The American College of Cardiology (ACC) has published new appropriate use criteria (AUC) focused on the use of stress testing and anatomic diagnostic procedures to evaluate known or suspected chronic coronary disease (CCD).
The document represents a collaboration between the ACC and the American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, American Society of Preventive Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. It was published in full in the Journal of the American College of Cardiology.[1]
This new AUC is an update to a 2013 document focused on the detection and risk assessment of stable ischemic heart disease (SIHD). The change in terminology from SIHD to CCD dates back to 2019, when the European Society of Cardiology made the distinction in its own guidelines.[2] Ratings of “appropriate,” “may be appropriate” or “rarely appropriate” are provided for a total of 64 clinical scenarios that cover the treatment of both symptomatic and asymptomatic patients. Multiple clinical scenarios that have been added, revised, expanded or even removed compared to the 2013 AUC. Testing modalities are not “ranked” against one another, as multiple modalities may be equally appropriate for any given scenario.
Another key update compared to the previous AUC is that the terms “likely anginal” and “less-likely anginal” are now used instead of “typical/definite angina” and “atypical/probable angina.”
“The 2023 AUC for multimodality imaging in CCD has been substantially revised in an effort to make application easier and more closely aligned to how clinical decisions are made in practice,” according to writing group co-chair David E. Winchester, MD, MS, a cardiologist with the University of Florida, and colleagues. “Special attention has been paid to aligning this document with clinical practice guidelines and contemporary scientific studies.”
AUC documents—including those developed and published by the ACC—are designed to help guide physicians as they go through the decision-making process.
“AUC should not replace clinician judgment and practice experience, but should function as tools to improve patient care and health outcomes in a cost-effective manner,” the authors wrote.
The ACC’s statement about the new AUC is available here. A breakdown of key takeaways is available here. Read the AUC in full here.
According to the Protecting Access to Medicare Act of 2014, physicians must use CMS- approved clinical decision support mechanisms to consult AUC criteria when they order advanced imaging services for Medicare patients. After multiple delays, the federal AUC requirement is in a testing period until further notice.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.