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Cardiology assessments

CV risk assessment clinic

These clinics aim to support you in diagnosing patients at risk, or with suspected cardiovascular disease, specifically coronary artery disease (CAD).

Why refer for CV risk assessment at GenesisCare?

Cardiovascular disease is one of the most common diseases in Australia. Three quarters of Australians are at risk of developing cardiovascular disease during their lifetime.1

At GenesisCare we now offer integrated CV risk assessment clinics that utilise results from our dedicated cardiac CT service, including coronary artery calcium scoring and computed tomography coronary angiography (CTCA). Referring to our CV risk assessment clinics reduces latency to diagnosis and requires one simple referral – delivering fast access and providing individualised patient-centric management plans for our shared patients.

What is involved in a CV risk assessment?

We have designed two pathways for patients depending on if they have experienced potential symptoms of CAD or not.

To ensure we are correctly classifying our shared patients, our CV risk assessment clinics for asymptomatic patients may start with a coronary artery calcium score. We offer this service at the following locations.

Once your patient’s coronary artery calcium score is available, they will be reviewed by a cardiologist, at a location convenient for them. You will receive a report of their calcium score result as well as a letter from the clinic detailing their individual, guideline-adherent management plan.

Recently there have been questions around whether calcium scoring should be used as the central tool for cardiac risk assessment.2 It has been suggested that traditional risk scores may lack precision when being applied to individuals, as they are derived from large populations.3 A recent Australian publication found that 31% of women and 16% of males who experience a cardiac event had not been identified as high risk by traditional risk calculators. 4

Coronary artery scoring has been shown to outperform risk factor scores and has shown to be superior to traditional risk factors for predicting cardiac events in recent studies.3,5 Accordingly, coronary calcium scores have emerged as an attractive tool to improve risk stratification, risk reclassification and guiding therapy decisions in asymptomatic patients.6  A zero calcium score allows patients to remain free of statin therapy for the next five years.6

Asymptomatic patient pathway

 

To determine which diagnostic test is most appropriate for your patient, this pathway starts with an appointment with one of our cardiologists. Based on history and presenting features, our cardiologists will determine the most appropriate diagnostic test for your patient. This may include stress echocardiogram, CT coronary angiography (CTCA) or stress testing. If it is decided that CTCA is appropriate they can access this service at one of our locations:

You will receive a report of their initial testing result as well as a letter from the clinic detailing their individual, guideline adherent management plan.

There has been increasing evidence showing patient benefits of computed tomography coronary angiography (CTCA) scans. These include a lower risk of death from cardiac events7, greater diagnostic certainty, and more appropriate use of invasive angiography.8

CTCA is a non-invasive test with a negative predictive value of nearly 100% for the exclusion of coronary artery disease (CAD).As such, even those patients who have had tests in the past and returned zero calcium scores, but have since developed symptoms such as chest pain, should be considered for a CTCA to rule out CAD.8

Furthermore, the National Institute for Health and Care Excellence (NICE) released an updated guideline on stable chest pain in 2016 recommending all patients with chest pain, typical or atypical, should be investigated with CTCA in the first instance.10

Symptomatic patient pathway

References

  1. https://www.heartfoundation.org.au/activities-finding-or-opinion/key-stats-cardiovascular-disease
  2. Aroney, C., 2019. Heart, Lung and Circulation28(2), pp.207-212.
  3. Mitchell, J.D., Paisley, R., Moon, P., Novak, E. and Villines, T.C., 2018. JACC: Cardiovascular Imaging11(12), pp.1799-1806.
  4. Loai Albarqouni, Jennifer A Doust, Dianna Magliano, Elizabeth LM Barr, Jonathan E Shaw and Paul P Glasziou.Med J Aust 2019; 210 (4): 161-167.
  5. Venkataraman, P., Stanton, T., Liew, D., Huynh, Q., Nicholls, S.J., Mitchell, G.K., Watts, G.F., Tonkin, A.M. and Marwick, T.H., 2020.. Medical Journal of Australia213(4), pp.170-177.
  6. Chua, A., Blankstein, R. and Ko, B., 2020. Australian Journal of General Practice, 49(8), p.464.
  7. SCOT-Heart Investigators, 2018. New England Journal of Medicine,379(10), pp.924-933.
  8. Mittal, T.K., Pottle, A., Nicol, E., Barbir, M., Ariff, B., Mirsadraee, S., Dubowitz, M., Gorog, D.A., Clifford, P., Firoozan, S. and Smith, R., 2017. European Heart Journal-Cardiovascular Imaging,18(8), pp.922-929.
  9. Litt, H.I., Gatsonis, C., Snyder, B., Singh, H., Miller, C.D., Entrikin, D.W., Leaming, J.M., Gavin, L.J., Pacella, C.B., Hollander, J.E., 2012. N Engl J Med. 2012;366(15): 1393-1403.
  10. Fyyaz, S., Papachristidis, A., Byrne, J. and Alfakih, K., 2018. British Journal of Cardiology,25, pp.107-109.

Cardio-oncology

What is cardio-oncology

Cardio-oncology is a service that delivers cardiac care to patients undergoing or with a history of receiving potentially cardio-toxic cancer treatments. Depending on where your patient is in their treatment, we work in partnership with the referring physician to ensure that treatment is completed without interruption. For patients who have completed treatment, we work with their general practitioner to ensure a long-term cardiovascular risk reduction plan is in place to maximise long term heart health for our patients.

Find out more about our cardio-oncology service.