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Appropriate use advice for:

M May be Appropriate May be
Appropriate R Rarely Appropriate Rarely
Appropriate A Appropriate Appropriate No AUC Advice No AUC Advice Not Applicable Not Applicable X

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CMS Coverage Advice (Medicare)

Evaluate Email Advice

Resources

Reference Documents

AUC for ICD and CRT: Russo A.M., Stainback R.F., Bailey S.R., et al. ACCF/HRS/AHA/ASE/ HFSA/SCAI/SCCT/SCMR 2013 appropriate use criteria for implantable cardioverter-defibrillators and cardiac resynchronization therapy. J Am Coll Cardiol 2013;61:1318–68.
2008 Device-Based Therapy Guideline: Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 guidelines for device based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices). J Am Coll Cardiol 2008;51:e1– 62.
Expert Consensus for ICD Patients outside of the Guideline: Kusumoto F.M., calkins H., Boehmer J. et al .HRS/ACC/AHA Expert Consensus Statement on the Use of Implantable Cardioverter-Defibrillator Therapy in Patients Who Are Not Included or Not Well Represented in Clinical Trials. J Am Coll Cardiol. 2014;64:1143-77.
CMS ICD National Coverage Decision: Centers for Medicare and Medicaid Services. Internet-Only Manual (IOMs).Medicare National Coverage Determinations Manual, (Part 1). Accessed 4/25/16

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In-App Disclaimer

By using this application and its content, you accept and agree to be bound by the following terms and conditions.

This Application was produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of publication. The results and recommendations provided by this application are not intended to, and should not, replace clinical judgment of the care provider. Further, the material is not intended to present the only, or necessarily the best, methods of procedures for the medical situation, but rather is intended to represent an approach, view, statement, or opinion. The content in this product is presented as an educational service intended for licensed healthcare professionals. Therapeutic options should be determined after discussion between the patient and their care provider.

The CMS ICD Coverage Decision included in this Application is for informational purposes only. User must contact CMS for appropriate qualifications. ACCF does not guarantee that a user might or might not expect coverage based on the responses selected in the Application.

You hereby agree to indemnify, defend, and hold ACCF, its directors, officers, shareholders, parents, subsidiaries, affiliates, agents, and licensors harmless from and against any and all liability, losses, damages, and costs, including, without limitation, reasonable attorney’s fees and costs, incurred in connection with any claim arising from your use of this application or its content.

About

When was this App last updated?

August 2016

How can I provide feedback?

Click here to fill out our feedback survey

How is this App intended to be used?

The ICD/CRT Appropriate Use Criteria App provides decision and documentation support for clinicians assessing the appropriateness of device implantation for their patients.

Record intended device and patient’s clinical indications.
Obtain procedure appropriate use rating according to ACC/HRS et al’s 2013 Appropriate Use Criteria for ICD and CRT document.
View suggested likelihood of CMS coverage for an ICD based on 2005 CMS Coverage Determination criteria.
Email yourself a record of patient inputs and the corresponding AUC and CMS advice.

This app can only provide appropriateness advice for those patient scenarios explicitly covered in ACC/HRS et al’s 2013 Appropriate Use Criteria for ICD and CRT document. Please see the full document for more information on how these scenarios were derived and rated. Regarding those scenarios for which the AUC document and this app do not currently provide an appropriateness rating, sound clinical judgement should be used. The information and recommendations in this App are meant to support clinical decision making. They are not meant to represent the only or best course of care, or replace clinical judgment. Therapeutic options should be determined after discussion between the patient and their care provider. Additionally, the CMS ICD Coverage Determination advice included in this Application is for informational purposes only. User must contact CMS for appropriate qualifications.

How was this App developed?

This app was developed as part of a continuing initiative to enable clinicians to access and implement ACC clinical policy at the point of care for better patient care and outcomes.

The content for this App is derived from the 2013 ACCF/HRS/AHA/ASE/HFSA/SCAI/SCCT/SCMR 2013 Appropriate Use Criteria for Implantable Cardioverter Defibrillators and Cardiac Resynchronization Therapy document, and the 2005 Centers for Medicare and Medicaid Services National Coverage Determination for Implantable Automatic Defibrillators, links to the full content of which can be found in the Resources section of this app. App content and design was further refined and vetted by ACC member clinicians, and through user testing with clinicians practicing in relevant specialties.

Please see the Resources section of this App for links to additional references.

For Support
Call: (202) 375-6000, ext. 5603 or (800) 253-4636
Fax: (202) 375-7000
Email: resource@acc.org

Evaluate * Answer each question in the series below to view Advice.

Select intended use

Select LVEF range

Select NYHA class

Select principal indication secondary prevention

Which of the following is associated with the CAD?

Is syncope accompanied by any of the following?

Indicate the patient's revascularization status

Select all the VT/VF indication(s) that apply

Select all the VT/VF indication(s) that apply

Select the VT/VF indications that apply

Is there evidence for any of the following reversible causes?

Select the indication that applies

Was significant CAD identified at cath performed following VF/VT?

Select the indication that best applies

Select relevant genetic disease

Indicate the cause of sustained VT/VF

Select all other cause(s) that apply

Select an indication of pharmacologically induced sustained VT/VF

Select relevant condition associated with unexplained syncope

Indicate EPS status

Indicate monomorphic VT status

Normal ECG and structurally normal heart?

Prior MI?

Was prior MI acute?

Indicate result of EPS

Select all CAD and/or EPS indication(s) that apply

Indicate EPS status

Which one of the following structural heart disease does the patient have?

Select nonischemic cardiomyopathy indication

What was the outcome of EPS?

Select all the VT indication(s) that apply

Indicate the NSVT status

Indicate an EPS status

Indicate the revascularization status

Patient revascularized for acute MI?

Is LVEF < 30% due to old infarction?

Select a cause for LVEF being < 35%

Indicate if the need for ppm post-revasc applies

Select cardiomyopathy or ppm status

On GDMT > 3 months before PCI/CABG?

Select the VT/VF status(es) that apply

Select the indication that accompanies patient's nonischemic cardiomyopathy

Select relevant etiology

Need for pacemaker and LV function not felt likely to improve?

Select relevant genetic condition

Further specify the nature of the cardiomyopathy

Select an EPS outcome

Is the patient taking beta-blockers?

Patient receiving GDMT?

On GDMT > 3 months?

Select relevant special condition/comorbidity

Does health care proxy consent to ICD?

Is patient able to understand or provide informed consent to ICD?

Further specify renal disease

Significant psychiatric illnesses that may be aggravated by device implantation or that may preclude regular follow-up?

Indicate life expectancy

Indicate patient age

Indicate the status of ventricular arrhythmias

Is patient pacemaker-dependent?

Select all additional indication(s) that apply

Patient received primary prevention ICD when LVEF was < 35%?

Indicate the choice of device replacement

Specify ventricular arrhythmias

Indicate the type of CRT replacement

Did patient receive a CRT-ICD when LVEF was < 35%?

Did patient receive a CRT-ICD when LVEF was < 35%?

Replace with CRT-ICD or CRT-pacemaker?

Select all additional indication(s) that apply

Specify all sinus node dysfunction indication(s) that apply

Select the AV conduction disease(s) that apply

Further specify sinus rhythm

Select all post-cardiac-valve-surgery symptoms that apply

Which of the following best define the acute MI or ischemic event?

Specify the tachyarrhythmias found in the patient

Select the parameter that further indicates atrial arrhythmias

Select indication(s) that apply

Indicate the type of cardiomyopathy

Indicate presence of LBBB and/or sinus rhythm

Indicate presence of LBBB or non-LBBB

Evaluate
* Answer each question in the series below to view Advice.

M May be Appropriate May be
Appropriate R Rarely Appropriate Rarely
Appropriate A Appropriate Appropriate No AUC Advice No AUC Advice Not Applicable Not Applicable X