Testing a New Care Model to Improve Diagnosis and Treatment for Adults 30 and Older With New Stable Chest Pain and Suspected Coronary Artery Disease in Germany

What this Trial Is About

Researchers are investigating a new nationwide care model called NVF to improve the diagnosis and treatment of patients with recent-onset stable chest pain and suspected coronary artery disease CAD in Germany. This study aims to enhance the use of coronary computed tomography CT as an alternative to cardiac catheterisation, potentially reducing cardiovascular events like heart attacks and strokes while lowering healthcare costs. The trial is a pragmatic, cluster-randomised stepped-wedge design conducted in 16 regions across Germany. Participants will be assigned to one of two groups usual care following national guidelines without structured coordination, or the IMPRO cross-sectoral care model that connects general practitioners with certified cardiac CT centres. The IMPRO program includes evidence-based initial assessments, shared decision-making among doctors and patients, quality-assured CT imaging, structured reporting, and ongoing training and quality monitoring at participating sites. This intervention is designed to improve diagnostic accuracy and care coordination. During the study, participants will be monitored for major adverse cardiovascular events MACE such as cardiovascular death, myocardial infarction, or stroke over 12 months, with extended follow-up up to 5 years. Researchers will also track procedure-related complications, test rates, hospitalizations, emergency visits, radiation exposure, quality of life, angina symptoms, and medical costs. Data collection includes baseline and follow-up assessments at 3 months, 12 months, and 5 years to evaluate clinical outcomes, safety, cost-effectiveness, and patient quality of life.

Improved Management of Patients With Recent-Onset Stable Chest Pain