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March 10, 2009 -- 6:15pm EDT

Bent Out of SHAPE
Today the Texas House of Representatives has been holding a public hearing on bill HB 1290, sponsored by Rep. Rene Oliveira, which mandates that any health insurance plan that covers medical screening must also cover Coronary Artery Calcium (CAC) screening, a test which currently is NOT covered by Medicare or by most insurance. This would be a major step forward for this imaging technology.

SHAPE logoTwo years ago, the Houston-based Society for Heart Attack Prevention and Eradication (SHAPE) group issued a set of guidelines for early detection of heart disease. As reported on Angioplasty.Org, the SHAPE recommendations generated quite a bit of controversy at the time, with passionate advocacy of the test on the part of the SHAPE authors, and comments from others in the cardiology community, such as Dr. Philip Greenland of Northwestern, who called the report "an apparent effort to subvert the long-standing evidence-based guidelines approaches" of the major heart societies, such as the ACC and AHA. A Texas bill, virtually the same as the current one, was voted down in committee.

Which is why, to everyone's surprise, Dr. Morteza Naghavi, founder of SHAPE and Chairman of the SHAPE Task Force, stated in a Friday press release that, "We are also pleased to know that the American Heart Association has elected to support the bill as well."

Well, not exactly.

As Larry Husten, former editor of, reported last night in his blog CardioBrief, the AHA has denied any endorsement. He writes that the AHA spokesperson said:

...he had told the Texas legislators that “I don’t know if we are there yet” and that without better scientific evidence the AHA would be unable “to put a card in favor” of the legislation.

I contacted Dr. Naghavi of SHAPE. He told me that he'd been informed of the AHA endorsement during a conference call last Thursday by Michael Gray of Rep. Olivera’s staff. Reportedly Joel Romo of the AHA had conveyed news of the AHA's support to Mr. Gray and was "upbeat about it."

This afternoon the SHAPE Society sent me the following statement:

"After the public announcement of the March 10 hearing of the Texas Heart Attack Prevention Screening Bill, our SHAPE representative was informed by Michael Gray, from Congressman Oliveira's office, that the verbal commitment he had received from AHA representative, Joel Romo, to support the bill is no longer on the table. We are extremely disappointed that, only hours prior to the hearing, AHA has backed out from supporting such monumental bill, and, instead, wished to remain "neutral". However, SHAPE remains hopeful that as new studies uncover in the field, AHA will reconsider its position."

Obviously, there's just a bit of politics going on here, most of it outside the House of Representatives. What's interesting is that among the many distinguished members of the SHAPE Task Force are Dr. Pamela Douglas, a past-president of the American College of Cardiology and Dr. Valentin Fuster, a past-president of the American Heart Association.

Angioplasty.Org will be posting an in-depth report on the SHAPE recommendations and their implications in today's healthcare environment. Stay tuned.

Late Update: SHAPE has revised its press release and removed the reference to the AHA endorsement, but you can still read the cached version here.

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