Results of a Community-Based Coronary CT Angiography Screening in Asymptomatic Adults With Cardiovascular Risk Factors: The Broward County Heart Project

Background. Coronary CT angiography (CCTA) and calcium scoring detect subclinical coronary atherosclerosis, but the results of community based screening in asymptomatic adults with cardiovascular risk factors are poorly described. Objective. To describe the results of the first phase of a county-funded CT screening program and their variation by demographics, health system, time, and ZIP code. Methods. Retrospective analysis of aggregate reports from the Broward County Florida Heart Project (May 2023 to September 2025). Eligible residents were those with insurance coverage, age 45 to 70 years (limited exceptions), free of known cardiovascular disease and symptoms, with at least one risk factor. Examinations at six hospitals in four health systems were classified by the program team as normal (Category 1), abnormal (Category 2), or very abnormal (Category 3), with a separate flag for other non coronary abnormality. We used Wilson confidence intervals and chi square, trend, and Mantel Haenszel tests. Results. Among 7,135 participants (58.3% men; 79.0% White, 8.0% Black, 17.2% Hispanic), 43.2% had Category 1, 45.4% Category 2, and 11.4% Category 3 results; 56.8% (95% CI, 55.7% to 58.0%) had abnormal or very abnormal results. The proportion rose from 39.3% at 45 to 55 years to 78.5% at 71 or older (trend P<0.001) and was higher in men than women (68.9% vs 39.8%; odds ratio [OR], 3.36; 95% CI, 3.05 to 3.71). Rates were lower in Black than White participants (38.9% vs 58.6%; hospital adjusted OR, 0.45; 95% CI, 0.38 to 0.54) and in Hispanic than non Hispanic participants (51.0% vs 57.8%). Abnormal results ranged from 39.5% to 60.3% across health systems (P<0.001). Variation across the 50 highest volume ZIP codes did not exceed chance (P=0.53). Conclusions. More than half of insured, asymptomatic adults with risk factors screened in this community program had abnormal results, with steep age and sex gradients and unexplained variation across health systems. Black, Hispanic, and female residents were under-represented relative to the county