Abstract 258: Adherence To The AHA / ACCF / SCAI / ASE /ASNC - 2012 Appropriate Use Criteria For Diagnostic Cardiac Catheterization In An Academic Medical Center.

Abstract

Objective: To examine the adherence to the published appropriate use criteria (AUC) for diagnostic cardiac catheterization (DCC) in an academic medical center.

Background: In May 2012, the American Heart Association and other subspecialty societies have developed AUC for DCC to address the growing rational use of cardiac catheterization in delivering high quality health care. The application of all the subsets of AUC indications to examine the adherence of cardiologists in academic center has not been well studied.

Methods: We retrospectively examined a random sample of 499 patients who underwent DCC in our institution between January 1, 2013 to June 30, 2013, seven months after the publication of AUC for DCC; and classified as appropriate, uncertain and inappropriate categories according to the AUC. Indications not addressed in the AUC were considered unclassified.

Results: The mean age of the study population was 65 (± 13) years with 67% males. Distribution of DCC according to AUC is shown in Table-1. Most DCC were appropriate (93%; n= 462), 6% (n=31) were uncertain and none were inappropriate. Approximately 1% (n=6) DCC were unclassifiable and all had known obstructive coronary artery disease (CAD) with worsening or limiting symptoms without non invasive stress testing and did not meet criteria for unstable angina. About one quarter (22%; n= 21/86) of DCC performed for patients in the suspected CAD with or without prior non invasive stress testing group were uncertain, 78% (n= 65/86) were appropriate and none were inappropriate. Most DCC (92%) were performed by interventional cardiologists (Figure 1).

Conclusions: Most DCCs performed at this academic hospital are adherent with AUC criteria, however variability exists by indication and provider type. Unclassified patients as mentioned above who got referred for DCC by treating cardiologists led to a significant change in their management plan, thereby suggesting these group of patients which currently do not fit to any subset AUC criteria need consideration for further subset AUC categorization. About 22% of the DCC performed in the suspected CAD group were uncertain, none were inappropriate which make our results prominently discordant to recent findings observed among DCC procedures performed for suspected CAD in New York State.