A new strategy for all Corewell Health William Beaumont University Hospital patients referred for a Cardiac CTA (with FFR-CT if indicated) is being implemented. Our Cardiac CTA program has provided high-quality cardiac imaging for more than 15 years. The success of the program, together with elevation of Cardiac CT in the recent ACC/AHA Chest Pain Guidelines, has increased the number of referrals for Cardiac CT. Although we are working hard to meet the increased demand, wait times remain too long.
To better serve your patients, we have improved the referral process. An essential component of this service is that all (eligible) patients who are referred for Cardiac CT are pretreated with a beta blocker (or appropriate alternative Rx) to slow their heart rate prior to arriving at the hospital. A lower heart rate (goal < 60 bpm) during the CT scan provides higher quality images and decreases the duration of the visit for your patient.
Beginning Tuesday, Jan. 2, for all patients referred for Cardiac CT/FFR-CT, please follow these instructions:
- Provide Rx for a beta blocker (unless a clinical contraindication or exception exists, see Table 1).
- If an exception exists, please document in the Epic order “comments” (or on the paper Rx).
- Follow the “Suggested Beta Blocker Dose” instructions (see Table 2).
Table 1: Exceptions and Scenarios (Epic dot phrase: “.cardiacCTinfo”)
| Exception | Suggestion |
|---|
| Patient already on a BB (or alternative Rx) | Consider additional AM dose if clinically appropriate |
| Allergy or other contraindication to BB | Please document in Epic order “comments” section |
| Heart rate < 65 bpm | Consider “low dose” Rx the morning of CT exam |
| BP < 110 systolic | Consider holding other BP Rx if clinically appropriate |
| Clinical Judgment precludes “pre” treatment | Please document in Epic order “comments” section |
| Structural imaging (TAVR, TMVR, etc.) | BB and Nitro will not be given by our staff |
| Pulmonary Vein / AF ablation studies | Provide BB Rx if coronary artery evaluation desired |
| LA appendage (Watchman) studies | Provide BB Rx if coronary artery evaluation desired |
Table 2: Suggested Beta Blocker Dose; modified as appropriate (Epic dot phrase: “.cardiacCTinfo”)
| When | HR <65 or SBP <110 | HR 65-75 and SBP >110 | HR >75 and SBP >110 |
|---|
| Night before CT | None | Metoprolol Succinate 25 mg | Metoprolol Succinate 50 mg |
| Morning of CT | None | Metoprolol Succinate 25 mg | Metoprolol Succinate 50 mg |
*For eligible patients who are unable to achieve goal heart rate, consider Rx with Ivabradine 5 mg the night before and morning of CT.
Beginning Tuesday, Dec. 19, a Corewell Health imaging staff member will call patients to inform them of the new required pretreatment. If the patient has not been provided with a Rx for heart rate control, they will be asked to reschedule their appointment unless an exception exists.