Innovative Screening Identifies Heart Disease in Firefighters: SCCT Findings

In a pivotal study presented at the Society of Cardiovascular Computed Tomography (SCCT) meeting on July 19, 2025, researchers revealed that coronary computed tomography angiography (CCTA) effectively identifies underlying coronary artery disease (CAD) in firefighters, a demographic at heightened risk for cardiovascular issues. The findings underscore the urgent need for enhanced screening protocols beyond traditional evaluations, particularly as sudden cardiac death remains a leading cause of line-of-duty fatalities among firefighters, accounting for 40% of such deaths in 2023.

The study, led by Dr. Carrie Burns, District Physician at South Metro Fire Rescue in Centennial, Colorado, received the SCCT Best Abstract Award. Dr. Burns emphasized that "the implementation of screening CCTA identified underlying CAD in a significant proportion of firefighters who were not recognized as elevated cardiovascular risks by standard tests, prompting substantial changes in preventive management."

Historically, firefighters have been an overlooked population concerning cardiac health, often underdiagnosed due to their strong physicality and reluctance towards medical evaluations, fearing potential impacts on their operational status. According to Dr. Burns, "Firefighters are strong people with strong opinions, and like military personnel or police, they may avoid evaluations that could jeopardize their ability to work."

In their initiative, Burns and her team conducted CCTA exams on 309 firefighters as part of their annual occupational physicals. Eligibility was extended to individuals aged 40 years or older or those with identifiable cardiovascular risk factors. The study incorporated rigorous cardiovascular assessments, including the American Heart Association's Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) risk score and coronary artery calcium (CAC) scoring, employing advanced AI-enabled software from Cleerly Labs for plaque analysis.

The results were striking: 34% of the firefighters exhibited CAC scores above zero, with 88% demonstrating any coronary artery disease on CCTA. Notably, 83% of those with zero CAC scores had noncalcified plaque, indicating that traditional risk assessment tools may underestimate the cardiovascular risk in this population. Furthermore, 9.1% of participants were found to have a severe coronary artery disease burden, while 90.2% with coronary plaque had nonobstructive coronary artery disease.

The study's outcomes signal a critical shift in understanding the cardiac health of firefighters, revealing that the AHA PREVENT score frequently underestimated their risk. Dr. Burns indicated that this could lead to delayed implementation of necessary preventive strategies. As a result, 28.6% of the firefighters were referred to cardiology for further lipid management based on the findings from the quantitative coronary plaque analysis.

Despite these promising results, there are challenges to the continued implementation of the screening program, including the costs associated with the exams, managing radiation exposure, and addressing incidental findings that arise during screenings. The team is currently gathering one-year follow-up data to further assess the program's effectiveness.

The implications of this study extend beyond the firefighting community, raising awareness about the need for tailored cardiovascular assessments in high-risk occupational groups. As Dr. Burns noted, the ongoing initiative will continue to refine screening practices and improve preventive care for firefighters, ultimately aiming to reduce the alarming rate of cardiac-related fatalities in this brave profession. The findings from this study may prompt regulatory bodies and fire departments to reconsider their health protocols, advocating for a more proactive approach to occupational health screenings nationwide.