The criteria, which aim to help clinicians determine when cardiac catheterization is a reasonable option for the evaluation of patients for heart disease, are the newest addition to the growing list of AUC documents.
The AUC for diagnostic catheterization were developed by a technical panel that identified 166 possible clinical scenarios when referral for diagnostic catheterization might be considered. The appropriateness of these scenarios, which were drawn from the medical literature and anticipated clinical applications, were then assessed and rated as either "appropriate," "inappropriate," or "uncertain." Altogether, the group determined cardiac catheterization to be "appropriate" in about half of the clinical situations evaluated. Nearly 30 percent of the scenarios were rated as "uncertain," while 25 percent were deemed unreasonable or inappropriate. The authors stressed that an uncertain designation should not be used as grounds for denial of reimbursement.
In general, the AUC note that cardiac catheterization is appropriate in patients with the following:
- No prior stress testing but who report symptoms and have a high pretest probability, or high likelihood of disease in the physician’s judgment;
- Definite or suspected acute coronary syndrome; and
- Typical symptoms and intermediate- or high-risk findings on prior diagnostic testing.
The criteria also highlight certain situations in which individuals should not be referred directly to cardiac catheterization. Among others, these include diagnostic work-ups for:
- Asymptomatic patients at low risk for CAD 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 (If a patient has significant risk factors or is undergoing transplantation or heart valve surgery, diagnostic catheterization is warranted.).
Moving forward, the new AUC will be translated into order sheets and decision support tools. Furthermore, the indications will be linked with the coronary revascularization AUC to increase the number of patients undergoing appropriate invasive catheterization procedures before discussions and considerations surrounding revascularization occur. The criteria will be published in print in the May 29 issue of the Journal of the American College of Cardiology.
The AUC were developed in collaboration with the American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Thoracic Surgeons.