Appropriate Use of Cardiovascular Technology: 2013 ACCF Appropriate Use Criteria Methodology Update. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force


The following are 10 points to remember about this report:

1. An appropriate diagnostic or therapeutic procedure is one in which the expected clinical benefit exceeds the risks of the procedure by a sufficiently wide margin such that the procedure is generally considered acceptable or reasonable care.

2. The focus of Appropriate Use Criteria (AUC) is to encourage optimal patient care by the professional stewardship of technology utilization within cardiovascular medicine.

3. For diagnostic imaging procedures, benefits include incremental information, which when combined with clinical judgment, augment efficient patient care and the expected negative consequences (risks include the potential hazard of missed diagnoses, radiation, contrast, and/or unnecessary downstream procedures).

4. For therapeutic procedures such as revascularization or implanted cardiac defibrillator/cardiac resynchronization therapy, the benefits include survival or health outcomes (such as improved symptoms, functional status, and/or quality of life) weighed against the risks of the procedure and subsequent related care.

5. The task force continues to emphasize that an appropriate procedure is a reasonable option, but may not uniformly be necessary for such patients.

6. When possible, AUC now provide a hierarchy of indications to guide use of the AUC in a systematic fashion, tailored for each modality, and assist in applying a particular clinical situation to one of the indications.

7. To ensure optimal utilization of diagnostic and therapeutic techniques, measurement of appropriate use in ‘real-world’ clinical practice based on AUC is necessary to assess practice performance, to provide direction for educational and continuous quality initiatives efforts, and to provide valuable real-world data to inform future AUC efforts.

8. The AUC effort aims to join with all cardiovascular practitioners and stakeholders in providing the optimal clinical decision making to foster high-quality cardiovascular care for their patients, and to work toward patterns of care that promote appropriate utilization and minimize use that lacks sufficient value whenever possible.

9. The AUC now seem to be having an impact on performance of tests in certain patient populations, with the goal of substantial reduction in waste due to unnecessary tests and procedures.

10. The AUC intent is as a guiding document; the final decision to proceed with testing or a procedure remains at the bedside where patient–physician interaction simply cannot be universally policy-based and must be done in the context of a discussion about treatment and patient goals, which is never a black or white decision.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Implantable Devices, SCD/Ventricular Arrhythmias

Keywords: Defibrillators, Patient Care, Cardiac Pacing, Artificial, Unnecessary Procedures, Cardiovascular System, European Continental Ancestry Group, Cardiovascular Diseases, Diagnostic Imaging, African Continental Ancestry Group, United States, Cardiac Resynchronization Therapy

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