Sunday, April 8, 2012

Choose, But Choose Wisely, Part 4

OK, on to the list from the American College of Cardiology.


1.  Don’t perform stress cardiac imaging or advanced non-invasive imaging in the initial evaluation of patients without cardiac symptoms unless high-risk markers are present.


This recommendation is similar to the ACP's recommendation discussed here.


2.  Don’t perform annual stress cardiac imaging or advanced non-invasive imaging as part of routine follow-up in asymptomatic patients.
 This is a great one.  I can't tell you how many patients I see who are getting an annual stress test due to a history of coronary artery disease, even though they don't have any symptoms.  It's not necessary, not indicated, and leads to unwarranted interventions.


3.  Don’t perform stress cardiac imaging or advanced non-invasive
imaging as a pre-operative assessment in patients scheduled to undergo low-risk non-cardiac surgery. 
Another good one, and a recommendation that, I'm glad to say, in my experience is already followed.  I usually use the ACC/AHA guidelines when I do a pre-operative assessment on a patient.  If you're interested, the complete guidelines are here.


4.  Don’t perform echocardiography as routine follow-up for mild, asymptomatic native valve disease in adult patients with no change in signs or symptoms. 
So, people with mitral valve prolapse, a bit of aortic stenosis, etc- don't do an echocardiogram unless there is a change in the physical exam or symptoms develop.


5.  Don’t perform stenting of non-culprit lesions during percutaneous coronary intervention (PCI) for uncomplicated hemodynamically stable ST-segment elevation myocardial infarction (STEMI).
This one sounds fancy, but it's really quite simple.  When a patient has a heart attack and gets rushed to the cath lab, only the area that caused the heart attack should get a stent.  It might be tempting to put a stent in other areas that have some blockage, but if they didn't cause the heart attack, they should be left alone (as long as the patient is otherwise stable).




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