Today’s release of the 2012 Appropriate Use Criteria (AUC) for Diagnostic Catheterization aims to provide guidance on the performance of diagnostic cardiac catheterization. In the series of AUC documents put forth by the ACC and collaborating professional societies, this is the first AUC document addressing diagnostic cardiac catheterization. The criteria were released by the ACC and the Society for Cardiovascular Angiography and Interventions (SCAI) in collaboration with a dozen other professional societies.

Cardiac catheterization is an invasive diagnostic procedure that allows physicians to see the vessels and arteries leading to the heart and its chambers, and measure their pressure. The technical panel identified 166 possible clinical scenarios when referral for diagnostic catheterization might be considered – drawn from the medical literature and current clinical applications – and then assessed the appropriateness for each indication based on accepted methodology.

In general, the technical panel advises that cardiac catheterization is appropriate in patients:

• Without prior stress testing but who report symptoms and have a high pretest probability, or high likelihood of disease in the physician’s judgment
• With definite or suspected acute coronary syndrome
• With typical symptoms and intermediate- or high-risk findings on prior diagnostic testing

The panel noted certain situations in which individuals should not be referred directly to cardiac catheterization. Among others, these include diagnostic workups for:

• Asymptomatic patients at low risk for coronary artery disease or without significant symptoms suggestive of heart disease
• As part of a preoperative work up for non-cardiac surgery in patients with good functional or exercise capacity and/or
• Those undergoing low-risk surgeries (with few exceptions like in patients with significant risk factors, or undergoing transplantation or heart valve surgery)

These criteria are important for physicians to consider as they make clinical judgments and discuss medical decisions with their patients. Ultimately, medical decisions are individualized depending on the clinical situations and with shared decision making with patients. Moving forward, these criteria will be translated into decision support tools, and linked with the previously published coronary revascularization AUC for optimal patient care.

In general, given the continued focus on achieving the triple aim in health care, more and more attention is being given to AUC as a means of reducing variations in care and ensuring appropriate use of technologies and therapies.

On Wednesdays here on the blog over the next two months, we’ll be featuring a special AUC series focusing on the “basics” of what the AUC are, how to use them now, how the AUC can/will be used in the future, as well as the various ACC resources and tools available.

We’re looking forward to the discussions and your feedback, so stay tuned!

Also, in case you missed it, yesterday the ACC and SCAI, in collaboration with the Society of Thoracic Surgeons and the Society for Vascular Medicine, released an updated consensus statement for cardiac cath labs. Read the article on CardioSource.org here.

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