There may be discordance with the appropriateness of some advanced imaging tests due to multiple societies’ appropriate use criteria (AUC), according to a report published March 23 in JAMA Cardiology.

The study looked at 592 patients who underwent nuclear myocardial perfusion imaging at a Veterans Affairs medical center between December 2010 and July 2011. Appropriateness was assessed using ACC’s AUC and the American College of Radiology’s (ACR) AUC.

Results showed that 111 (18.8 percent) could not be matched to an ACR AUC rating, 349 patients (59 percent) had the same appropriateness category for the ACR and ACC AUC method, and 132 patients (22.3 percent) were discordant.

The authors explain that one major limitation to their study is that appropriateness was rated with the 2009 ACC AUC, which have since been updated with the 2013 ACC multimodality AUC. They add that moving forward, “the capacity for AUC methods to identify clinically relevant outcomes, such as the detection of myocardial ischemia, warrants further study.”

In a related commentary, Robert C. Hendel, MD, FACC, chair of ACC’s AUC Implementation and Evaluation Committee and a member of ACC’s Board of Trustees, explains that substantial methodological differences exist between each organization’s approach to AUC, including ACC’s “greater reliance of risk stratification based on clinical factors, which results in a far greater specificity of clinical indications with the ACC version.”

Hendel adds that “It is apparent in the age of value-based care, and with continued emphasis on elimination of unnecessary procedures and costs, that AUC offer substantial opportunity to optimize care via guidance provided from careful analysis of published data. The AUC are not intended to be guidelines but should provide a mechanism to inform practitioners on ‘reasonable’ technology utilization. However, to alter the current state, these criteria must be well constructed and validated.”

Keywords: Area Under Curve, Cardiac Imaging Techniques, Coronary Artery Disease, Myocardial Ischemia, Myocardial Perfusion Imaging, Unnecessary Procedures, Veterans

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