Putting Perspective on New AUC for ICD and CRT

The recent release of appropriate use criteria (AUC) for use of implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy comes at a time of heightened scrutiny of ICD implantation, according to a new perspective piece published in the Journal of the American Medical Association.

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According to perspective author Mike Mitka, MSJ, a 2011 study found a seemingly high rate of 22.5 percent of inappropriate use of ICDs in patients with chronic heart failure of less than three months duration or in patients within 40 days of acute MI or within 90 days of coronary artery bypass graft surgery. In the same year, the high percentage of improper ICD implantations also caught the eye of the U.S. Department of Justice which investigated whether such procedures constituted Medicare billing fraud.

The new criteria seek to guide appropriate care and improve care and health outcomes by enhancing physician and patient decision making, Mitka notes. He quotes Andrea M. Russo, MD, FACC, a member of the AUC for ICD and CRT technical panel, who said the criteria are designed to reflect real life. "Guidelines present broader recommendations, but in real life, patients are different, with different comorbidities that may not be covered by guidelines," she said.

Alan Kadish, MD, FACC, who was also interviewed for the article, said the new criteria are "superb" in that they break down syndromes in detail. "It allows for clinical judgment," he said. "Rather than just saying yes or no, it provides three levels of appropriateness and scoring, allowing clinicians to tailor their therapy to individual patients."



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