Access to CCTA at safety-net hospitals across the United States.

Background: Coronary CT angiography (CCTA) has received a class 1A indication for the evaluation of patients with acute and stable chest pain after studies revealed the use of CCTA reduces mortality, rates of MI, unnecessary invasive procedures, and healthcare expenditure compared to traditional stress testing. Despite this recommendation, hospitals across the U.S. have not adopted CCTA at levels expected for standard of care. We sought to evaluate the availability of CCTA at U.S. safety-net hospitals.

Methods: U.S. safety-net hospitals were identified using the Lown Institute definition. The ability to perform CCTA at each of these hospitals was assessed. Data was stratified based on rural vs. urban geography, bed size, state, and academic status. Critical access hospitals, specialty hospitals, and those without emergency services were excluded. Variations in CCTA availability were compared with Chi-square tests.

Results: 391 safety-net hospitals in the U.S. were identified according to the criteria, of which 179 (45.8 ​%) offer CCTA. Availability of CCTA varied significantly depending on the size of the facility (0-49 beds: 7.7 ​%, 50-99 beds: 43.8 ​%, 100-199 beds: 45.6 ​%, 200-399 beds: 71 ​%, and ≥400 beds: 88.9 ​%, p ​< ​0.001), rural vs. urban setting, (22 ​% vs. 57 ​%, p ​< ​0.001), and academic vs. non-academic settings (97 ​% vs. 41 ​%, p ​< ​0.001).

Conclusions: Fewer than half of identified U.S. safety-net hospitals were found to provide CCTA for the evaluation of cardiac patients despite its 1A recommendation. This research highlights alarming trends in cardiovascular health care disparities and serves as a call to action to combat inequity through the expansion of CCTA availability.