New Heart Foundation recommendations for coronary artery calcium scoring

By Melanie Hinze
The National Heart Foundation of Australia has released a position statement on the use of coronary artery calcium (CAC) scoring for the primary prevention of cardiovascular disease (CVD), stating that CAC scoring can have a role in reclassifying absolute cardiovascular risk for selected patients in Australia.

‘CAC scoring can have a role in reclassification of absolute cardiovascular risk for selected patients in Australia, in conjunction with traditional absolute risk assessment and as part of a shared decision-making approach that considers the preferences and values of individual patients,’ the statement noted. If CAC scoring was undertaken, a CAC score of 0 agatston units (AU) could reclassify a person to a low absolute CVD risk status, while a CAC score greater than 99 AU (or ≥75th percentile for age and sex) could reclassify a person to a high absolute CVD risk status, it stated.

Heart Foundation Chief Medical Adviser and cardiologist, Professor Garry Jennings, said that CAC scoring was not necessary in people already determined to be at high risk of heart attack or stroke, or when the results were unlikely to change management. Additionally, in the GP setting CAC scoring was unlikely to be useful when a patient’s risk factors were being appropriately managed.

‘A GP could consider a coronary artery calcium score for patients determined to have a moderate risk of heart attack or stroke, and if they are uncertain about how intensely to manage that risk,’ he said.

‘Calcium scoring may also be appropriate for patients who are found to be at low risk, but who have additional risk enhancing factors, such as a strong family history of CVD.’

Professor Jennings said that an absolute CVD risk assessment, subsidised by Medicare, remained the current recommended standard for the primary prevention of CVD. In addition, he noted that CAC scoring was not subsidised by Medicare, and the out-of-pocket expense may make it inaccessible for many patients.

‘Where coronary artery calcium scoring may be appropriate, GPs should discuss the benefits and potential risks with their patient as part of a shared decision-making approach,’ he said.

While the position statement, published in the Medical Journal of Australia, was based on the best available evidence, the Heart Foundation called for more research to better define the role of CAC-guided risk assessment and management of the Australian population.
Med J Aust 2021; doi: 10.5694/mja2.51039.