Cardiovascular disease (CVD) has stubbornly remained the leading cause of death in the world for over three decades. Many of these deaths are caused by coronary artery disease (CAD), and roughly 21 million American adults live with the disease today. Unfortunately, many patients living with CAD could go years undiagnosed because they do not experience symptoms. It is common to receive a diagnosis only after a major event like a heart attack.
A poll conducted in 2023 found more than half of people surveyed did not correctly identify CVD as the leading cause of death, suggesting that people at risk for this disease may not be aware of its severity or the risk factors. Knowledge is power since early detection and treatment can be the difference between managing a chronic condition and facing life-altering consequences.
Why it matters
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As the epidemic has grown, our industry has been racing to find new ways to accurately diagnose and treat CVD earlier. When coronary computed tomography angiography (CCTA) was introduced, it marked a major advancement with its ability to provide anatomical assessment of the arteries for plaque burden. CCTA is a noninvasive diagnostic test that combines X-ray and other technology to produce detailed, three-dimensional images of the heart’s arteries. Leveraging artificial intelligence (AI) has streamlined the assessment of stenosis detected on CCTA, helping determine whether an interventional procedure to treat a blockage is necessary. Furthermore, new AI tools offer insight into the type and volume of plaque present in the arteries. These advancements provide physicians with more accurate, personalized information about their patients’ heart health and can inform treatment plans. Despite the valuable information these new tools can provide, they have historically been under-reimbursed, creating a barrier to adoption for health systems and clinicians.
The relatively low reimbursement for CCTA has been puzzling for the cardiology community, especially when considering the limitations of other diagnostic tools which historically were more highly reimbursed. Conventional methods can yield a false negative rate of up to 20-30%, leading to undetected disease, and a false positive rate of up to 55%, leading to additional unnecessary procedures. All of this can lead to delays in treatment, increased risks for complications, rising costs to the healthcare system, and a poor patient experience overall.
Support for coronary CTA is growing
Recently, after advocacy by the Society of Cardiovascular Computed Tomography (SCCT), the American College of Cardiology (ACC), and the American College of Radiology (ACR), which believe in the value of the technology, recommend it in their guidelines, the U.S. Centers for Medicare and Medicaid Services (CMS) enhanced reimbursement for these CCTA-based technologies (which began on January 1, 2025), more than doubling the CCTA payment rate.
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When we can diagnose CAD earlier, helping patients lead longer and healthier lives while saving our healthcare systems time and money, there’s a lot to celebrate, as SCCT noted in a statement following the ruling, it’s a “huge win” that will bring us closer to earlier detection, more accurate diagnoses, and more efficient care pathways.
Impacting patient care
The increased CCTA accessibility is a win for both patients and healthcare providers. Patients will benefit from accurate, comprehensive, actionable diagnostics that can help direct them to more timely interventions and therapies. Healthcare providers can feel confident in adopting these technologies as a first-line approach to assess patients suspected of having CAD, reducing the need for unnecessary invasive procedures and ultimately streamlining the pathway to diagnosis and treatment.
Additionally, the broader application of these tools means that patients who previously might have had difficulty reaching a CAD diagnosis can now receive a clear view of their heart health without invasive imaging and get the care they need earlier in their disease journey. As more providers implement CCTA into their practices, doctors will have a clearer picture of their patients’ overall heart health in the early stages of CAD. This can set the stage for productive conversations about lifestyle changes, additional risk factors, and management techniques that can drive better decision-making.
Implications for health systems
Incorporating non-invasive, advanced diagnostics like CCTA into standard care practice has the potential to reduce strain on healthcare system resources and patient burden by minimizing unnecessary cath lab visits, as well as improve outcomes on a broader scale. Hospital systems now have a financially viable way to adopt advanced imaging technologies that can lead to earlier diagnosis and, as a result, potentially reduce the need for emergency interventions when CAD has advanced.
Looking ahead
The ruling from CMS is an encouraging step forward on our long, shared journey toward more equitable, effective, and earlier CAD detection and treatment. With better access to tools like CCTA and diagnostic tools that leverage CCTA, clinicians can better support their patients in managing overall cardiovascular health, patients will benefit from less invasive care and enhanced quality of life, and health systems could ultimately see reduced costs and streamlined workflows.
For all of us in the cardiovascular care space, this update should be viewed as not just a policy change, but also a call to action. We must use this moment to address disparities in care, adopt evidence-based technologies, and ensure that every patient has access to the tools needed for accurate diagnosis and effective treatment. We should support these advancements and the development of groundbreaking innovations to better manage, treat, and prevent CAD.
Photo: FG Trade, Getty Images
Campbell Rogers brings a wealth of experience to HeartFlow, where he serves as the Chief Medical Officer. Prior to joining HeartFlow, he was the Chief Scientific Officer and Global Head of Research and Development at Cordis Corporation, Johnson & Johnson, where he was responsible for leading investments and research in cardiovascular devices. Prior to Cordis, he was Associate Professor of Medicine at Harvard Medical School and the Harvard-M.I.T. Division of Health Sciences and Technology, and Director of the Cardiac Catheterization and Experimental Cardiovascular Interventional Laboratories at Brigham and Women’s Hospital. He served as Principal Investigator for numerous interventional cardiology device, diagnostic, and pharmacology trials, is the author of numerous journal articles, chapters, and books in the area of coronary artery and other cardiovascular diseases, and was the recipient of research grant awards from the NIH and AHA. He received his A.B. from Harvard College and his M.D. from Harvard Medical School.
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