PT  - JOURNAL ARTICLE
AU  - Iain Thomas Parsons
AU  - Clare Bannister
AU  - John Badelek
AU  - Mark Ingram
AU  - Emma Wood
AU  - Alex Horton
AU  - Michael Hickman
AU  - Edward Leatham
TI  - The HASTE Protocol: a standardised CT Coronary Angiography service operated from a District General Hospital
AID  - 10.1136/openhrt-2018-000817
DP  - 2018 Jul 01
TA  - Open Heart
PG  - e000817
VI  - 5
IP  - 2
4099  - http://openheart.bmj.com/content/5/2/e000817.short
4100  - http://openheart.bmj.com/content/5/2/e000817.full
SO  - Open Heart2018 Jul 01; 5
AB  - Introduction CT coronary angiography (CTCA) has excellent sensitivity but lacks specificity when compared with invasive coronary angiography (ICA) particularly in patients with a high coronary calcium burden. CTCA has been shown in large trials to decrease the requirement for diagnostic ICA and provide diagnostic clarity. We describe the methodology used to provide a standardised CTCA service established in a District General Hospital, which may assist other hospitals aiming to develop a cardiac CT service.Methods Scan request forms, authorisation and patient instruction were recorded. Patient preparation prior to CTCA as well as exclusion and inclusion criteria were documented. Scans were interpreted using a multidisciplinary team (MDT) approach in order to organise follow-up, medication and further investigation.Results Over 6 months, 157 consecutive scans were performed. CTCA was completed in 88% (n=138/157) and considered of diagnostic quality in 82% (n=129/157). The median radiation dose was 3.42 mSv. Overall, 64% of patients had evidence of coronary calcium. Following MDT review, 72% (n=113/157) of patients were discharged without requiring invasive angiography. 15% (n=24/157) of patients went on to have invasive angiography showing non-obstructive disease and 13% (20/157) of patients underwent percutaneous coronary intervention (11%) or bypass surgery (1%).Discussion Appropriate referrals, patient preparation and scan quality remain significant factors in running a CTCA service. Despite this, the vast majority of patients can be discharged on the basis of the CTCA alone. An MDT approach is key to the delivery of a cardiac CT service.