New appropriate use criteria guide treatment of patients with hear...( If you're committed to fitness the d...),Health

If you're committed to fitness, the decision to climb a couple of flights of stairs rather than take the elevator is clear. But if you develop chest pain on the way up, deciding how to treat the symptoms of clogged arteries in your heart is much more complicated.

Whether it's appropriate to treat chest pain with medical therapy alone or prescribe medical therapy and also perform revascularizationthat is, by restoring good blood flow to the heart muscle with a balloon-tipped catheter or bypass surgerydepends on several factors that vary from patient to patient. In some cases the decision is obvious; in others, it's more nuanced.

Now physicians, patients and health insurers have a practical tool for weighing each of those factors and arriving at the right treatment decision. The new document, titled "Appropriate Use Criteria for Coronary Revascularization," appears in the February 10, 2009, issue of the Journal of the American College of Cardiology (JACC) and online at www.acc.org. The document will also be published in the January 5, 2009, online issues of Catheterization and Cardiovascular Interventions (CCI) and Circulation: Journal of the American Heart Association, and online at www.scai.org.

"One of the strengths of this document is that it provides a framework for thinking about clinical scenarios and having a discussion about coronary revascularization," said Manesh R. Patel, M.D., chair of the appropriate use criteria writing group and an assistant professor of medicine at Duke University and the Duke Clinical Research Institute in Durham, NC. "These recommendations describe when coronary revascularization would be expected to improve a patient's health status."

The new appropriate use criteria are the first to focus on cardiac treatment, rather than on diagnostic testing. They were jointly developed by the American College of Cardiology
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