Megan Tooley, Cardiovascular Roundtable
The American College of Cardiology (ACC), in partnership with 10 other professional societies, has developed the first appropriate use criteria (AUC) for non-coronary vascular testing.
These new criteria, released online ahead of print in the Journal of the American College of Cardiology, rank the appropriateness of peripheral vascular ultrasound and physiological studies in patients with suspected or known non-coronary vascular disease.
About half of evaluated indications considered “appropriate”
The new criteria evaluate the appropriateness of 159 common situations for which vascular ultrasound and physiological testing are commonly used. As they also take into consideration the timing and frequency of testing (e.g., at 3-5 months, every 6 months), a grand total of 255 indications are included. Of these, 117 are rated appropriate, 84 uncertain, and 54 inappropriate.
Generally, vascular studies ordered primarily on the basis of clinical signs and symptoms indicating risk are considered appropriate, as well as studies to establish a “baseline” following revascularization.
“Inappropriate” exams unlikely to influence clinical decision making
The writing committee noted that studies rated “inappropriate” are not likely to cause harm, but do not provide useful information to guide clinical choices. As such, these studies have the potential to both delay time to diagnosis and effective patient management, and also add unnecessary costs to patient care.
Examples of inappropriate studies include carotid screening ultrasound for patients at low risk for heart attack and stroke, and performing a follow-up study in patients with a normal baseline study and no new symptoms.
As with all AUC developed by the ACC, the writing committee also stressed that these criteria are intended to support physicians in deciding the optimal diagnostic pathway, but not supersede clinical judgment for individual patients.
These new AUC for PVD add to the growing list of guidelines and criteria intended to support the appropriate utilization of CV imaging services.
In the upcoming 2012-2013 Cardiovascular Roundtable national meeting series, we’ll explore this topic in greater detail, providing strategies to ensure rational use of non-invasive CV imaging in your own institution. Register to secure your seat for one of our fall sessions.
(CardioSource, June 2012; Mohler ER, et al., JACC, 2012)