March 1st, 2013

ACC and HRS Release Appropriate Use Criteria for ICDs and CRTs

The American College of Cardiology (ACC) and the Heart Rhythm Society (HRS) today published appropriate use criteria for implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT). The document offers an expert consensus on the appropriateness of  369 separate real-life clinical scenarios in six areas: ICDs for secondary prevention, ICDs for primary prevention, comorbidities, CRT devices, generator replacement, and dual- versus single-chamber ICDs.

After a writing committee drafted the scenarios, a separate technical panel gave a numerical rating from 1-9 to each of the scenarios. The scenarios were determined to be “appropriate” (median 7 to 9), “may be appropriate” (median 4 to 6), or “rarely appropriate” (median 1 to 3). The panel deemed 45% of the scenarios as appropriate, 33% as may be appropriate, and 22% as rarely appropriate. 

“The goal of this document is to help inform medical decisions 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,” explained Dr. Andrea M. Russo, writing committee co-chair, in an ACC/HRS press release.

“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,” said Russo. “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.”

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