‘Appropriate use’ criteria for diagnostic catheterization may not be reliable for guiding clinical decisions
Appropriate use criteria were designed to encourage more rational consumption of health care resources. A procedure is deemed appropriate if its anticipated benefits outweigh its harms. In the field of cardiovascular disease, dramatically increasing health care costs have threatened sustainability. Diagnostic cardiac catheterization is an example of a procedure with substantial geographic variability and for which there have been questions of overuse. Researchers applied the appropriate use criteria that were established in 2012 for cardiac catheterization to a cohort of 48,336 patients without a history of coronary artery disease (CAD) to address the validity of the criteria and identify knowledge gaps. Patients were given an appropriateness score of appropriate, inappropriate, or uncertain based on data collected at the time of the index angiography.
The study found that obstructive CAD is more likely to be diagnosed when the invasive angiography is rated as appropriate. However, a substantial portion of patients with inappropriate or uncertain scores also had CAD, which shows the need for future studies to be done to evaluate the appropriateness criteria. The author of an editorial says that the study highlights some of the challenges and opportunities of applying the appropriate use criteria to large data sets.
Source: American College of Physicians