2 societies decline to endorse imaging guidelines for chest pain

The Society for Cardiovascular Angiography and Interventions (SCAI) and the American Society of Echocardiography (ASE) have declined to endorse new guidelines on appropriate use criteria (AUC) for emergency department (ED) patients with chest pain.

The guidelines—released by the American College of Cardiology (ACC) and American College of Radiology (ACR)—examined 20 different clinical scenarios, detailing when imaging is recommended in each instance. The 20 scenarios were separated into four categories: suspected non-ST-segment elevation acute coronary syndromes, suspected pulmonary embolism, suspected acute syndrome of the aorta, and patients for whom a leading diagnosis is problematic or not possible.

The full guidelines were published on Jan. 22 by both the Journal of the American College of Cardiology and the Journal of the American College of Radiology. On that same day, James C. Blankenship, MD, SCAI president, released a statement on the SCAI website.

“SCAI was invited to endorse this AUC document, but declined due to concerns that it would adversely impact the care of our patients,” Blankenship wrote.

Blankenship then listed several reasons for the decision, including the rating of invasive coronary angiography as “rarely appropriate” in scenarios where it is commonly used, the lack of certain scenarios, and the fact that not enough information was provided about a new “M*” designation.

In addition, Blankenship wrote, there is concern that these ratings could “prevent some patients from receiving care that is appropriate and necessary.”

Susan E. Wiegers, MD, ASE president, wrote a letter to all ASE members detailing the group’s own reasoning for not endorsing the guidelines. One of the ASE’s biggest concerns, Wiegers explained, is how much importance is being immediately given to these guidelines.

“We, like the SCAI, are also deeply concerned that this coverage denial based on AUC ratings will prevent certain patients from receiving care that is truly appropriate and necessary,” Wiegers wrote. “The AUC are now widely being used to direct care—used by payers to create patient treatment protocols, put into EMR systems to direct ordering and used as compliance measures for rating physician performance. This raises the level of scrutiny and caution needed before issuing these documents.”

SCAI and ASE co-wrote a letter to the JACC about their concerns, but Blankenship said the journal decided not to publish it. It will instead be printed in upcoming publications of both Catheterization and Cardiovascular Interventions and the Journal of the American Society of Echocardiography.