Reducing disparities and improving coronary patient outcomes

One person dies every 33 seconds from cardiovascular disease in the U.S. But just who is dying? Rural populations experience higher cardiovascular death rates than urban populations, often due to longer travel distances to hospitals and specialty clinics, higher prevalence of risk factors such as hypertension, obesity, and tobacco use, and health care disparities including fewer physicians and specialized physicians and limited access to state-of-the-art medical technology.

A study published in the Journal of the American College of Cardiology (Nov. 2024) analyzed federal death data of more than 11 million adults in the U.S. who died of heart attacks, strokes, and other cardiovascular diseases between 2010 and 2022. The findings point to a crisis of cardiovascular deaths in rural America:

• After the COVID-19 pandemic, cardiovascular deaths among rural patients rose significantly by 3.4 deaths per 100,000 people, a relative increase of 0.8 percent. 
• During the same period, death rates dropped by a relative 6.4 percent in urban areas, with nearly 24 fewer deaths per 100,000 people.
• By 2022, rural adults ages 25 to 64 had a 21 percent relative jump in cardiovascular death rates compared to 2010. That same age group in large metropolitan areas saw only a 3 percent relative increase.
  
  

Given the statistics, rural hospitals need multiple methods to effectively address heart disease and reduce mortality rates in rural communities. Programs focused on lifestyle changes like smoking cessation, nutrition, and exercise are one way. Access to leading-edge technologies is another important tool. Coronary computed tomography angiography (CCTA) can be a powerful diagnostic tool in rural clinicians’ arsenal for the early detection of heart disease.

Saving lives begins with preventative care. CCTA can detect and assess a wide variety of heart conditions including plaque buildup, coronary artery disease (CAD), blood vessel abnormalities, heart muscle issues, and more — even before symptoms show. Left unchecked, these conditions can lead to heart attack and death.

Real-world evidence: CCTA works

The most striking evidence of the efficacy of CCTA can be found in the Scottish Computed Tomography of the Heart (SCOT-HEART) randomized controlled trial. Based on the original trial plus two follow-up investigations, the real-world evidence now spans a decade.

Published in the Lancet in 2015, the findings of the SCOT-HEART trial demonstrated that management guided by CCTA improved the diagnosis, management, and outcome of patients with stable chest pain. Specifically in patients with suspected angina due to coronary heart disease, CCTA led to a change in diagnosis in 27 percent of patients, a change in investigations in 15 percent of patients, and a change in treatment in 23 percent of patients.

The SCOT-HEART investigators later presented their five-year follow-up results in the New England Journal of Medicine, and the results were impressive. The findings showed a 41 percent reduction in deaths and non-fatal heart attacks at a five-year endpoint among patients with stable chest pain who were treated with standard cardiovascular care plus CCTA, as compared to those treated with standard care alone.

Most recently, researchers aimed to assess whether CCTA-guided care results in sustained long-term improvements in management and outcomes by evaluating 10-year outcomes from the SCOT-HEART trial. In this study, the researchers conclude that CCTA-guided management is associated with a beneficial long-term impact on patient care. After a decade of follow-up, CCTA-guided management continued to be associated with reduction in the rates of coronary heart disease death or non-fatal myocardial infarction and sustained increases in the use of preventive therapies.

Since the 2015 SCOT-HEART trial, CCTA has gained momentum as a modality of choice for the detection and evaluation of coronary disease:

• In 2019, CCTA was given a class 1 recommendation from the European Society of Cardiology for suspected coronary artery disease. 
• In 2021, the U.S. chest pain guidelines elevated CCTA to a class 1A recommendation for the evaluation of acute and stable chest pain in patients without known CAD. The 2023 update in the multimodality appropriate use criteria for chronic coronary disease rated CCTA “appropriate” in nearly all symptomatic patient scenarios — a significant gain compared to the 2013 iteration. 
• In a retrospective analysis of data conducted in 2024, researchers found the adoption of CCTA led to a significant reduction in the length of stay for patients in the ED-run observation medicine unit.
  
  

CCTA offers a reliable and efficient diagnostic alternative to traditional noninvasive tests such as stress testing with electrocardiogram with high diagnostic accuracy, which means faster decision-making and reduced need for invasive procedures. In rural communities where heart disease is highly prevalent, speedy, accurate detection can help save lives.

Benefits of CCTA adoption in rural communities

While rural hospitals face multiple challenges including tight budgets and staffing shortages, the benefits of implementing CCTA are worth careful consideration. Adopting CCTA can help rural providers:

• Generate revenue: In the past, payment for CCTA was lower than the cost of performing the test. Beginning in 2025, CMS doubled the reimbursement for CCTA. This higher payment incentive offers the promise for increased imaging revenue. Doubled reimbursement makes CCTA investment and ROI more financially viable.
• Increase access and equity: One study found that only 22 percent of safety-net hospitals in rural settings offer CCTA compared to 57 percent in urban settings. Clearly rural hospitals that implement a CCTA program help to reduce health care inequity and bridge the gap in cardiology access, especially in locations where full-time specialists are not available.
• Offer affordable care: Many rural patients are uninsured or underinsured. CCTA has been shown to be a cost-effective diagnostic tool. By preventing unnecessary invasive procedures (like invasive angiography) and reducing emergency department visits or re-hospitalizations, a CCTA program can help alleviate financial burdens for patients in rural communities.  
• Demonstrate community commitment: Offering advanced cardiac imaging locally shows community commitment and willingness to modernize and expand services with state-of-the-art upgrades that support better patient care. This, in turn, builds trust and goodwill with patients and local doctors. 
• Reduce transfers: In rural communities, cardiac specialists or heart centers can be hours away. Local access to advanced cardiac imaging reduces the need for unnecessary transfers to urban centers, enabling earlier diagnosis and treatment and lowering overall health care costs for patients. Most importantly, if a patient comes in experiencing chest pain, they can get diagnosed and treated right away — when every second counts.  
• Address workforce shortages: Rural hospitals face a significant technologist shortage, but a strong CCTA program can actually help attract and retain staff by offering meaningful cross training and opportunities to expand advanced imaging skills. The right CCTA system can even automate workflow and routine tasks like protocol selection and image post-processing, reducing technologist burnout and enhancing overall productivity. The latest CCTA platforms further support smaller teams by standardizing exam setup and helping ensure consistent, high-quality cardiac imaging even with varying technologist experience levels.
• Improve patient outcomes: CCTA supports early detection of coronary artery disease and preventative care. CCTA can also help avoid unnecessary invasive procedures by improving triage accuracy. The SCOT HEART data speaks volumes along with various studies that link CCTA utilization to improved patient outcomes. For example, CCTA is associated with approximately a 30 percent reduction in the rate of subsequent myocardial infarctions.
  
  

Closing the gap in cardiac care

With CMS now doubling reimbursement for coronary CT angiography, the financial outlook for rural hospitals to offer this service has significantly improved. At the same time, advanced CT systems capable of CCTA have become more affordable and better suited for rural facilities, offering faster exams, lower dose, and broader clinical utility. Simply stated, investing in a CCTA program not only supports early heart disease detection but also helps rural hospitals retain patients, reduce the need for transfers, improve outcomes in underserved communities, and remain financially viable.

NRHA adapted the above piece from Fujifilm Healthcare Solutions, a trusted NRHA partner, for publication within the Association’s Rural Health Voices blog.
 

Don Boshela serves as computed tomography (CT) product manager for FUJIFILM Healthcare Americas Corporation. In his role, he drives product planning, market strategy, and customer engagement for Fujifilm's CT portfolio. With a strong background of over 30 plus years in CT and diagnostic imaging solutions, Don works closely with clinical partners and engineering teams to ensure Fujifilm's CT offerings meet the evolving needs of providers and patients.