Friday, October 21, 2005

DCRI Researchers Help Create First-Ever Appropriateness Criteria for Cardiovascular Imaging
By Julie McKeel

The American College of Cardiology Foundation (ACCF) released a pioneering set of Appropriateness Criteria, filling a critical need for guidelines regarding the use of cardiovascular imaging. The Single Photon Emission Computed Tomography Myocardial Perfusion Imaging (SPECT MPI) Appropriateness Criteria, created collaboratively with the American Society of Nuclear Cardiology (ASNC), were published in the Oct. 18, 2005 , issue of the Journal of the American College of Cardiology.

According to Dr. Ralph Brindis (University of California at San Francisco, CA), chair of the Appropriateness Criteria Working Group, the "development of Appropriateness Criteria will benefit not only clinicians and patients but also society as a whole through the encouragement of a cost-effective approach in cardiovascular care delivery."

The Appropriateness Criteria were developed to promote safer and more affordable cardiovascular care and also to help decrease the health care discrepancies reported among a variety of patient populations. They are designed to help experienced physicians decide whether performing a procedure or test is a reasonable step in sound clinical practice and include best practices detailed in the ACCF's Clinical Guidelines.

The DCRI's Dr. Manesh Patel and Dr. Eric Peterson, along with DUMC's Chief of the Division of Cardiology Dr. Pamela Douglas, participated in the Appropriateness Criteria Working Group.

Manesh Patel, MD

According to Patel, "technological advances in cardiac imaging have led to an explosive growth in cardiac imaging. Unfortunately, the evidence is lacking for the clinical scenarios in which imaging can benefit patients."

"Additionally, the cost has grown tremendously," Patel continued. "Therefore, in response to payers, clinicians, and patients who need to understand the 'appropriate use' [of cardiac imaging], the College commissioned a working group to look into the use of these technologies."

To build the inaugural set of Appropriateness Criteria, a representative panel of clinical experts from the ACCF and ASNC met to assess the benefits and risks of a procedure for different indications or patient scenarios. The panel used the RAND/UCLA appropriateness method to score each indication, within a range of one to nine, to identify appropriate, inappropriate, and possibly appropriate criteria requiring more patient-specific information.

“In a landmark production, the College has identified 13 indications labeled as ‘inappropriate' [indicating that] nuclear cardiac imaging should not be performed [in these cases]," said Patel.

The criteria provide cardiovascular specialists with guidelines for the appropriate use of cardiac imaging, helping to ensure that the techniques are used equitably and efficiently across patient populations.

"For our fellow physicians, Appropriateness Criteria allow examination of one's personal practice patterns and at the same time help facilitate reimbursement," said Brindis.

Dr. Douglas agreed. "We are proud of the bold step the ACCF has taken to develop these criteria, and we will continue to provide on-the-ground guidance to clinicians and payers, including outlining future steps required to accommodate technological advances and to provide the finest cardiovascular care," she stated after the College's announcement.

The next steps, according to Patel, are "to evaluate cardiac CT and MRI. As a research fellow, this is a unique opportunity to integrate evidence-based medicine and expert opinion on cardiac imaging to shape health care policy."