Today the first Appropriate Use Criteria (AUC) for peripheral vascular ultrasound and physiological testing was released. Developed by the ACCF in collaboration with 10 other professional societies, the criteria help clinicians maximize the appropriate use of certain noninvasive vascular tests when caring for patients with suspected or known non-coronary arterial disorders.
It is estimated that more than 20 million adults in the U.S. have some form of vascular disease. Since ultrasound and other noninvasive laboratory tests can be essential tools to help clinicians evaluate vascular blockages and disease, the AUC were created in order to ensure the effective use of these diagnostic imaging tools.
The new criteria focus on indications where ultrasound and physiological testing is frequently considered. Of the 159 indications rated, 117 were rated as appropriate, 84 were rated as uncertain, and 54 were rated as inappropriate.
In particular, arterial vascular testing was found to be “appropriate” in about half of the clinical situations evaluated. For example, there was “significant consensus regarding the appropriateness of cerebrovascular duplex ultrasound for evaluation of the patient with signs or clinical symptoms of cerebrovascular disease with 7 of 8 clinical indications rated as appropriate and 1 clinical indication rated as uncertain.”
Overall, vascular studies were deemed appropriate when clinical signs and symptoms were the main reason for testing. For example, it is reasonable to order a lower extremity vascular study for a patient who reports calf pain upon walking that resolves with rest. Tests that were conducted in patients with existing atherosclerotic disease or to establish a “baseline” after a revascularization procedure were also considered appropriate based on ratings.
Of the indications rated as “uncertain,” the panel noted variations in practice and important gaps in the evidence that made it difficult to determine appropriateness. For example, there was uncertainty regarding the use of cerebrovascular duplex for assessment of the asymptomatic patient with risk factors or comorbidities associated with carotid artery stenosis, with 6 of 7 indications receiving an uncertain score. According to the writing panel, clinical and cost-effectiveness studies on non-invasive vascular testing are needed in order to gain more clarity.
Notably, one in five uses of vascular testing were determined to be “inappropriate” meaning that, although doing the test does not cause harm, the information gleaned would not further inform clinical judgment.
This new document joins the growing list of clinical guidelines that currently includes AUC for echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging, cardiac radionuclide imaging, coronary revascularization and diagnostic catheterization. The intent of AUC is to “avoid over- or underutilization, thereby promoting optimal healthcare delivery along with justifying healthcare expenditures and promoting the best outcomes for patients with minimal risk.”
Over the past month here on the ACC in Touch blog, we’ve featured a special series – “Back to the Basics” of AUC – to discuss what the AUC are, how to use them now, how the AUC can/will be used in the future, as well as the various ACC resources and tools available. Click here to read more.
Read more about the new AUC document on CardioSource here. Also be sure to check out my interview with CardioSource Video News on the new AUC document below. I invite you to leave any comments or thoughts below.