Trends in Coded Indications for Percutaneous Coronary Interventions in Medicare and the Veterans Affairs After Implementation of Hospital-Level Reporting of Appropriate Use Criteria

A systematic review of existing appropriate use criteria in cardiovascular disease from the last 15 years

Appropriate use criteria (AUC) aim to impact the provision of high-value care. This scoping review identified AUC regarding the procedural and operative treatment of cardiovascular disease and described the evolution of AUC in this space over time, including changes in the focus, strategy, and language of AUC. The summative presentation of these AUC identifies elements of AUC that may lead to successes in, and barriers to, implementation across disease processes, specialties, and societies. AUC topics include coronary artery disease, peripheral artery disease, valvular disease, venous disease, renal artery stenosis, and mesenteric ischemia, among others.

The appropriate use criteria: Improvements for its integration into real world clinical practice

The purpose of this position statement is to suggest ways in which future appropriate use criteria (AUC) for coronary revascularization might be restructured to: (1) incorporate improvement in quality of life and angina relief as primary goals of therapy, (2) integrate the findings of recent trials into quality appraisal, (3) employ the combined information of the coronary angiogram and invasive physiologic measurements together with the results of stress test imaging to assess risk, and (4) recognize the essential role that patient preference plays in making individualized therapeutic decisions. The AUC is a valuable tool within the quality assurance process; it is vital that interventionists ensure that percutaneous coronary intervention case selection is both evidence-based and patient oriented. Appropriate patient selection is an important quality indicator and adherence to evidence-based practice should be one metric in a portfolio of process and outcome indicators that measure quality.