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Cardiac catheterization - an invasive diagnostic procedure thatallows doctors to see the vessels and arteries leading to the heartand its chambers - is performed thousands of times in the UnitedStates each year and, in some cases, can be the best method todiagnose heart problems. Still, the procedure is costly and maypose risks to certain patients, so determining when the benefits ofperforming the procedure outweigh the risks is essential. A newreport issued by the American College of Cardiology Foundation(ACCF) and the Society for Cardiovascular Angiography andInterventions (SCAI) in collaboration with a dozen otherprofessional societies provides detailed criteria to helpclinicians determine when cardiac catheterization is a reasonableoption for the evaluation of patients for heart disease . "Invasive coronary catheterization is a cornerstone for how wediagnose and care for people with heart disease," said ManeshPatel, MD, the John Bush Simpson Assistant Professor of Cardiologyat Duke University and co-chair of the writing group. "We want toencourage the appropriate and judicious use of all of ourtechniques and procedures. With this document, we aim to help allclinicians - not just cardiologists - determine when it would bereasonable to perform diagnostic cardiac catheterization." The panel identified 166 possible clinical scenarios when referralfor diagnostic catheterization might be considered - drawn from themedical literature and anticipated clinical applications - and thenassessed the appropriateness for each indication. Altogether, thegroup determined cardiac catheterization to be "appropriate" inabout half of the clinical situations evaluated. Nearly 30 percentof the scenarios were rated as "uncertain," where the procedure maybe considered reasonable. The authors stress an uncertain designation should not be used as grounds for denialof reimbursement. Notably, cardiac catheterization was deemed notreasonable or "inappropriate" for 25 percent of the indicationsrated. Dr. Patel adds these are cases for which the procedure isnot needed most of the time, but it is expected that a smallpercentage of the cases may be justified based on extenuatingclinical circumstances. "When the procedure and the incremental information it providesoutweighs the risk, it allows us to provide differential care thatcan help improve a patient's symptoms, health status and long-termclinical outcomes," said Dr. Patel. "In our ongoing effort toprovide efficient, quality cardiovascular care, we hope thesecriteria will support real-time clinical decisions." While the document primarily focuses on the standard use ofcatheterization to detect blockages in the arteries that areindicative of coronary artery disease , the writing group also considered its application as part of an arrhythmia work up, in pre-operative testing and to evaluate patients withpossible valve disease, pulmonary hypertension or issues with the heart muscles' squeezing capacity. Althoughexperts want to guard against overuse of cardiac catheterizationand spare patients unnecessary procedures, there is also concernabout underuse of the test, especially in patients who need moretimely diagnosis and for whom a cardiac stress test, for example,might delay a correct diagnosis and add unnecessary costs. Ingeneral, the technical panel advises that cardiac catheterizationis appropriate in patients: Without prior stress testing but who report symptoms and have ahigh pretest probability, or high likelihood of disease in thephysician's judgment With definite or suspected acute coronary syndrome With typical symptoms and intermediate- or high-risk findings onprior diagnostic testing The panel noted certain situations in which individuals should notbe referred directly to cardiac catheterization. Among others,these include diagnostic workups for: Asymptomatic patients at low risk for CAD or without significantsymptoms suggestive of heart disease As part of a preoperative work up for non-cardiac surgery inpatients with good functional or exercise capacity and/or Those undergoing low-risk surgeries (if a patient has significantrisk factors or is undergoing transplantation or heart valvesurgery, diagnostic catheterization is warranted) Dr. Patel says because there are many nuances in caring forpatients with heart disease, clinical judgment should play a rolefor individual patients and there might be other valid reasons todo a catheterization. The writing group and technical panel favorthe collaborative interaction between patients, referringclinicians and cardiologists in determining the need for theseinvasive procedures. As always, careful assessment of patients'risk and presenting symptoms, as well as results of any stress andother noninvasive tests, should factor into decisions to refer tothe cath lab. This document will be translated into order sheets and decisionsupport tools as part of both ACCF's and SCAI's ongoing commitmentto improving cardiac care. In addition, the writing group intendedthat these indications would be linked with the coronaryrevascularization AUC to increase the right patients undergoingappropriate invasive catheterization procedures before discussionsand considerations around revascularization. The appropriate use criteria were developed in collaboration withthe American Association for Thoracic Surgery, American HeartAssociation, American Society of Echocardiography, American Societyof Nuclear Cardiology, Heart Failure Society of America, HeartRhythm Society, Society of Critical Care Medicine, Society ofCardiovascular Computed Tomography and Society for CardiovascularMagnetic Resonance and the Society of Thoracic Surgeons. Additional References Citations. I am an expert from SZLRIDER.COM, while we provides the quality product, such as China Led Tube Lights T8 , China Dimmable Led Light Bulbs, Dimmable E27 Led Bulb,and more.
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