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SCAI Updates Its Appropriate Use Criteria (AUC) Calculator Apps for Stent Procedures
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screenshots of SCAI Apps
October 6, 2014 -- The Society for Cardiovascular Angiography and Interventions (SCAI) has announced an expansion and update to its Appropriate Use Criteria calculator apps, now incorporating data for diagnostic catheterization and imaging. SCAI introduced this tool two years ago to aid interventional cardiologists in their decision-making process and to help document those decisions in the patient's record.

In recent years, several high profile cases of "over-stenting" or inappropriate angioplasty hit the headlines, and much criticism was targeted towards the specialty of interventional cardiology. The reality, however, is that invasive cardiology has historically been one of the most data-oriented of the medical specialties, partly due to the original leadership of pioneers such as Andreas Gruentzig, who insisted on quantifying outcomes to prove the efficacy and safety of these procedures.

In 2012, the seven professional societies involved in the field of coronary revascularization issued a guidelines update for when and if such procedures should be used. The guidelines used the terms "Appropriate," "Uncertain," and "Inappropriate," terms that were first proposed in a RAND Corporation study in the 1980s. These terms often have been misinterpreted by the press and more recently by insurers, as detailed in a recent article on Angioplasty.Org, "Will a Denial of Service DOS Attack Hit New York State Medicaid Patients? Or Perhaps Your State?" As discussed in our article, the recommendation, made in November 2012, to change these terms to "Appropriate," "May Be Appropriate"(to replace "Uncertain"), and "Rarely Appropriate" (to replace "Inappropriate") are not currently integrated into the official guidelines and so are also not part of this app.

Given the widepsread concern about overuse of stents and related procedures, being able to document the reasoning behind decisions of whether or not to proceed with an angioplasty or stent placement is of heightened importance to both interventional cardiologists and hospital administrators. The SCAI app helps significantly with that process. Using a simple questionnaire, the appropriateness of a procedure, as written in the guidelines, is displayed in green, yellow, or red, with variations pertaining to the specific patient information further refining the ultimate decision. This data can be cut-and-pasted from the app to a paper document or transferred to the patient's Electronic Health Record. Should the physician feel it is in the patient's best interest to override the recommendations, he or she can enter that information as well. It would seem that utilizing this tool to clearly document the decision-making process would go a long way to avoiding future litigation.

The SCAU AUC tool is available for use online via a web browser, in the Google Play Store for Android users, and in the iTunes Store for iOS users. The apps are free and available to all.

The press release from SCAI follows:

SCAI Expands AUC Calculator App to Support Clinical Decision Making for Diagnostic Catheterization and Imaging for Heart Failure

October 1, 2014 -- Washington, DC -- New updates to the Society for Cardiovascular Angiography and Interventions’ (SCAI) highly regarded appropriate use criteria (AUC) calculator tool will help healthcare providers in making treatment decisions for patients who are candidates for diagnostic catheterization or imaging for heart failure. The updated tool – available online or through an iOS and Android app – is available for download today.

Since the original AUC calculator app debuted in 2012, thousands of invasive/interventional cardiologists and other healthcare providers have downloaded the tool to help them assess the appropriateness of heart revascularization procedures. Today’s reboot expands the app’s clinical decision making options.

“SCAI’s electronic applications are a key part of our ongoing efforts to improve the quality of care provided in cardiac catheterization laboratories throughout the world,” said SCAI 2014-15 President Charles Chambers, M.D., FSCAI. “With these new functions, we are providing the latest and most accurate information to assist physicians in decision making that will improve patient outcomes and reduce healthcare costs.”

SCAI provides all of its electronic applications as web-based and mobile documentation tools that enable users to review the latest AUC with iOS and Android phones, tablets and laptops, reducing the need to carry printed documents. Once members of the cardiac catheterization laboratory team input facts about a patient’s case, the app will indicate where a “typical” case with those same characteristics would fall on a spectrum of “appropriate,” “uncertain” or “inappropriate” for diagnostic catheterization or for revascularization, as defined by the latest recommendations published by leading cardiovascular societies, including -- 

Physicians can then use the information generated by the app to recommend treatments or procedures. The AUC app also allows providers to copy and paste patient clinical scenario and AUC results from the app into the patient’s electronic health record (EHR).

“SCAI’s apps don’t replace clinical judgment, but rather they provide case-specific information that informs clinical decision making,” said Kalon Ho, M.D., FSCAI, director for Quality Assurance in the Cardiovascular Division at Beth Israel Deaconess Medical Center in Boston, vice-chair of SCAI’s Quality Improvement Committee and the lead developer on SCAI’s AUC calculator tools. “The new additions to the AUC app will help general and interventional cardiologists quickly and easily update their patients’ clinical records and document the steps used to recommend tests and treatments.”

SCAI’s calculator apps are becoming essential tools in a growing number of cardiac catheterization laboratories, as evidenced by two studies presented at the SCAI 2014 Scientific Sessions in May. In the cardiac cath labs at both Baptist Health Lexington in Lexington, Ky., and Beth Israel Deaconess Medical Center in Boston, interventional cardiologists now routinely use SCAI’s AUC calculator before they proceed with angioplasty procedures. Data about each patient’s case are keyed into the calculator, which generates immediate guidance on the “appropriateness” of cases similar to the one under consideration as well as documentation that can be printed with the touch of a button.

Independent analyses conducted at both of these cath labs found that using SCAI’s coronary revascularization calculator improved the team’s AUC scores. Over a two-year period, Baptist Health more than doubled the number of cases deemed appropriate.

“Supporting our members’ quality improvement efforts has always been an important priority for SCAI,” said Dr. Chambers. “Innovative tools like the AUC calculator mean quality information is just a click away and can be accessed quickly to make the best treatment decisions.”

All of SCAI’s quality improvement tools can be accessed free via

SCAI’s library of electronic applications is part of the SCAI-Quality Improvement Toolkit (SCAI-QIT), which was developed with founding support from Daiichi Sankyo, Inc. and Eli Lilly and Company, and with support from AstraZeneca. SCAI gratefully acknowledges this support while taking sole responsibility for all content developed and disseminated through this effort.

About SCAI
The Society for Cardiovascular Angiography and Interventions is a 4,000-member professional organization representing invasive and interventional cardiologists in approximately 70 nations. SCAI's mission is to promote excellence in invasive/interventional cardiovascular medicine through physician education and representation, and advancement of quality standards to enhance patient care. SCAI's public education program, SecondsCount, offers comprehensive information about cardiovascular disease. For more information about SCAI and SecondsCount, visit or Follow @SCAI and @SCAINews on Twitter for the latest heart health news. 

Reported by Burt Cohen, October 6, 2014