ACCF/HRS/AHA/ASE/HFSA/SCAI/SCCT/SCMR 2013 Appropriate Use Criteria for Implantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Heart Rhythm Society, American Heart Association, American Society of Echocardiography, Heart Failure Society of America, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance
ACCF/HRS/AHA/ASE/HFSA/SCAI/SCCT/SCMR 2013 Appropriate Use Criteria for Implantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Heart Rhythm Society, American Heart Association, American Society of Echocardiography, Heart Failure Society of America, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance
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DOI：
10.1016/j.jacc.2012.12.017
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发表时间：
2013-03-26
影响因子：
24
通讯作者：
Barrett, Erin A.
中科院分区：
文献类型：
--
作者：
Oetgen, William J.;Allen, Joseph M.;Barrett, Erin A.
美国心脏病学会基金会与心律学会以及主要专业和亚专业学会合作，对经常考虑植入式心律转复器（ICD）和心脏起搏治疗（CRT）的常见临床情况进行了审查。本文件涵盖的临床场景涉及二级预防、一级预防、合并症、择期更换指示器时的发生器更换、双腔ICD和CRT。适应症（临床场景）源自常见应用或预期用途，以及当前临床实践指南和检查器械植入的研究结果。本文件中的369种适应症由多学科写作小组编写，并由单独的独立技术小组在1至9分的量表上进行评分，以指定适当（中位数7至9），可能适当（中位数4至6）和很少适当（中位数1至3）的护理。最终评级反映了17名技术小组成员的中位数评分：45%的适应症被评为适当，33%被评为可能适当，22%被评为很少适当。一般而言，适当的名称被分配给支持器械植入的临床试验证据和/或临床经验可用的情况。相比之下，临床试验证据有限或由于情有可原的原因器械植入似乎合理的情况被归类为可能适当。有数据显示伤害或无数据可用且医学判断认为器械治疗不明智的情况被归类为“非常不适当”。例如，包括预期寿命和认知功能在内的合并症影响了适当性评级，ICD/CRT的适当使用标准有可能提高医生决策，医疗服务和报销政策。此外，识别被评为可能适当的临床场景有助于识别将从未来研究中受益的领域。
The American College of Cardiology Foundation in collaboration with the Heart Rhythm Society and key specialty and subspecialty societies conducted a review of common clinical scenarios where implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) are frequently considered. The clinical scenarios covered in this document address secondary prevention, primary prevention, comorbidities, generator replacement at elective replacement indicator, dual-chamber ICD, and CRT.The indications (clinical scenarios) were derived from common applications or anticipated uses, as well as from current clinical practice guidelines and results of studies examining device implantation. The 369 indications in this document were developed by a multidisciplinary writing group and scored by a separate independent technical panel on a scale of 1 to 9 to designate care that is Appropriate (median 7 to 9), May Be Appropriate (median 4 to 6), and Rarely Appropriate (median 1 to 3). The final ratings reflect the median score of the 17 technical panel members: 45% of the indications were rated as Appropriate, 33% were rated May Be Appropriate and 22% were rated Rarely Appropriate.In general, Appropriate designations were assigned to scenarios for which clinical trial evidence and/or clinical experience was available that supported device implantation. By contrast, scenarios for which clinical trial evidence was limited or device implantation seemed reasonable for extenuating reasons were categorized as May Be Appropriate. Scenarios for which there were data showing harm, or no data were available, and medical judgment deemed device therapy ill-advised were categorized as Rarely Appropriate. For example, comorbidities including life expectancy and cognitive function impacted appropriateness ratings.The Appropriate Use Criteria for ICD/CRT have the potential to enhance physician decision making, healthcare delivery, and reimbursement policy. Furthermore, recognition of clinical scenarios rated as May Be Appropriate facilitates the identification of areas that would benefit from future research.