Table 1
Summary of primary findings in FLAME-ASCVD (Systemic inFLAMmation and rolE of hsCRP as a biomarker in AtheroSclerotic CardioVascular Disease).
| BASELINE CHARACTERISTICS OF PARTICIPATING CARDIOLOGISTS | |||
|---|---|---|---|
| Total (N = 589) | Interventional cardiologists (n = 241) | General cardiologists (n = 348) | |
| Mean number of patients with ASCVD and CKD seen/treated in typical month ± (SD)* | 39.3 (30.3) | 34.3 (27.1) | 42.7 (31.9) |
| Total (N = 490) | Interventional cardiologists (n = 206) | General cardiologists (n = 284) | |
| Age in years, mean (SD)* | 47.2 (9.1) | 46 (7.9) | 48.1 (9.8) |
| Total (N = 214) | Interventional cardiologists (n = 77) | General cardiologists (n = 137) | |
| Mean time in practice, years ± (SD) | 16.4 (7.0) | 15.9 (6.6) | 16.7 (7.3) |
| Total (N = 602) | Interventional cardiologists (n = 247) | General cardiologists (n = 355) | |
| Region, n (%)† | |||
| Europe, 241 (40) | |||
| France* | 60 (10) | 13 (5) | 47 (13) |
| Germany | 60 (10) | 24 (10) | 36 (10) |
| Italy | 61 (10) | 30 (12) | 31 (9) |
| United Kingdom | 60 (10) | 18 (7) | 42 (12) |
| East Asia, 120 (20) | |||
| China | 60 (10) | 30 (12) | 30 (8) |
| Japan | 60 (10) | 30 (12) | 30 (8) |
| Asia Pacific, 121 (20) | |||
| Australia | 60 (10) | 30 (12) | 30 (8) |
| India | 61 (10) | 30 (12) | 31 (9) |
| Latin America, 60 (10) | |||
| Brazil* | 60 (10) | 13 (5) | 47 (13) |
| Middle East, 60 (10) | |||
| Saudi Arabia | 60 (10) | 29 (12) | 31 (9) |
| Practice type, n (%)† | |||
| Public (hospital, medical center, clinical practice) | 297(49) | 126 (51) | 171 (48) |
| Private (hospital, clinical practice) | 227 (38) | 76 (31) | 151 (43) |
| Voluntary, non-profit hospital University hospital* | 78 (13) | 45 (18) | 33 (9) |
| Practice setting, n (%)† | |||
| Urban | 540 (90) | 218 (88) | 322 (91) |
| Suburban | 52 (9) | 24 (10) | 28 (8) |
| Rural | 10 (2) | 5 (2) | 5 (1) |
| Sex, n (%)† | |||
| Male* | 494 (82) | 215 (87) | 280 (79) |
| Female* | 96 (16) | 30 (12) | 67 (19) |
| Prefer Not to Answer | <1 (2) | 2 (1) | 7 (2) |
| Total (N = 585) | Interventional cardiologists (n = 238) | General cardiologists (n = 347) | |
| Mean number of patients seen/treated per typical month ± (SD) | |||
| Total number of patients, any condition* | 321.4 (200.4) | 297.3 (195.2) | 337.9 (202.4) |
| Total (N = 535) | Interventional cardiologists (n = 224) | General cardiologists (n = 311) | |
| Mean number of patients seen/treated per typical month with the following conditions ± (SD) | |||
| ASCVD‡ | 91.7 (79.9) | 87.0 (89.8) | 95 (72.0) |
| Heart failure* | 51.7 (42.5) | 41.3 (37.7) | 59.3 (44.2) |
| Arrhythmia* | 39.9 (29.9) | 33.9 (29.6) | 44.1 (29.4) |
| AMI | 34.4 (31.2) | 33.9 (28.2) | 34.7 (33.2) |
| Cardiomyopathy* | 31.4 (29.6) | 28.3 (29.3) | 33.5 (29.6) |
| Valvular disease* | 32.8 (27.0) | 28.5 (24.1) | 35.8 (28.5) |
| Cerebrovascular disease* | 28.1 (27.4) | 24.0 (24.5) | 31.0 (29.0) |
| PAD | 26.4 (22.4) | 25.2 (23.2) | 27.3 (21.8) |
| Aortic disease | 20.6 (19.6) | 19.7 (20.9) | 21.2 (18.6) |
| DVT/PE | 17.7 (17.2) | 17.8 (18.5) | 17.6 (16.3) |
| Pericardial disease | 13.9 (14.1) | 13.5 (14.0) | 14.2 (14.2) |
| Total (N = 571) | Interventional cardiologists (n = 232) | General cardiologists (n = 339) | |
| Mean number of patients with ASCVD† seen/treated in typical month by type ± (SD) | |||
| Coronary heart disease | 65.5 (62.2) | 60.6 (68.1) | 69.0 (57.6) |
| Cerebrovascular disease* | 21.7 (21.4) | 17.9 (19.8) | 24.4 (22) |
| Risk factors of ASCVD discussed with patients§ | |||
| Risk Factor (%) | Total (N = 601) | Interventional cardiologists (n = 247) | General cardiologists (n = 354) |
| Hypertension* | 88 | 85 | 91 |
| Hyperlipidemia* | 82 | 74 | 87 |
| Lifestyle habits (diet, exercise)* | 80 | 75 | 83 |
| Hyperglycemia (both diabetes and pre-diabetes) | 78 | 76 | 79 |
| Overweight or obesity* | 78 | 69 | 84 |
| Impact of tobacco use | 75 | 71 | 77 |
| Risk factors for CAD and renal disease | 55 | 51 | 58 |
| CKD | 56 | 58 | 55 |
| Genetics/family history | 54 | 52 | 55 |
| Systemic inflammation | 43 | 41 | 45 |
| TOP REASONS FOR CONSIDERING OR NOT CONSIDERING SYSTEMIC INFLAMMATION IN THE MANAGEMENT OF PATIENTS WITH ASCVD AND CKD|| | |||
| Total | Interventional cardiologists | General cardiologists | |
| Reasons to consider systemic inflammation (%) | N = 602 | n = 247 | n = 355 |
| How aggressively to treat ASCVD | 60 | 63 | 58 |
| Lifestyle recommendations | 49 | 44 | 52 |
| How aggressively to treat CKD | 44 | 44 | 44 |
| Reasons to not consider systemic inflammation (%) | N = 275 | n = 108 | n = 167 |
| Systemic inflammation would not change how I manage/treat | 56 | 52 | 58 |
| There are no available medications to treat systemic inflammation* | 48 | 56 | 44 |
| Systemic inflammation is a less useful indicator than other laboratory measures | 24 | 21 | 25 |
| CARDIOLOGISTS’ ATTITUDES (% AGREE/STRONGLY AGREE) TOWARDS ROLE OF SYSTEMIC INFLAMMATION IN ASCVD AND CKD# | |||
| Agree/Strongly agree (%) | Total (N = 602) | Interventional cardiologists (n = 247) | General cardiologists (n = 355) |
| Ongoing chronic inflammation is an important contributor to the risk of recurrent cardiovascular event | 73 | 72 | 73 |
| I believe systemic inflammation is a risk factor to develop ASCVD | 71 | 70 | 72 |
| Systemic inflammation is one the key drivers for cardiovascular events in patients with ASCVD and CKD | 64 | 63 | 65 |
| I would like to learn more about the role of systemic inflammation in ASCVD | 62 | 61 | 63 |
| Residual inflammatory risk still persists even with availability of evidence-based preventive cardiovascular therapies for ASCVD with CKD patients at risk | 61 | 59 | 63 |
| A lack of treatment options is the greatest unmet need facing patients with ASCVD and CKD | 57 | 61 | 55 |
| TOP THREE REASONS FOR CONSIDERING OR NOT CONSIDERING HSCRP TESTING TO IDENTIFY SI IN PATIENTS WITH ASCVD AND CKD** | |||
| Total N = 602 | Interventional cardiologists n = 247 | General Cardiologists n = 355 | |
| Reasons to consider hsCRP, ranked 1 to 3 (%) | |||
| hsCRP will influence my clinical decisions* | 43 | 48 | 39 |
| Proven clinical efficacy | 36 | 34 | 36 |
| Is widely used for diagnosing inflammation* | 34 | 28 | 38 |
| Reasons to not consider hsCRP (%) | |||
| There are not any available treatments; will not change clinical outcomes | 26 | 27 | 26 |
| hsCRP variability | 23 | 25 | 21 |
| hsCRP will not influence my practice | 22 | 22 | 22 |
[i] *Statistical significance was observed between the groups IC and GC, p < 0.05.
†Percentages may not sum to 100% due to rounding.
‡ASCVD defined as a patient who has had one or more of the following in the last 5 years: 1) Coronary heart disease defined as at least one of the following: documented history of MI, prior coronary revascularization procedure, or ≥50% stenosis in major epicardial coronary artery documented by cardiac catheterization or CT coronary angiography; 2) Cerebrovascular disease defined as at least one of the following: prior stroke of atherosclerotic origin, prior carotid artery revascularization procedure, or ≥50% stenosis in carotid artery documented by X-ray angiography, MR angiography, CT angiography or Doppler ultrasound; 3) Symptomatic peripheral artery disease defined as at least one of the following (or as locally defined): intermittent claudication with an ankle-brachial index (ABI) ≤ 0.90 at rest, intermittent claudication with a ≥50% stenosis in peripheral artery (excluding carotid) documented by X-ray angiography, MR angiography, CT angiography or Doppler ultrasound, prior peripheral artery (excluding carotid) revascularization procedure, or lower extremity amputation at or above ankle due to atherosclerotic disease (excluding e.g., trauma or osteomyelitis).
§Responses were to the survey question: When discussing the risk of ASCVD with your patients, which of the following factors do you most often discuss?
||Response to the survey questions: A. Which aspects of management/treatment of patients with both ASCVD and CKD are influenced by the results of the test you order to measure systemic inflammation? B. In cases which you do not consider systemic inflammation in decision-making for your patients with both ASCVD and CKD, what are the reason(s)?
#Responses were to the survey question: To what extent do you agree or disagree with the following statements (on a scale of 1 [strongly disagree] or 7 [strongly agree]; agree/strongly agree refer to a pooled score of 6 and 7).
**Responses were to the survey questions: A. Which of the following, if any, are the top 3 reasons you would consider hsCRP testing to diagnose systemic inflammation in an ASCVD patient with CKD? B. Which of the following, if any, are reasons why you would not use hsCRP testing to diagnose systemic inflammation in an ASCVD patient with CKD?
Abbreviations: AMI, acute myocardial infarction; ASCVD, atherosclerotic cardiovascular disease; CAD, coronary artery disease; CKD, chronic kidney disease; DVT/PE, deep vein thrombosis/pulmonary embolism; hsCRP, high-sensitivity C-reactive protein; PAD, peripheral artery disease; SD, standard deviation; SI, systemic inflammation.
