The ACC has released changes to the methodology of appropriate use criteria (AUC) development, including changes to the writing group, rating panel, rating process, and more. The document, ACC Appropriate Use Criteria Methodology: 2018 Update, was published Feb. 19 in the Journal of the American College of Cardiology.

Of note, changes have been made to the writing group, which will now include a Fellow in Training, and the rating panel, which will now include an expert in statistical analysis and an expert in clinical trial design. "The composition of each group involved in AUC development has been altered to comply with mandates from the Centers for Medicare and Medicaid Services," explains Robert C. Hendel, MD, FACC, co-chair of writing group.

The rating process itself now includes a clarification of the number of rating cycles, the use of electronic surveys to collect ratings and live rating during in-person meetings. In addition, the scope and design of AUC documents have shifted to focus on multiple modality documents. Further, there is now an inclusion of annual review and process for modification as well as a process for updates and revisions.

The first AUC document was published in 2005 for indications for radionuclide imaging. The authors explain that the growth of the AUC portfolio over the past 14 years has led to "both transformation and maturation of many of the aspects of AUC methodology."

"AUC should be viewed as an evaluation of the evidence base and rational use of cardiovascular technologies in patient populations, rather than as a judgment of those ordering and delivering use of such technologies," said Hendel.

The authors note that in 2013 changes were made to the AUC terminology "based on input from external stakeholders, including the payer community, state and national government regulators, and the Institute of Medicine, along with internal feedback from ACC's Board of Governors, relevant professional societies, and the cardiovascular community."

"The primary objective is to provide an unbiased consensus for the most appropriate management of patients with complex heart disease," adds Bruce D. Lindsay, MD, FACC, co-chair of writing group.

Keywords: Consensus, Federal Government, Judgment, Area Under Curve, Centers for Medicare and Medicaid Services, U.S., Medicaid, Medicare, Cardiology, Heart Diseases, Radionuclide Imaging

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