Prospective evaluation of the updated 2010 ACCF Cardiac CT Appropriate Use Criteria.
Prospective evaluation of the updated 2010 ACCF Cardiac CT Appropriate Use Criteria.
- 2012
BACKGROUND: The cardiac CT Appropriate Use Criteria (AUC) were updated in 2010 to reflect technical advances, evolving expert consensus, and rapidly expanding clinical evidence. CONCLUSION: The 2010 cardiac CT AUC update lead to more complete classification and to large shifts in the appropriateness ratings, underscoring the importance of ensuring the periodic revision of AUCs for evolving imaging technologies such that they perform optimally as quality measurement and reimbursement tools. Copyright A 2012 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved. METHODS: The 2006 and 2010 criteria were prospectively applied at the point of service to a consecutive series of patients referred for CTA at a single center (n = 1216). Patient interview and review of available health records were used to determine the CTA indication. The proportions of patients within categories of appropriate (A), uncertain (U), inappropriate (I), and not covered were described and compared between the 2006 and 2010 criteria. OBJECTIVE: We evaluated the effect of the AUC update on their clinical performance, including the completeness and distribution of appropriateness ratings and test outcomes among a consecutive series of patients referred for CT angiography (CTA). RESULTS: The 2010 criteria significantly reduced the proportion of uncertain (30.5%-11.4%), inappropriate (16.0%-12.9%), and no covered (12.1%-4.7%; P < 0.001) indications, while increasing the proportion of appropriate tests from 41.4% to 71%. By the 2010 criteria, appropriate indications were more likely to lead to the detection of coronary artery stenosis (11.5% vs 6.7%; P = 0.03) and complete examinations (95.0% vs 90.8%; P = 0.03).
English
1876-861X
*Coronary Angiography/mt [Methods]
*Coronary Artery Disease/ra [Radiography]
*Physician's Practice Patterns
*Tomography, X-Ray Computed
Adult
Aged
Chi-Square Distribution
Coronary Angiography/st [Standards]
District of Columbia
Female
Guideline Adherence
Humans
Male
Middle Aged
Patient Selection
Physician's Practice Patterns/st [Standards]
Practice Guidelines as Topic
Predictive Value of Tests
Prognosis
Prospective Studies
Referral and Consultation
Severity of Illness Index
Time Factors
Tomography, X-Ray Computed/st [Standards]
Unnecessary Procedures
MedStar Health Research Institute
MedStar Heart & Vascular Institute
Evaluation Studies
Journal Article
BACKGROUND: The cardiac CT Appropriate Use Criteria (AUC) were updated in 2010 to reflect technical advances, evolving expert consensus, and rapidly expanding clinical evidence. CONCLUSION: The 2010 cardiac CT AUC update lead to more complete classification and to large shifts in the appropriateness ratings, underscoring the importance of ensuring the periodic revision of AUCs for evolving imaging technologies such that they perform optimally as quality measurement and reimbursement tools. Copyright A 2012 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved. METHODS: The 2006 and 2010 criteria were prospectively applied at the point of service to a consecutive series of patients referred for CTA at a single center (n = 1216). Patient interview and review of available health records were used to determine the CTA indication. The proportions of patients within categories of appropriate (A), uncertain (U), inappropriate (I), and not covered were described and compared between the 2006 and 2010 criteria. OBJECTIVE: We evaluated the effect of the AUC update on their clinical performance, including the completeness and distribution of appropriateness ratings and test outcomes among a consecutive series of patients referred for CT angiography (CTA). RESULTS: The 2010 criteria significantly reduced the proportion of uncertain (30.5%-11.4%), inappropriate (16.0%-12.9%), and no covered (12.1%-4.7%; P < 0.001) indications, while increasing the proportion of appropriate tests from 41.4% to 71%. By the 2010 criteria, appropriate indications were more likely to lead to the detection of coronary artery stenosis (11.5% vs 6.7%; P = 0.03) and complete examinations (95.0% vs 90.8%; P = 0.03).
English
1876-861X
*Coronary Angiography/mt [Methods]
*Coronary Artery Disease/ra [Radiography]
*Physician's Practice Patterns
*Tomography, X-Ray Computed
Adult
Aged
Chi-Square Distribution
Coronary Angiography/st [Standards]
District of Columbia
Female
Guideline Adherence
Humans
Male
Middle Aged
Patient Selection
Physician's Practice Patterns/st [Standards]
Practice Guidelines as Topic
Predictive Value of Tests
Prognosis
Prospective Studies
Referral and Consultation
Severity of Illness Index
Time Factors
Tomography, X-Ray Computed/st [Standards]
Unnecessary Procedures
MedStar Health Research Institute
MedStar Heart & Vascular Institute
Evaluation Studies
Journal Article