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New appropriate use criteria guide treatment of patients with heart blockage
Date:1/5/2009

, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and American Society of Nuclear Cardiology. They have been endorsed by the American Society of Echocardiography, Heart Failure Society of America, and Society of Cardiovascular Computed Tomography.

Appropriate use criteria differ from clinical guidelines both in their purpose and their format. While guidelines provide a comprehensive summary of evidence from clinical trials, appropriate use criteria focus on the types of patients cardiologists see in the clinic and hospital every day. Clinical studies may not have included such patients and, therefore, scientific evidence may not be readily available. Appropriate use criteria also present information in easily understood clinical scenarios that characterize patients according to four critical features:

  • The severity and type of symptoms;
  • How much cholesterol plaque has built up and in which arteries;
  • How much of the heart muscle, according to stress testing, is being starved for blood and oxygen (a condition known as ischemia); and
  • Whether the patient is already taking the right heart medications in the right dosages.
  • In developing the appropriate use criteria, a 17-member technical panel made up of general cardiologists, interventional cardiologists, cardiac surgeons, internal medicine specialists, health services researchers and others sifted through approximately 180 clinical scenarios, scoring each according to whether revascularization was appropriate, inappropriate or uncertain.

    "This was quite a serious undertaking," said Peter K. Smith, M.D., a cardiac surgeon member of the writing committee on behalf of The Society of Thoracic Surgeons. "The process involved extensive review and debate of the available body of evidence, and resulted in remarkable consensus
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Contact: Amanda Jekowsky
ajekowsk@acc.org
202-375-6645
American College of Cardiology
Source:Eurekalert

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