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ACC/HRS release appropriate use criteria for ICDs and CRT
Date:2/28/2013

ir and Director of Electrophysiology and Arrhythmia Services at Cooper University Hospital.

The scenarios cover six areas: ICDs for secondary prevention, ICDs for primary prevention, comorbidities, CRT devices, generator replacement, and dual- versus single-chamber ICDs.

A 10-member writing committee drafted the scenarios, while a separate technical panel rated each on a numerical scale as "Appropriate" (median 7 to 9), "May Be Appropriate" (median 4 to 6), or "Rarely Appropriate" (median 1 to 3). Of the 369 scenarios, 45% were deemed Appropriate, 33% were rated May Be Appropriate, and 22% were determined Rarely Appropriate. The writing committee stated that the appropriate use criteria can help inform the decision making process but should not be used as a substitute for careful clinical judgment and clinical practice experience nor current coverage and reimbursement policies.

"The decision to implant an ICD or CRT device is often complex, based on clinical evidence and clinical judgment, while taking into account comorbidities and other individual patient factors," said Russo. "While this document was designed to help inform clinical decision making, it does not establish 'rules' by which decisions should be made in clinical practice. Healthcare providers and other stakeholders should continue to acknowledge the pivotal role of clinical judgment in determining whether device implantation is indicated for an individual patient."

Russo added that the appropriate use criteria "can also be used to create algorithms or educational tools that help identify resource utilization or variations in care." These tools can be used at the point of caresuch as hospitals or physician officeswhere utilization decisions are made. Data generated from these tools or collected in registries can be used to identify the patient mix for these procedures for individual institutions. This information can then be used for benchmarking over time and for c
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Contact: Rachel Cagan
rcagan@acc.org
202-375-6395
American College of Cardiology
Source:Eurekalert

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