New appropriate use criteria guide treatment of patients with hear...(between specialties. Dr. Smith is also ...),Health

Revascularization was considered appropriate if the expected improvements in survival, symptoms, functional status and/or quality of life outweighed the possible risks. In most cases, the panel considered revascularization as either bypass surgery or a catheter procedure (also known as percutaneous coronary intervention, or PCI). Because evidence is available to support either procedure for patients with advanced coronary disease, each method of revascularization was independently rated.

The panel determined that revascularization would be inappropriate in a patient who had plaque build-up in one or two arteries, experienced symptoms only during heavy exercise, had a small amount of heart muscle at risk, and was not taking medication to help control symptoms. However, they deemed revascularization appropriate if a similar patient had severe symptoms despite already taking the best available heart medication.

Appropriate use criteria are not intended to diminish the importance of clinical judgment in evaluating individual patients, nor to include every possible type of patient. Instead, one of their most important uses will be in evaluating patterns of care, and in helping to reduce the large variation in rates of revascularization that has been observed throughout the country.

"For physicians who look at the appropriate use criteria and conclude that 95 to 100 percent of the revascularization procedures they perform would be graded as appropriateterrific," said Gregory J. Dehmer, M.D., a writing committee member and past president of the Society for Cardiovascular Angiography and Interventions. "But for those who find that only 60 or 70 percent of their procedures are appropriate and the rest are inappropriate, this document provides a very powerful message and gives them a benchmark for improving their practice." Dr. Dehme
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