Symptoms of recurrent ischemia and/or high-risk findings on noninvasive testing performed after index hospitalization?

Node : 3100

AUC Definitions

Appropriate

Procedure is generally acceptable and is a reasonable approach for the indication. There may be clinical scenarios in which the use of coronary revascularization for an indication considered to be appropriate does not always represent reasonable practice, such that the benefit of the procedure does not outweigh the risks.

Inappropriate

Procedure is not generally acceptable and is not a reasonable approach for the indication. The rating of a revascularization indication as inappropriate or uncertain should not preclude a provider from performing revascularization procedures when there are patient- and condition-specific data to support that decision. Indeed, this may reflect optimal clinical care, if supported by mitigating patient characteristics.

Uncertain

Procedure may be generally acceptable and may be a reasonable approach for the indication. Uncertainty implies that more research and/or patient information is needed to classify the indication definitively. The rating of a revascularization indication as inappropriate or uncertain should not preclude a provider from performing revascularization procedures when there are patient- and condition-specific data to support that decision. Indeed, this may reflect optimal clinical care, if supported by mitigating patient characteristics. Likewise, uncertain indications require individual physician judgment and understanding of the patient to better determine the usefulness of revascularization for a particular clinical scenario. The ranking of uncertain (4 to 6) should not be viewed as excluding the use of revascularization for such patients.

Clinical Judgement

Appropriateness criteria are designed to examine the use of diagnostic and therapeutic procedures to support efficient use of medical resources during the pursuit of quality medical care. The primary objective of the appropriate use criteria (AUC) for coronary revascularization is to improve physician decision making and patient education regarding expected benefits from revascularization and to guide future research. The 2012 AUC represent a practical standard upon which to assess and better understand variability in the use of cardiovascular procedures. Appropriate use criteria are intended to assist patients and clinicians, but are not intended to diminish the acknowledged difficulty or uncertainty of clinical decision making and cannot act as substitutes for sound clinical judgment and practice experience.

What are Indications?

The term indication is used interchangeably with clinical scenario in the document for brevity and does not imply that a procedure should necessarily be performed. Some patients seen in clinical practice are not represented in these appropriate use criteria or have additional extenuating features that would alter the appropriateness of treatment as compared with the clinical scenarios presented.