Save Your Heart Campaign

March 21, 2022

Ms. Chiquita Brooks-LaSure
CMS Administrator
Department of Health and Human Services
Washington DC

Re: Saving 100,000 American lives and $100 Billion avoidable healthcare cost annually

Dear Ms. Chiquita Brooks-LaSure,

I am writing to you because coverage for coronary calcium scoring is long overdue by almost a decade and the lack of coverage has resulted in over 100,000 premature cardiac deaths and over $100 billion of avoidable cardiovascular healthcare expenditures annually from preventable first heart attack.

You are the new CMS Administrator and have an influential role of guiding President Biden's healthcare policy team. You expressed during your interview with Alan Weil of Policy Spotlght that you are looking for innovations to reduce healthcare disparity and improve equity. First heart attack disproportionately impacts the minority population more than others.

After losing over 1,000,000 American lives in the last two years to the COVID-19 pandemic, I am advocating to provide the option to as many older adult Americans with silent heart disease from not becoming one of the over 600,000 who fall victim to a first heart attack every year. The main reason is most of these victims did not access the effective medical therapy that is covered by all  insurance because their access to a $100 Coronary Calcium Scoring test that can determine if they have silent heart disease is not covered. Simply put, the treatment is covered but the definitive test to determine if treatment is needed is not.

I chose to write this letter embedded within this website to make it easier to understand the reasons why and how access to coronary calcium scoring saves lives - potentially over 100,000 annually in the US initially and this number will increase over time.

I am a practicing cardiologist with over 40 years of practice experience. The last 20 years have been focused on preventing heart attack and developed a best practice model with published performance data. We have successfully "turned off the faucet instead of just mopping the floor" more than 10 years ago. Other medical practitioners can be taught to replicate this model and every medical practice can become a basic heart attack and stroke prevention clinic with specialist support.

It is past the time for all healthcare insurance companies, other than Medicare, to pay for coronary calcium scoring test. It was approved and strongly (Class IIa) recommended by the American Heart Association and the American College of Cardiology nearly 10 years ago. A few years earlier (2010), the state of Texas passed the Texas Heart Attack Prevention Bill which mandated insurance coverage for calcium scoring. Most cardiologists accept the fact that most first heart attacks are preventable - but only if those with silent heart disease are identified earlier and optimal medical therapy is prescribed before a heart attack strikes.

Coronary calcium scoring is like "mammography for the heart" but unlike screening mammography, it needs to be done only once or twice in a lifetime in most cases. Detecting silent coronary plaques before one of them ruptures and cause a heart attack opens the door for effective and inexpensive plaque-stabilizing, plaque-regressing medical therapy. Most Americans who experienced a first heart attack have no cardiac symptoms before and therefore, are unaware they have a silent heart disease. If they and their physicians knew in advance, the outcome would have been different. This lack of appropriate medical care affects everyone but more so the minority population. Access to coronary calcium scoring can begin to improve both the quality and equity of cardiovascular care. Just as a suspicious mass found in screening mammography will not be ignored by both physicians and patients alike, coronary calcifications due to silent heart disease detected during calcium scoring test are not likely to be ignored either.

The American College of Cardiology in the last slide above called attention to an extreme example of disparity of cardiac care and lack of healthcare equity in parts of the US that are farthest away from the mainland, like Guam - an island with a population of 170,000 and hosts an important military base. Like the mainland, coronary heart disease is their number 1 killer but unlike the mainland, their mortality is 2.64 times higher. We can help them prevent as many first heart attacks as possible by accurately identifying those with silent heart disease by calcium scoring followed by plaque-stabilizing, plaque-regressing medical therapy. 

Another positive indirect consequence is private insurance companies generally follow Medicare lead. This will have a significant impact on reducing Medicare expenditures. Here is a clear example: a new Medicare beneficiary had a calcium score of 500 at age 55 and has been on optimal medical therapy since. Now at age 65 and on Medicare, his/her plaques have all stabilized and he/she is not likely to have a heart attack or stroke, or need stent or heart bypass or other expensive cardiac procedures and hospitalizations, thus saving many tens of thousands in Medicare healthcare dollars per beneficiary.

I want the opportunity to discuss Save Your Heart Campaign with you. I hope that you will take the necessary action in your leadership role and adviser to President Biden so that coronary calcium scoring is covered by Medicare and Medicaid starting this year.  The war against first heart attack and the associated escalating cardiovascular healthcare cost is a winnable war. Everyone needs to take a stand in 2022. There is no neutral position - you and the President are either FOR or AGAINST winning the war against first heart attack. 

Yours sincerely,

Rolando L. deGoma, MD
Rolando L. deGoma, MD, FACC, FNLA
drdegoma@saveyourheartcampaign.com

P.S.
Please find the time to watch these two short videos in this website: