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,

The American College of Cardiology Foundation in colla e38 boration with the Heart Rhythm Society and key specialty and subspecialty societies conducted a review of common clinical scenarios where implantable cardioverter e39 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 lCD, 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 snidies 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 implanta tion. By contrast, scenarios for which clinical trial evidence was limited or device implantation seemed reasonable for extenuating reasons were categorized as May Be Appro priate. 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 appropriate e45 ness 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.