Study Design

CONCRETE is an implementation study of CT calcium scoring in GP setting. The design is a pragmatic cluster randomized trial in which direct access to CT calcium scoring is compared to standard of care in patients with chest discomfort. Randomization will take place at GP office level.

The primary units of randomization are 80 GPs, who will be randomized (1:1) to a strategy. For secondary analyses, we aim to obtain informed consent of the approximately 1600 subjects.


Implementation of direct access to CT calcium scoring for patients with chest discomfort in GP setting. Patients in both strategies will be asked for consent to full in questionnaires regarding chest pain complaints and quality of life and for the researchers to gather data on work- up and follow- up.


CONCRETE aims to: (1) evaluate whether GP access to CT calcium scoring leads to earlier CAD diagnosis and treatment, (2) assess and optimize gender-specific diagnostic stratification based on the calcium score, (3) determine which (cluster of) symptoms and risk factors could assist in web-based self-assessment of CAD, and (4) translate study findings to initiate a change in Dutch health care policy by providing data on cost-effectiveness.

Main study parameters of CONCRETE is to determine the increase in detection / treatment rate of CAD in GP offices with the calcium score-based strategy, compared to GP offices with the standard of care strategy.

Researchers study design