Auto-CAC™ is a non-contrast low-dose CT scan of the chest that provides a rapid coronary artery calcium (CAC) score, using the onsite CT machine, and cloud-based supervised AI powered by HeartLung.

When a patient presents to the ED with acute chest pain, the designated ED staff member does a HEART Score, which includes an ECG and an initial troponin level. (high-sensitivity troponin [hs-cTn] is preferred for timeliness.) If the HEART Score is 0-6, the patient is transferred for an Auto-CAC™ scan. If the CAC score is 0-100, the patient can be safely discharged home with the HeartLungTM app for 30-Day Home-Based Triage.

In November 2021, for the first time, the American Heart Association and American College of Cardiology, along with a number of other organizations, included CAC in the management of patients with stable chest pain who are not at high risk.

These patients account for the majority of unnecessary utilization of beds and resources in the Emergency Department and are usually discharged after 8-12 hours. Including CAC can allow for rapid discharge of low risk patients who have no evidence of atherosclerotic coronary calcifications

Galati M et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.

The HEART Score is a method of evaluating symptomatic chest pain, recommended by the American Heart Association. The patient is quickly evaluated in five categories, receiving 0-2 points in each:

HEART Score: Low risk:0-3; Intermediate risk:4-6; High risk:>7

About 80% of patients with acute chest pain will be in the low-to-intermediate risk range of 0-6.

These patients will proceed directly for Auto-CAC™ screening. When results are returned, any patient with a normal initial troponin and CAC < 100 may safely discharged home with the HeartLung™ app for 30-Day Self-Reported Home-Based Triage.

Auto-CAC™ delivers a PDF document in a standard format within 30 minutes of the CT scan.

The patient is instructed (or assisted) to download the Patient app in order to schedule a follow-up appointment at the hospital’s outpatient clinic over the next few days. After downloading the app, the patient enters demographic information, answers a few simple questions, and are then directed to select an appointment with one of the hospital’s health care providers as soon as possible.

The HeartLung™ app includes self-triage reporting, guidelines-based preventive care recommendations, and reminders for scheduling visits with primary care physicians (PCPs).

No. In fact, Auto-CAC™ complements ED SOPs by including ACC/AHA endorsed guidelines and patient-care pathways that the ED can utilize to streamline its process. By using Auto-CACTM 80% of patients with acute chest pain can be quickly evaluated and safely discharged to home within one hour. The remaining 20% of patients who require advanced or invasive testing continue to be treated per current Standards of Care.

In the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain, Gulati et al state that across all age groups that present with chest pain, slightly more than 50% of the cases are non-cardiac.

Patients may not be able to differentiate pain from chest or lung sources. Non-ACS chest pain causes may include:

• Angina

• Cardiac Dysrhythmia

• Chest Wall Pain

• Gastrointestinal Disease

• Mitral Valve Prolapse

• Musculoskeletal

• Peptic Ulcer Disease

• Pericarditis

• Superficial Injury

Chest pain causes deriving from the lungs may include:

• Acid Reflux

• Asthma

• Costochondritis

• Esophagitis

• Infections

• Pleuritis

• Pulmonary Embolism

• Unstable angina

• HEART Score >7

• Known atherosclerotic cardiovascular disease (ASCVD)

• HEART Score >7

• Patients < 40 years old

• Consistent accuracy with 24/7 availability and speed

• Easy to perform: No patient prep, no contrast

• Improves patient flow through the ED

• Lowers bedtime for low-risk/low-revenue patients

• Decreases risk of misdiagnoses and inadvertent discharge of ACS

Including Auto-CAC™ in the ED evaluation of chest pain, liability is reduced. With a documented CAC score = 0, discharging a patient follows 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain. Discharging low-to-intermediate risk patients with the HeartLung™ app also documents home-based self-triage and proof that guidelines-based recommendations were provided. CAC scores > 100 continue to follow current ED guidelines, eliminating unintentional discharge of high-risk patients.

Auto-CAC™ uses DICOM (Digital Imaging and Communications in Medicine), the internationally agreed standard for managing medical imaging information and related data. DICOM includes PACS (Picture Archiving and Communication System, a HIPAA-compliant medical imaging technology used to securely store and digitally transmit electronic images and clinically-relevant reports. The images are anonymized. The patient’s Electronic Health Record (EHR) is securely exchanged by Health Level 7 (HL7) and stored on the Ambra Cloud.

The American Council of Science and Health, founded in 1978 to “promote science and debunkJunk,” published an article by Frederic W. Grannis, Jr., MD, on February 18, 2022. Dr. Grannis addresses the alleged danger of diagnostic CT scans, mainly from Dr. Rebecca Smith-Bindman, MD, who co-founded and incorporated ALARA Imaging with her husband in 2020.

Dr. Bindman’s company, ALARA (As Little As Reasonably Achievable) Imaging, is based on her paper of 2009, using the linear no-threshold theory (LNT) to predict alarming rates of cancer from CT scans. Many physicists repudiate LNT and models do not support it. Consensus statements assert that the theory is “not established science” for the low radiation doses of current CT imaging. In fact, included in the American Association of Physicists in Medicine Position Statement on Radiation Risks from Medical Imaging Procedures, is the statement, “…the anticipated benefits to the patient are highly likely to outweigh any small potential risks.“

Using Auto-CAC™ can reduce unnecessary testing and hospital ED stay, consequently reducing costs. Furthermore, by discharging low risk patients, the ED can free up beds for more patients, generating more revenue. Expert analyses shows that Auto-CACTM can increase revenues by 25%. With a low-to- intermediate CAC score and a negative troponin level, patient can be discharged home within one hour with the Patient app.

By rapidly evaluating and discharging low-risk/low-revenue patients, the ED can maintain a steady patient flow and focus on patients with complex, high-revenue conditions. Business intelligence from Patient App dashboard can guide hospital management with ED-related Key Performance Indicators (KPI).