Primary care patients' perspectives on CT coronary calcium scoring and exercise electrocardiography

Background: Computed tomography coronary calcium scoring (CT-CCS) shows higher sensitivity for obstructive coronary artery disease (OCAD) detection than exercise electrocardiography (x-ECG), but its role as initial diagnostic test in primary care remains unclear. Objective(s): This study assessed patients’ perspectives on CT-CCS or x-ECG testing and diagnostic results. Methods: In this one-year pilot study, 38 general practitioner practices were included. After cluster randomisation, 19 practices were assigned to refer patients with atypical angina pectoris or non-specific thoracic complaints for CT-CCS and 19 practices were assigned to request x-ECG. Patients’ management remained at the discretion of the GPs. Patients’ perspectives on the diagnostic test were assessed through a questionnaire, and clinical data were collected using electronic patient records. Outcome measures included patients’ perspectives, OCAD diagnosis and initiation of cardiovascular risk management (CVRM). Results: 101 patients (25 x-ECG; 76 CT-CCS) were included. Overall, CT-CCS patients were more satisfied with the test compared to x-ECG patients (p < 0.001), found the test easier to undergo (p < 0.001), had a higher willingness to retest (p = 0.01) and better perception of the information received from the GP (p = 0.03). Four of 17 CT-CCS patients (24%) with CT-CCS ≥100 were diagnosed with OCAD, and 14 (82%) started CVRM. The only patient with a positive x-ECG out of 25 (4%) was included in CVRM but not diagnosed with OCAD. Conclusion: CT-CCS patients were overall more satisfied with their test than x-ECG patients. Coronary calcium scoring is a promising diagnostic tool for detecting OCAD in primary care.