Utility of a real‐time appropriate use criteria decision support application for percutaneous coronary interventions in non‐acute coronary syndrome

Chen, Stuart H.; Ho, Kalon K.L.; Gannon, Stephen; Thyagarajan, Braghadheeswar; Chakrabarti, Anjan; Potter, Brian J.; Singla, Anand; Piccirillo, Bryan; Meduri, Christopher; Cutlip, Donald E.

doi:10.1002/ccd.26350

Cited by 3 publications

(2 citation statements)

References 16 publications

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“…The America 2012 AUC were used in 11 studies [ 18 , 22 , 24 , 28 , 30 , 31 , 32 , 33 , 41 , 43 , 46 ], the America 2009 AUC were used in nine studies [ 25 , 26 , 27 , 29 , 36 , 40 , 48 , 51 , 52 ], the America 2017 AUC were used in three studies [ 21 , 34 , 50 ], and the China 2016 AUC and Japan 2007 AUC were both used once [ 37 , 53 ]. Thirteen studies were performed in the US [ 18 , 25 , 26 , 27 , 28 , 30 , 31 , 32 , 40 , 46 , 48 , 50 , 51 ], three in Japan [ 33 , 34 , 37 ], two in India [ 41 , 43 ], two in Canada [ 36 , 52 ], one in China [ 53 ], one in Pakistan [ 22 ], one in Indonesia [ 21 ], one in the UK [ 29 ], and one in both Canada and the US [ 24 ]. Five studies were performed in developing countries [ 21 ...…”

Section: Resultsmentioning

confidence: 99%

Appropriateness of Percutaneous Coronary Interventions: A Systematic Review and Meta-Analysis

Liu

Chen

Chang

et al. 2023

JCDD

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Background: Since the foundation of appropriate use criteria (AUC) for coronary revascularization, the proportion of inappropriate (later revised as “rarely inappropriate”) percutaneous coronary interventions (PCIs) varied in different populations. However, the pooled inappropriate PCI rate remains unknown. Methods: We searched the PubMed, Cochrane, Embase, and Sinomed databases for studies related to AUC and PCIs. Studies that reported inappropriate/rarely appropriate PCI rates were included. A random effects model was employed in the meta-analysis because of the high statistical heterogeneity. Results: Thirty-seven studies were included in our study, of which eight studies reported the appropriateness of acute PCIs or PCIs in acute coronary syndrome (ACS) patients, 25 studies reported the appropriateness of non-acute/elective PCIs or PCIs in non-ACS/stable ischemic heart disease (SIHD) patients, and 15 studies reported both acute and non-acute PCIs or did not distinguish the urgency of PCI. The pooled inappropriate PCI rate was 4.3% (95% CI: 2.6–6.4%) in acute scenarios, 8.9% (95% CI: 6.7–11.0%) in non-acute scenarios, and 6.1% (95% CI: 4.9–7.3%) overall. The inappropriate/rarely appropriate PCI rate was significantly higher in non-acute than acute scenarios. No difference in the inappropriate PCI rate was detected based on the study location, the country’s level of development, or the presence of chronic total occlusion (CTO). Conclusions: The worldwide inappropriate PCI rate is generally identical but comparatively high, especially under non-acute scenarios.

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Section: Resultsmentioning

confidence: 99%

Appropriateness of Percutaneous Coronary Interventions: A Systematic Review and Meta-Analysis

Liu

Chen

Chang

et al. 2023

JCDD

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“…There have been prior reports of successful quality improvement initiatives for AUC scores. Utilization of the SCAI AUC application was reported by both Chen & Jackson [18,19] as an effective tool for improving AUC scores. Provider education has also been reported as effective [20].…”

Section: Journal Of Cardiology and Cardiovascular Therapy Discussionmentioning

confidence: 99%

Balloon Angioplasty of Chronic Total Occlusion of the Coronary Sinus due to Lead Maturation Process

Kamel¹

2016

JOCCT

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Introduction: Appropriate Use Criteria Scores for percutaneous intervention (AUC-PCI) are being used to evaluate appropriateness of procedures performed by hospitals and interventional cardiologists. Effective strategies for improving AUC-PCI scores are needed. Methods:We reviewed all inappropriate for one year. Multiple interventions targeting the root causes were implemented. We then evaluated the subsequent percentage change for AUC scores, prior stress imaging, non-obstructive disease and PCI volume.Results: From 2012 Quarter 2-2013 Quarter 1 (2012Q2-2013Q1) the inappropriate PCI rate was 1.7%; Following the intervention, there were 0.0% inappropriate PCI for one year. PCI volume increased by 5.35%; stress testing increased by 5.1% and the rate of non-obstructive disease increased by 1.5%. Conclusion:Our experience demonstrates that 0.0% inappropriate PCI rates are not only achievable, but can be sustained for one year. Secondarily, there was an increase in stress testing and PCI volume without a change in the rate of non-obstructive disease.

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Implementation of appropriate use criteria for cardiology tests and procedures: a systematic review and meta-analysis

Winchester

Merritt

Waheed

et al. 2020

European Heart Journal - Quality of Care and Clinical Outcomes

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Aims The American College of Cardiology appropriate use criteria (AUC) provide clinicians with evidence-informed recommendations for cardiac care. Adopting AUC into clinical workflows may present challenges, and there may be specific implementation strategies that are effective in promoting effective use of AUC. We sought to assess the effect of implementing AUC in clinical practice. Methods and results We conducted a meta-analysis of studies found through a systematic search of the MEDLINE, Web of Science, Cochrane, or CINAHL databases. Peer-reviewed manuscripts published after 2005 that reported on the implementation of AUC for a cardiovascular test or procedure were included. The main outcome was to determine if AUC implementation was associated with a reduction in inappropriate/rarely appropriate care. Of the 18 included studies, the majority used pre/post-cohort designs; few (n = 3) were randomized trials. Most studies used multiple strategies (n = 12, 66.7%). Education was the most common individual intervention strategy (n = 13, 72.2%), followed by audit and feedback (n = 8, 44.4%) and computerized physician order entry (n = 6, 33.3%). No studies reported on formal use of stakeholder engagement or ‘nudges’. In meta-analysis, AUC implementation was associated with a reduction in inappropriate/rarely appropriate care (odds ratio 0.62, 95% confidence interval 0.49–0.78). Funnel plot suggests the possibility of publication bias. Conclusion We found most published efforts to implement AUC observed reductions in inappropriate/rarely appropriate care. Studies rarely explored how or why the implementation strategy was effective. Because interventions were infrequently tested in isolation, it is difficult to make observations about their effectiveness as stand-alone strategies. Study registration PROSPERO 2018 CRD42018091602. Available from https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018091602.

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Utility of a real‐time appropriate use criteria decision support application for percutaneous coronary interventions in non‐acute coronary syndrome

Abstract: Use of a real-time AUC application together with angiographic audit may improve the accuracy of reporting PCI appropriateness. © 2015 Wiley Periodicals, Inc.

Cited by 3 publications

References 16 publications

Appropriateness of Percutaneous Coronary Interventions: A Systematic Review and Meta-Analysis

Appropriateness of Percutaneous Coronary Interventions: A Systematic Review and Meta-Analysis

Balloon Angioplasty of Chronic Total Occlusion of the Coronary Sinus due to Lead Maturation Process

Implementation of appropriate use criteria for cardiology tests and procedures: a systematic review and meta-analysis

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