost of care with the CT+HeartFlow pathway.9
|SPECT||Stress Echo||Coronary CTA||HeartFlow Analysis|
|Does my patient have CAD?||X||X||X||X|
|Do the vessels have plaque?||X||X|
|Where are the coronary artery speciﬁc stenoses?||X||X|
|Is there possible ischemia?||X||X||X|
|What are the lesion-speciﬁc functional limitations?||X|
|Which vessels may beneﬁt from PCI/CABG/OMT?||X|
|Is prognostic information provided?||X||X||X||X|
high rate of false negatives; higher radiation exposure;
lacks anatomic data
lacks anatomic data
High sensitivity can lead to overutilization of invasive testing|
when not paired with
Currently not as well known as other tests
standard of care
usual care testing;
provides anatomic data
More accurate than|
other non-invasive tests;
provides anatomic and
lower radiation; single
* Diagnostic performance of SPECT, CCTA and FFRCT evaluated in a head-to-head comparison for the identification of ischaemia.
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Are you ready to make the change? Whether you are an avid user of stress tests and curious to learn more about the benefits of the CT + HeartFlow pathway, are looking to build a CT program and need help figuring out where to start or have a growing program but need to better understand how physiology fits in, contact our team. We’re ready to help. In the meantime, review some of the helpful resources below to learn more.
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