New criteria provide guidance on when cardiac catheterization is appropriate to evaluate patients for heart disease. The appropriate use criteria were released last week by the American College of Cardiology Foundation and the Society for Cardiovascular Angiography and Interventions.
The expert panel that developed the criteria identified 166 possible clinical scenarios in which diagnostic catheterization might be considered and then divided them into appropriate, inappropriate and uncertain uses. Cardiac catheterization was determined to be appropriate in 75 of the situations, uncertain in 49 and inappropriate in 42. The authors noted that use of catheterization is still reasonable in the uncertain situations, so that designation should not be used as grounds for denial of reimbursement.
The criteria primarily focus on the use of catheterization to detect blockages in the arteries that are indicative of coronary artery disease (CAD), but the panel also considered a number of other areas, including arrhythmia workup, preoperative testing and possible valve disease or pulmonary hypertension.
Among other situations, the panel advised that cardiac catheterization is appropriate in patients:
- with definite or suspected acute coronary syndrome;
- without prior stress testing but who report symptoms and have a high pretest probability of heart disease;
- 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:
- asymptomatic patients at low risk for CAD or without significant symptoms suggestive of heart disease;
- stable patients preparing for non-cardiac surgery who have good functional or exercise capacity (≥4 METS without symptoms) and/or
- stable patients preparing for low-risk non-cardiac surgery.
These criteria will be translated into order sheets and decision support tools by the writing organizations. They 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 and Society for Cardiovascular Magnetic Resonance and the Society of Thoracic Surgeons. The criteria were published in the May 29 Journal of the American College of Cardiology as well as in Catheterization and Cardiovascular Interventions and the Journal of Thoracic and Cardiovascular Surgery.