Coronary artery disease (CAD) is the leading cause of death worldwide. For decades, the gold-standard test used to diagnose CAD was invasive coronary angiography (ICA). However, nearly half of the patients who receive ICA are found to have either no disease or non-significant CAD, meaning that while they receive a definitive diagnosis, they do not receive any therapeutic benefit. This is of concern because ICA is an expensive procedure, and it carries a small but real risk to patients (roughly 1/1000 ICAs results in stroke, heart attack and/or death). More recently, a non-invasive diagnostic test, cardiac computed tomographic angiography (CCTA), has been shown to be as effective as ICA at diagnosing CAD in the right patient population, while being significantly less expensive and less risky for patients.
Our team has used Artificial Intelligence (AI) to develop and validate a predictive model for determining which patients should proceed directly to ICA versus which should receive CCTA. We have also developed and tested a centralized triage pathway for ICA and CCTA to direct patients to the most appropriate test and validated its acceptability to both patients and referring physicians. We are now evaluating the AI tool combined with the centralized triage pathway through a multisite randomized control trial at Hamilton Health Sciences and Niagara Health. This model of care will reduce risk to patients, reduce wait times for ICA and reduce costs to the health care system.
Presented by:
JD Schwalm, Associate Professor, Department of Medicine, Division of Cardiology, McMaster University
Dr. Schwalm is an Associate Professor in the Department of Medicine, Division of Cardiology at McMaster University. He is an Interventional Cardiologist at Hamilton Health Sciences and Niagara Health with clinical interests in both coronary and structural interventions (including Transcatheter Edge-to-Edge Repair). Dr Schwalm is the site lead for cardiology at the Hamilton General Hospital, a Scientist at the Population Health Research Institute and the Director of the Centre for Evidence-Based Implementation (CEBI). His research focus is knowledge translation/implementation sciences as it relates to the field of cardiology at the patient, physician, and health system level. Dr Schwalm has authored over 90 peer-reviewed publications and 4 book chapters.
JeremyPetch, Founder and Director, CREATE (CentRE for dAta science and digiTal hEalth)
Dr. Jeremy Petch is the founder and Director of CREATE (CentRE for dAta science and digiTal hEalth), a multidisciplinary research and innovation team with expertise in digital health and clinical artificial intelligence, located at Hamilton Health Sciences. He is an Associate Professor at the Institute for Health Policy, Management and Evaluation at the University of Toronto and an Associate Investigator at the Population Health Research Institute. Prior to joining HHS, he led St. Michael’s Hospital’s transformation into a data-driven organization, through the deployment of an advanced data and analytics infrastructure and co-founding the Li Ka Shing Centre for Healthcare Analytics Research and Training (LKS-CHART). Dr. Petch was previously a core member of CADTH’s Health Technology Expert Review Panel, chair of the board of Regent Park Community Health Centre, and co-chair of the Greater Hamilton Health Network’s Digital Health Secretariat.
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