ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Stable Ischemic Heart Disease
- Grace Ronan
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The American College of Cardiology Foundation along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical presentations for stable ischemic heart disease (SIHD) to consider use of stress testing and anatomic diagnostic procedures. This document reflects an updating of the prior Appropriate Use Criteria (AUC) published for radionuclide imaging (RNI), stress echocardiography (Echo), calcium scoring, coronary computed tomography angiography (CCTA), stress cardiac magnetic resonance (CMR), and invasive coronary angiography for SIHD. This is in keeping with the commitment to revise and refine the AUC on a frequent basis. A major innovation in this document is the rating of tests side by side for the same indication. The side-by-side rating removes any concerns about differences in indication or interpretation stemming from prior use of separate documents for each test. However, the ratings were explicitly not competitive rankings due to the limited availability of comparative evidence, patient variability, and range of capabilities available in any given local setting.
The indications for this review are limited to the detection and risk assessment of SIHD and were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Eighty clinical scenarios were developed by a writing committee and scored by a separate rating panel on a scale of 1–9, to designate Appropriate, May Be Appropriate, or Rarely Appropriate use following a modified Delphi process following the recently updated AUC development methodology.
The use of some modalities of testing in the initial evaluation of patients with symptoms representing ischemic equivalents, newly diagnosed heart failure, arrhythmias, and syncope was generally found to be Appropriate or May Be Appropriate, except in cases where low pre-test probability or low risk limited the benefit of most testing except exercise electrocardiogram (ECG). Testing for the evaluation of new or worsening symptoms following a prior test or procedure was found to be Appropriate. In addition, testing was found to be Appropriate or May Be Appropriate for patients within 90 days of an abnormal or uncertain prior result. Pre-operative testing was rated Appropriate or May Be Appropriate only for patients who had poor functional capacity and were undergoing vascular or intermediate risk surgery with 1 or more clinical risk factors or an organ transplant. The exercise ECG was suggested as an Appropriate test for cardiac rehabilitation clearance or for exercise prescription purposes.
Testing in asymptomatic patients was generally found to be Rarely Appropriate, except for calcium scoring and exercise testing in intermediate and high-risk individuals and either stress or anatomic imaging in higher-risk individuals, which were all rated as May Be Appropriate. All modalities of follow-up testing after a prior test or percutaneous coronary intervention (PCI) within 2 years and within 5 years after coronary artery bypass graft (CABG) in the absence of new symptoms were rated Rarely Appropriate. Pre-operative testing for patients with good functional capacity, prior normal testing within 1 year, or prior to low-risk surgery also were found to be Rarely Appropriate. Imaging for an exercise prescription or prior to the initiation of cardiac rehabilitation was Rarely Appropriate except for cardiac rehabilitation clearance for heart failure patients.
In an effort to respond to the need for the rational use of imaging services in the delivery of high-quality care, the American College of Cardiology Foundation (ACCF) has undertaken a process to determine the appropriate use of cardiovascular imaging for selected patient indications.
Appropriate Use Criteria (AUC) publications reflect an ongoing effort by the ACCF to critically and systematically create, review, and categorize clinical situations where tests and procedures are utilized by physicians caring for patients with cardiovascular diseases. The process is based on current understanding of the technical capabilities of the procedures examined, evidence base, and clinical experience. Although not intended to be entirely comprehensive, the indications are meant to identify common scenarios encompassing the majority of contemporary practice. Given the breadth of information they convey, the indications do not directly correspond to the Ninth Revision of the International Classification of Diseases system as these codes do not include clinical information, such as symptom status.
The ACCF believes that careful blending of a broad range of clinical experiences and available evidence-based information will help guide a more efficient and equitable allocation of health care resources in cardiovascular imaging. The ultimate objective of AUC is to improve patient care and health outcomes in a cost-effective manner but is not intended to ignore ambiguity and nuance intrinsic to clinical decision making. Local parameters, such as the availability or quality of equipment or personnel may influence the selection of appropriate imaging procedures. AUC, thus, should not be considered substitutes for sound clinical judgment and practice experience.
We are grateful to the rating panel, a professional group with a wide range of skills and insights, for their thoughtful and thorough deliberation of the merits of cardiac testing for stable ischemic heart disease (SIHD). In addition to our thanks to the rating panel for their dedicated work and review; we would like to offer special thanks to the many individuals who provided a careful review of the draft indications; to Jenissa Haidari and Joseph Allen, who continually drove the process forward; and to the entire Task Force for their dedication, insight, and leadership.
Michael J. Wolk, MD, MACC
Past Chair, Appropriate Use Criteria Task Force
Ralph G. Brindis, MD, MPH, FACC, FSCAI
Moderator, Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Stable Ischemic Heart Disease Rating Panel
- ABIM’s Choosing Wisely: an initiative of the ABIM foundation. http://www.choosingwisely.org. Accessed January 1, 2013
- Patel MR, Spertus JA, Brindis RG, et al. ACCF proposed method for evaluating the appropriateness of cardiovascular imaging. J Am Coll Cardiol 2005;46:1606-13. CrossRef
- Hendel RC, Patel MR, Allen JM, et al. Appropriate use of cardiovascular technology: 2013 ACCF appropriate use criteria methodology update: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force. J Am Coll Cardiol 2013;61:1305-17. CrossRef
- Fitch K, Bernstein SJ, Aguilar MD, et al. The RAND/UCLA appropriateness method user’s manual. Santa Monica, CA: RAND Corporation; 2001.
- The Intersocietal Accreditation Commission. The IAC Echocardiography Standards. http://www.intersocietal.org/echo/main/standards.htm. Accessed June 9, 2013
- Pellikka PA, Nagueh SF, Elhendy AA, et al. American Society of Echocardiography recommendations for performance, interpretation, and application of stress echocardiography. J Am Soc Echocardiogr 2007;20:1021-41. CrossRef
- Picard MH, Adams D, Bierig SM, et al. American Society of Echocardiography recommendations for quality echocardiography laboratory operations. J Am Soc Echocardiogr 2011;24:1-10. CrossRef
- The Intersocietal Accreditation Commission. Nuclear PET Standards. http://www.intersocietal.org/nuclear/main/standards.htm. Accessed March 15, 2012
- The American College of Radiology. Nuclear Medicine & PET Accreditation. http://www.acr.org/Quality-Safety/Accreditation/Nuclear-Med-PET. Accessed October 30, 2013
- Hansen CL, Goldstein RA, Akinboboye OO, et al. Myocardial perfusion and function: single photon emission computed tomography. J Nucl Cardiol 2007;14:e39-60. CrossRef
- Holly TA, Abbott BG, Al-Mallah M, et al. Single photon-emission computed tomography. J Nucl Cardiol 2010;17:941-73. CrossRef
- The Intersocietal Accreditation Commission. The IAC Standards and Guidelines for MRI Accreditation. http://www.intersocietal.org/mri/main/mri_standards.htm. Accessed February 5, 2012
- The American College of Radiology. MRI Accreditation. http://www.acr.org/Quality-Safety/Accreditation/MRI. Accessed October 30, 2013
- Kramer CM, Barkhausen J, Flamm SD, et al. Standardized cardiovascular magnetic resonance imaging (CMR) protocols, society for cardiovascular magnetic resonance: board of trustees task force on standardized protocols. J Cardiovasc Magn Reson 2008;10:35. CrossRef
- Hundley WG, Bluemke D, Bogaert JG, et al. Society for cardiovascular magnetic resonance guidelines for reporting cardiovascular magnetic resonance examinations. J Cardiovasc Magn Reson 2009;11:5. CrossRef
- The Intersocietal Accreditation Commission. The IAC Standards and Guidelines for CT Accreditation. http://www.intersocietal.org/ct/main/ct_standards.htm. Accessed January 18, 2012
- The American College of Radiology. Computed Tomography Accreditation. http://www.acr.org/Quality-Safety/Accreditation/CT. Accessed October 30, 2013
- Raff GL, Abidov A, Achenbach S, et al. SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography. J Cardiovasc Comput Tomogr 2009;3:122-36. CrossRef
- Abbara S, Arbab-Zadeh A, Callister TQ, et al. SCCT guidelines for performance of coronary computed tomographic angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 2009;3:190-204. CrossRef
- Naidu SS, Rao SV, Blankenship J, et al. Clinical expert consensus statement on best practices in the cardiac catheterization laboratory: society for cardiovascular angiography and interventions. Catheter Cardiovasc Interv 2012;80:456-64. CrossRef
- The Accreditation for Cardiovascular Excellence 2013 Cath/PCI Standards. http://www.cvexcel.org/Documents/CathPCIProcess.aspx. Accessed January 18, 2012
- Chambers CE, Fetterly KA, Holzer R, et al. Radiation safety program for the cardiac catheterization laboratory. Catheter Cardiovasc Interv 2011;77:546-56. CrossRef
- Douglas PS, Carr JJ, Cerqueira MD, et al. Developing an action plan for patient radiation safety in adult cardiovascular medicine: proceedings from the Duke University Clinical Research Institute/American College of Cardiology Foundation/American Heart Association Think Tank held on February 28, 2011. J Am Coll Cardiol 2012;59(20):1833-47. doi:10.1016/j.jacc.2012.01.005. CrossRef
- Halliburton SS, Abbara S, Chen MY, et al. SCCT guidelines on radiation dose and dose-optimization strategies in cardiovascular CT. J Cardiovasc Comput Tomogr 2011;5:198-224. CrossRef
- The AAPM position statement on radiation risks from medical imaging procedures. http://www.aapm.org/org/policies/details.asp?id=318&type=pp¤t=true. Accessed January 20, 2013
- Morise AP, Haddad WJ, Beckner D. Development and validation of a clinical score to estimate the probability of coronary artery disease in men and women presenting with suspected coronary disease. Am J Med 1997;102:350-6. CrossRef
- Pryor DB, Shaw L, McCants CB, et al. Value of the history and physical in identifying patients at increased risk for coronary artery disease. Ann Intern Med 1993;118:81-90. CrossRef
- Fihn SD, Gardin JM, Abrams J, et al 2012 ACCF/AHA/ACP/ AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2012;60:e44-164. CrossRef
- Diamond GA, Forrester JS. Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med 1979;300:1350-8. CrossRef
- Pryor DB, Harrell FE Jr, Lee KL, et al. Estimating the likelihood of significant coronary artery disease. Am J Med 1983;75:771-80. CrossRef
- Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). J Am Coll Cardiol 2002;40:1531-40. CrossRef
- Diamond GA. A clinically relevant classification of chest discomfort. J Am Coll Cardiol 1983;1:574-5. CrossRef
- Expert Panel on Detection. Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486-97. CrossRef
- Assmann G, Cullen P, Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the Prospective Cardiovascular Munster (PROCAM) study. Circulation 2002;105:310-5. CrossRef
- Yancy CW, Jessup M, Bozkurt B, et al. ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;2013(62):e147-239. CrossRef
- Zipes DP, Camm AJ, Borggrefe M, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol 2006;48:e247-346. CrossRef
- Zipes DP, Jalife J, editors. Cardiac electrophysiology: from cell to bedside. Philadelphia, PA: Elsevier; 2000.
- Bikkina M, Larson MG, Levy D. Prognostic implications of asymptomatic ventricular arrhythmias: the Framingham Heart Study. Ann Intern Med 1992;117:990-6. CrossRef
- Moya A, Sutton R, Ammirati F, et al. Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J 2009;30:2631-71. CrossRef
- Fleisher LA, Beckman JA, Brown KA, et al 2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. J Am Coll Cardiol 2009;54:e13-118. CrossRef
- Campeau L. Letter: grading of angina pectoris. Circulation 1976;54:522-3.
- Hendel RC, Patel MR, Kramer CM, et al. ACCF/ACR/SCCT/ SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol 2006;48:1475-97. CrossRef
- Taylor AJ, Cerqueira M, Hodgson JM, et al. ACCF/SCCT/ACR/ AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol 2010;56:1864-94. CrossRef
- Douglas PS, Garcia MJ, Haines DE, et al. ACCF/ASE/AHA/ ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 appropriate use criteria for echocardiography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance Endorsed by the American College of Chest Physicians. J Am Coll Cardiol 2011;57:1126-66. CrossRef
- Hendel RC, Berman DS, Di Carli MF, et al. ACCF/ASNC/ACR/ AHA/ASE/SCCT/SCMR/SNM 2009 appropriate use criteria for cardiac radionuclide imaging: A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine. J Am Coll Cardiol 2009;53:2201-29. CrossRef
- Nandalur KR, Dwamena BA, Choudhri AF, et al. Diagnostic performance of stress cardiac magnetic resonance imaging in the detection of coronary artery disease: a meta-analysis. J Am Coll Cardiol 2007;50:1343-53. CrossRef
- Hamon M, Fau G, Nee G, et al. Meta-analysis of the diagnostic performance of stress perfusion cardiovascular magnetic resonance for detection of coronary artery disease. J Cardiovasc Magn Reson 2010;12:29. CrossRef
- Schwitter J, Wacker CM, Wilke N, et al. MR-IMPACT II: magnetic resonance imaging for myocardial perfusion assessment in coronary artery disease trial: perfusion-cardiac magnetic resonance vs. single-photon emission computed tomography for the detection of coronary artery disease: a comparative multicentre, multivendor trial. Eur Heart J 2013;34:775-81. CrossRef
- Greenwood JP, Maredia N, Younger JF, et al. Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): a prospective trial. Lancet 2012;379:453-60. CrossRef
- Lipinski M, McVey C, Berger J, et al. Prognostic value of stress cardiac magnetic resonance imaging in patients with known or suspected coronary artery disease: a systematic review and meta-analysis. J Am Coll Cardiol 2013;62:826-38. CrossRef
- Kapetanopoulos A, Heller GV, Selker HP, et al. Acute resting myocardial perfusion imaging in patients with diabetes mellitus: results from the Emergency Room Assessment of Sestamibi for Evaluation of Chest Pain (ERASE Chest Pain) trial. J Nucl Cardiol 2004;11:570-7. CrossRef
- Chinnaiyan KM, Peyser P, Goraya T, et al. Impact of a continuous quality improvement initiative on appropriate use of coronary computed tomography angiography. Results from a multicenter, statewide registry, the Advanced Cardiovascular Imaging Consortium. J Am Coll Cardiol 2012;60:1185-91. CrossRef
- Chinnaiyan KM, Raff GL, Goraya T, et al. Coronary computed tomography angiography after stress testing: results from a multicenter, statewide registry, ACIC (Advanced Cardiovascular Imaging Consortium). J Am Coll Cardiol 2012;59:688-95. CrossRef
- Shaw LJ, Hausleiter J, Achenbach S, et al. Coronary computed tomographic angiography as a gatekeeper to invasive diagnostic and surgical procedures: results from the multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: an International Multicenter) registry. J Am Coll Cardiol 2012;60:2103-14. CrossRef
- Shaw LJ, Mieres JH, Hendel RH, et al. Comparative effectiveness of exercise electrocardiography with or without myocardial perfusion single photon emission computed tomography in women with suspected coronary artery disease: results from the What Is the Optimal Method for Ischemia Evaluation in Women (WOMEN) trial. Circulation 2011;124:1239-49. CrossRef
- Mieres JH, Shaw LJ, Arai A, et al. Role of noninvasive testing in the clinical evaluation of women with suspected coronary artery disease: consensus statement from the Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention, American Heart Association. Circulation 2005;111:682-96. CrossRef
- Kohli P, Gulati M. Exercise stress testing in women: going back to the basics. Circulation 2010;122:2570-80. CrossRef
- The Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE). Duke University. ClinicalTrials.gov. website. http://clinicaltrials.gov/ct2/show/NCT01174550?term=promise&rank=8. Accessed February 18, 2013
- The International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA). New York University School of Medicine. http://clinicaltrials.gov/ct2/show/NCT01471522?term=ischemia&rank=1. Accessed December 15, 2012
- Litt HI, Gatsonis C, Snyder B, et al. CT angiography for safe discharge of patients with possible acute coronary syndromes. N Engl J Med 2012;366:1393-403. CrossRef
- Hoffmann U, Truong QA, Schoenfeld DA, et al. Coronary CT angiography versus standard evaluation in acute chest pain. N Engl J Med 2012;367:299-308. CrossRef
- Goldstein JA, Chinnaiyan KM, Abidov A, et al. The CT-STAT (coronary computed tomographic angiography for systematic triage of acute chest pain patients to treatment) trial. J Am Coll Cardiol 2011;58:1414-22. CrossRef
- Nabi F, Chang SM, Xu J, et al. Assessing risk in acute chest pain: the value of stress myocardial perfusion imaging in patients admitted through the emergency department. J Nucl Cardiol 2012;19:233-43. CrossRef
- ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Stable Ischemic Heart Disease
Journal of Nuclear Cardiology
Volume 21, Issue 1 , pp 192-220
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- Grace Ronan (1)
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- 1. Clinical Policy and Documents, American College of Cardiology, 2400 N Street, N.W., Washington, DC, 20036, USA