Perceptions of high-sensitivity C-reactive protein testing (hsCRP) in atherosclerotic cardiovascular disease: a US survey on cardiologists and nephrologists

High-sensitivity C-reactive protein (hsCRP) is a biomarker of systemic inflammation (SI) and its elevated level is considered a risk-enhancing factor for cardiovascular disease in primary prevention. This study aimed to understand opinions of US clinicians using hsCRP testing in the management of patients with atherosclerotic cardiovascular disease (ASCVD) with or without chronic kidney disease (CKD). Clinicians who ordered hsCRP testing with evaluation of patient-level data were surveyed, between June 2023–August 2023. Endpoints included self-identified drivers and barriers to hsCRP testing and assessment of posttest actions following SI recognition. Common factors perceived to prevent hsCRP testing were a lack of evidence showing improvements in patient cardiovascular outcomes after addressing SI in ASCVD and CKD (50%), and lack of proven efficacy of hsCRP testing (33%). Barriers to hsCRP testing included cost, insurance coverage and patient refusal. The most common reason for not considering SI in clinical decision-making was that it would not affect management of ASCVD. After the first hsCRP testing, an average reduction of hsCRP level is observed, but not lower than 2 mg/L. In this limited study sample, perceived limitations of hsCRP testing included insufficient evidence of improved cardiovascular outcomes in patients with ASCVD. High-sensitivity C-reactive protein (hsCRP) is an established marker of systemic inflammation (inflammation throughout the body) in patients with atherosclerotic cardiovascular disease (ASCVD), where arteries become narrowed. However, hsCRP is not routinely tested in patients as part of the management of this disease. This study examined the perceptions of US cardiologists and nephrologists who have previously used hsCRP testing in patients with ASCVD, some of whom also have chronic kidney disease (CKD), and provides insight into the perceived drivers and barriers to the use of hsCRP testing by these clinicians in their clinical practice. Based on survey responses, the most common reason that hsCRP testing was not widely adopted in clinical practice for patients with ASCVD was a lack of clinical evidence that it leads to improved patient outcomes. Additionally, around one third of respondents felt that cost and insurance coverage acted as barriers to hsCRP testing. This study demonstrated key self-identified motivations and barriers to routine hsCRP testing for cardiologists and nephrologists who treat patients with ASCVD with or without CKD. In recognizing the key perceptions of clinicians in these fields, results from this study identify the risk of systemic inflammation and provide clinical evidence supporting the use of hsCRP testing in patients with ASCVD.