Professor Gemma Figtree

A group of leading cardiologists has applied for a new Medicare item number for coronary artery calcium scoring, seeking $250 per scan for asymptomatic Australians at intermediate cardiovascular risk.

The application was made by CAD Frontiers, a not-for-profit headed by University of Sydney Professor Gemma Figtree, uniting clinicians and researchers from across institutions with the aim of finding new approaches to heart attack prevention [link here].

The group has proposed funding for CT of the coronary arteries for patients aged between 45-79 who are classed as having intermediate risk of cardiovascular events using contemporary risk calculators, or at low risk but with specific risk factors, including a family history of premature cardiovascular disease, elevated elevated Lp(a), or persistently elevated hs-CRP.

Patients at an indeterminate risk who require reclassification would also be eligible.

The applicants said the introduction of subsidised testing would result in:

• A reduction in MACE events and changes in patient management depending on whether a CAC score showed subclinical atherosclerosis or not,
• Reduction in patient uncertainty, with patients able to take a more informed role in shared decision making, and
• Changing the rate of lipid lowering medication prescriptions – “A CAC score can be used to re-classify individuals previously classified at intermediate risk into a lower risk group, thereby preventing or de-escalating unnecessary treatment,” the application said.

International dyslipidemia guidelines now recommend identifying subclinical coronary atherosclerosis for individuals at moderate risk, while both the CSANZ and Heart Foundation position statements both recommend CAC scoring for “appropriate populations”, the applicants noted.

The proposed MBS fee was $250 per test, with an estimated 247,000 patients to use the test in the first year of funding.

Eligible patients should be provided with one CAC test every five years, the application said.

The PICO Advisory Subcommittee Meeting, the first stage in the MSAC review process, is scheduled for 16-17 April, with consultation open until March 13 [link here].

The Evaluation Subcommittee (ESC) and Medical Services Advisory Committee (MSAC) meeting dates are yet to be finalised.

CAD Frontiers describes itself as an Australian-led international team working towards “a world without heart attacks”. The Sydney-based charity, where Professor Figtree serves as Chief Scientific Officer, argues that traditional risk factors fail to identify around 25% of people who develop coronary artery disease silently, without any risk factor warnings. Its research spans blood-based biomarkers, clinical pathways for early detection and novel therapeutics.