ACC Releases List of Five Tests/Procedures That May Be Overused or Misused as Part of Choosing Wisely Campaign

Choosing Wisely

The ACC on April 4 released a list of “Five Things Physicians and Patients Should Question” in cardiology as part of the Choosing Wisely® campaign, led by the ABIM Foundation with eight other medical specialty societies. The list identifies five targeted, evidence-based recommendations that can support physicians and patients in making wise choices about their care.

 The ACC list details the following five recommendations: 

  • Don’t perform stress cardiac imaging or advanced non-invasive imaging in the initial evaluation of patients without cardiac symptoms unless high-risk markers are present.
  • Don’t perform annual stress cardiac imaging or advanced non-invasive imaging as part of routine follow-up in asymptomatic patients.
  • Don’t perform stress cardiac imaging or advanced non-invasive imaging as a pre-operative assessment in patients scheduled to undergo low-risk non-cardiac surgery.
  • Don’t perform echocardiography as routine follow-up for mild, asymptomatic native valve disease in adult patients with no change in signs or symptoms.
  • Don’t perform stenting of non-culprit lesions during percutaneous coronary intervention (PCI) for uncomplicated hemodynamically stable ST-segment elevation myocardial infarction (STEMI).

The ACC’s list was developed over the last several months, with the College asking its standing clinical councils to recommend between three and five procedures that should not be performed or should be performed more rarely and only in specific circumstances. ACC staff took the councils’ recommendations and compared them to the ACC’s existing appropriate use criteria (AUC) and guidelines, choosing items for the five things list that had the tightest inappropriate score in the AUCs and were Class III recommendations in the guidelines. The ACC’s Advocacy Steering Committee and Clinical Quality Committee each then reviewed the five items before sending it to the ACC Executive Committee for final review and approval.

“While the ACC has taken a bold step in identifying and developing the list, the work doesn’t stop here,” says ACC Sr. Vice President of Science and Quality William Oetgen, MD, FACC, in an ACC in Touch Blog post. “Over the coming months and years, we will be working with the ABIM Foundation, Consumer Reports and a variety of Choosing Wisely campaign stakeholders, including the American Society of Nuclear Cardiology and the American Society of Echocardiography, to raise awareness of these lists and make them accessible to patients and the public.”

Learn more about Choosing Wisely and read all nine lists released at

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