ACC/HRS release appropriate use criteria for ICDs and CRT

February 28, 2013, American College of Cardiology

The American College of Cardiology and the Heart Rhythm Society, along with key specialty societies, today released appropriate use criteria for implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT). The document provides assessed levels of appropriateness for implanting the devices in 369 real-life clinical scenarios, with the goal of enhancing physician and patient decision making and improving care and health outcomes.

Implantable -defibrillators are devices that monitor the heart's rhythms and correct arrhythmias (abnormal heartbeats) by providing to the heart. By immediately responding to any abnormal rhythm, ICDs help prevent . uses an to synchronize the beating of the heart's left and right ventricles. This improves the heart's efficiency and reduces its stress. While both ICDs and CRT have expanded treatment options for , the ACC and HRS examined their use as part of an ongoing effort to critically and systematically review the diagnostic tests and procedures involved in .

The criteria focus on scenarios that were derived from physician experience, clinical practice guidelines, and results of studies examining device implantation. The scenarios identify "real life" clinical situations encountered in daily practice. These clinical presentations include patients that may not be specifically covered by clinical guidelines, which the organizations hope will provide valuable assistance for decision making by physicians and patients.

"The goal of this document is to help inform and assist clinicians and stakeholders in understanding areas of both consensus and uncertainty, while identifying areas where there are gaps in knowledge that warrant further research," noted Dr. Andrea M. Russo, writing committee co-chair and Director of Electrophysiology and Arrhythmia Services at Cooper University Hospital.

The scenarios cover six areas: ICDs for secondary prevention, ICDs for primary prevention, comorbidities, CRT devices, generator replacement, and dual- versus single-chamber ICDs.

A 10-member writing committee drafted the scenarios, while a separate technical panel rated each on a numerical scale as "Appropriate" (median 7 to 9), "May Be Appropriate" (median 4 to 6), or "Rarely Appropriate" (median 1 to 3). Of the 369 scenarios, 45% were deemed Appropriate, 33% were rated May Be Appropriate, and 22% were determined Rarely Appropriate. The writing committee stated that the appropriate use criteria can help inform the decision making process but should not be used as a substitute for careful clinical judgment and clinical practice experience nor current coverage and reimbursement policies.

"The decision to implant an ICD or CRT device is often complex, based on clinical evidence and clinical judgment, while taking into account comorbidities and other individual patient factors," said Russo. "While this document was designed to help inform clinical decision making, it does not establish 'rules' by which decisions should be made in clinical practice. Healthcare providers and other stakeholders should continue to acknowledge the pivotal role of clinical judgment in determining whether device implantation is indicated for an individual patient."

Russo added that the appropriate use criteria "can also be used to create algorithms or educational tools that help identify resource utilization or variations in care." These tools can be used at the point of care—such as hospitals or physician offices—where utilization decisions are made. Data generated from these tools or collected in registries can be used to identify the patient mix for these procedures for individual institutions. This information can then be used for benchmarking over time and for comparison to other organizations.

Explore further: Cardiologists suggest patient-centered approach to replacing implantable cardioverter-defibrillators

More information: The ACCF/HRS/AGS/AHA/ASE/HFSA/SCAI/SCCT/SCMR 2013 Appropriate Use Criteria for Implantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy is published on the websites of both the ACC and the HRS and will be published in the Mar. 26, 2013 print issue of the Journal of the American College of Cardiology.

Related Stories

Cardiologists suggest patient-centered approach to replacing implantable cardioverter-defibrillators

January 25, 2012
More than 100,000 implantable cardioverter-defibrillators (ICDs) are implanted in the United States annually, fully a quarter of those are generator replacements simply because the battery is depleted. But are all those replacements ...

HFSA updates recommendations for use of cardiac resynchronization therapy

February 27, 2012
Based on a review of the latest evidence, the Guidelines Committee of the Heart Failure Society of America now recommends that the use of cardiac resynchronization therapy (CRT) be expanded to a larger group of patients with ...

Gene variant may predict sudden cardiac death risk for blacks

May 11, 2011
(Medical Xpress) -- Researchers at Duke University Medical Center have pinpointed a common gene variant in blacks that may be associated with the development of life-threatening heart arrhythmias. The finding may help determine ...

Patients with implanted cardiac devices should learn about end-of-life options

October 5, 2011
An implanted device meant to correct heart rhythm may generate repeated painful shocks during a patient’s final hours, at a time when the natural process of dying often affects the heart’s rhythm. Yet, clinicians ...

Recommended for you

Starting periods before age of 12 linked to heightened risk of heart disease and stroke

January 15, 2018
Starting periods early—before the age of 12—is linked to a heightened risk of heart disease and stroke in later life, suggests an analysis of data from the UK Biobank study, published online in the journal Heart.

'Decorated' stem cells could offer targeted heart repair

January 10, 2018
Although cardiac stem cell therapy is a promising treatment for heart attack patients, directing the cells to the site of an injury - and getting them to stay there - remains challenging. In a new pilot study using an animal ...

Two simple tests could help to pinpoint cause of stroke

January 10, 2018
Detecting the cause of the deadliest form of stroke could be improved by a simple blood test added alongside a routine brain scan, research suggests.

Exercise is good for the heart, high blood pressure is bad—researchers find out why

January 10, 2018
When the heart is put under stress during exercise, it is considered healthy. Yet stress due to high blood pressure is bad for the heart. Why? And is this always the case? Researchers of the German Centre for Cardiovascular ...

Heart-muscle patches made with human cells improve heart attack recovery

January 10, 2018
Large, human cardiac-muscle patches created in the lab have been tested, for the first time, on large animals in a heart attack model. This clinically relevant approach showed that the patches significantly improved recovery ...

Place of residence linked to heart failure risk

January 9, 2018
Location. Location. Location.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.