Effects of Real-Time Notification of AI-Detected Incidental Coronary Artery Calcium on Statin Prescription: The NOTIFY-PICTURE Trial
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Patient and clinician notifications based on AI-CAC results improved statin prescription and downstream lipid testing, statin persistence, LDL-C reduction and CAD evaluation.
“Patient and clinician notifications based on AI-CAC results improved statin prescription and downstream lipid testing, statin persistence, low-density lipoprotein cholesterol (LDL-C) reduction and CAD evaluation.41–43”
From Prognostication and clinical opportunities with AI for coronary artery calcium: a scoping review (2026) · cites this paper as [42]
The NOTIFY-PICTURE results (page unavailable) report more statin prescriptions with notification than with usual care, particularly among patients without baseline ASCVD. The limitations state that statin adherence was not assessed and the trial lacked power to detect LDL-C changes; the paper does not report improved downstream lipid testing or CAD evaluation and says healthcare utilization did not increase. (LLM, conf=0.91)
Experimental — accuracy not yet measuredNotification of patients and clinicians based on AI-CAC results increases cardiovascular preventive discussions, statin prescription rates and statin persistence.
“Notification of patients and clinicians based on these results has been shown to increase cardiovascular preventive discussions, statin prescription rates and statin persistence.40–43”
From Prognostication and clinical opportunities with AI for coronary artery calcium: a scoping review (2026) · cites this paper as [42]
The NOTIFY-PICTURE results report higher statin prescription rates after notification (44% versus 9.8% with usual care), with the increase seen among patients without ASCVD but not those with ASCVD. The paper does not report an increase in cardiovascular preventive discussions, and its limitations state that statin adherence was not assessed; it therefore does not establish increased statin persistence. The supplied copy has no page numbers. (LLM, conf=0.90)
Experimental — accuracy not yet measuredThree included studies employed an AI algorithm (Bunkerhill Health) in which co-investigator CPL holds equity interest.
“Three included studies41–43 employed an AI algorithm (Bunkerhill Health) in which co-investigator CPL holds equity interest.”
From Prognostication and clinical opportunities with AI for coronary artery calcium: a scoping review (2026) · cites this paper as [42]
The NOTIFY-PICTURE methods passage (page not specified) says the trial screened CT scans using an AI algorithm, supporting its identification as one study that employed AI. Our copy does not name Bunkerhill Health as the algorithm’s provider or address CPL’s equity interest; this source also cannot establish how many studies the citing paper included. (LLM, conf=0.85)
Experimental — accuracy not yet measured
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Cites
Grundy, S. M., Stone, N. J., Bailey, A. L., Beam, C., Birtcher, K. K., Blumenthal, R. S., Braun, L. T., de Ferranti, S., Faiella-Tommasino, J., Forman, D. E., et al. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.11.003 · Cited by 2,691 · see citing works
Automated coronary calcium scoring using deep learning with multicenter external validation
Eng, D. K.-M., Chute, C., Khandwala, N., Rajpurkar, P., Long, J., Shleifer, S., Khalaf, M. H., Sandhu, A. T., Rodríguez, F., Maron, D. J., et al. (2021) · npj Digital Medicine · doi:10.1038/s41746-021-00460-1 · Cited by 185 · see citing works
Self-citationSandhu, A. T., Rodriguez, F., Ngo, S., Patel, B. N., Mastrodicasa, D., Eng, D., Khandwala, N., Balla, S., Sousa, D., & Maron, D. J. (2023) · Circulation · doi:10.1161/circulationaha.122.062746 · Cited by 174 · see citing works
Self-citationPeng, A. W., Dudum, R., Jain, S. S., Maron, D. J., Patel, B. N., Khandwala, N., Eng, D., Chaudhari, A. S., Sandhu, A. T., & Rodriguez, F. (2023) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2023.06.040 · Cited by 67 · see citing works
Self-citationForaker, R., Sperling, L., Bratzke, L., Budoff, M., Leppert, M., Razavi, A. C., Rodriguez, F., Shapiro, M. D., Whelton, S., Wong, N. D., et al. (2025) · Circulation · doi:10.1161/cir.0000000000001382 · Cited by 44 · see citing works
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Prognostication and clinical opportunities with AI for coronary artery calcium: a scoping review
McDonald, V. J. F., Parsa, S., Mastrodicasa, D., Rodriguez, F., Langlotz, C., Maron, D. J., Sandhu, A. T., Dudum, R., & Jain, S. S. (2026) · BMJ Digital Health & AI · doi:10.1136/bmjdh-2026-000053
Self-citationRadiology: Cardiothoracic Imaging Highlights 2025
Sanchez, D. A. P., de Farias, L. D. P. G., Onnis, C., Suchá, D., Escalon, J. G., Hanneman, K. A., Abbara, S., Litt, H. I., Gulsin, G. S., & Mastrodicasa, D. (2026) · Radiology Cardiothoracic Imaging · doi:10.1148/ryct.260065
Self-citationOpportunistic Coronary Artery Calcium Screening: Time for Clinical Implementation
Rodríguez, F., & Langlotz, C. P. (2026) · Circulation · doi:10.1161/circulationaha.126.081204
Self-citationLee, S., Cucksey, L., Guo, T., Rezaeianzadeh, R., Samarasinghe, Y., Leung, C., Chen, C., Mehareen, J., Fordyce, C. B., & Myers, R. L. (2026) · Research Square · doi:10.21203/rs.3.rs-10975699/v1
Keamy-Minor, E., Dudum, R., Bragdon, C. L., Ngo, S., Xu, S., Asch, S. M., Maron, D. J., Brown-Johnson, C., Sandhu, A. T., & Rodriguez, F. (2026) · American Heart Journal Plus Cardiology Research and Practice · doi:10.1016/j.ahjo.2026.100989
Self-citation
- Authors
- Dudum, R., Jain, S. S., Mastrodicasa, D., Furst, A., Xu, S., Ngo, S., Eng, D., Khandwala, N., Sousa, D., Chaudhari, A., Langlotz, C., Sandhu, A. T., Maron, D. J., & Rodriguez, F.
- Affiliations
- University of California, San Francisco (US)
- Stanford Medicine (US)
- University of Washington (US)
- VA Palo Alto Health Care System (US)
- Bunkerhill Health, Palo Alto, CA (D.E., N.K.).
- Patient Representative, Hollister, CA (D.S.).
- Department of Medicine, Division of Cardiovascular Medicine (S.S.J., A.F., S.X., S.N., A.T.S., D.J.M., F.R.), Stanford University, Stanford, CA.
- ORCID
- Venue
- Circulation
- Published
- 2026-01-20
- Volume
- 153
- Issue
- 3
- Pages
- 210-212
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC12829528
- OpenAlex
- W4416082460
- Cited by
- 5
- References
- 5
- Citations by year
- 2026: 5
- FWCI
- 2.88
- Type
- journal article
- Language
- en
- Open access
- green
- pmc.ncbi.nlm.nih.gov
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion)
- Funders
- Doris Duke Foundation (Grant #2022051)
- HHS | NIH | National Heart, Lung, and Blood Institute (R01HL168188, R01HL167974, R01HL169345)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Keywords
- coronary artery calcium, incidental finding, artificial intelligence, real-time alerts, statin prescribing, statin therapy, cardiovascular risk
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