Today, multiple societies released a joint expert consensus statement on appropriate use criteria (AUC) for emergency department patients with chest pain, providing guidance regarding the first imaging test to be ordered. It is published online in the Journal of The American College of Cardiology (JACC).
SCAI was invited to endorse this AUC document, but declined due to concerns that it would adversely impact the care of our patients. Some of our concerns included the following:
- Invasive coronary angiography is rated “rarely appropriate” in some scenarios which include patients for whom its use is common in clinical practice and is supported by ACC/AHA/SCAI guidelines;
- Common clinical scenarios are not included in the document;
- To our knowledge, the Writing Committee included no physicians who perform invasive coronary angiography;
- A new rating designation, the “M*”, is used in the document with no indication of how it will be interpreted by regulators or payors; and
- The document considers patient preference only to the extent that it would influence patients to avoid invasive catheterization.
We are also concerned that insurance coverage denial based on AUC ratings will prevent some patients from receiving care that is appropriate and necessary. While it is critical to avoid procedures that are not beneficial to patients, it is equally important for patients to receive procedures that are beneficial and for patients to have the option of considering procedures that may be beneficial to their health.
The American Society of Echocardiography (ASE) had similar concerns, and also declined to endorse the AUC document. SCAI and ASE co-authored a letter to the editor of JACC detailing these concerns, but the editor declined to publish it. Instead, it will be published as an editorial in Catheterization and Cardiovascular Interventions and the Journal of the American Society of Echocardiography.
As always, please contact me anytime with your thoughts and concerns at firstname.lastname@example.org.
James C. Blankenship, MD, MHCM, FSCAI
2015-16 SCAI President