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Cloudy forecast for appropriate use criteria
  1. Steven M Bradley
  1. Cardiovascular Service Line, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
  1. Correspondence to Dr Steven M Bradley, Cardiovascular Service Line, Minneapolis Heart Institute, Minneapolis, MN 55407, USA; steven.bradley{at}

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‘There is surely nothing quite so useless as doing with great efficiency what should not be done at all.’1 Appropriate use criteria are intended to help avoid the utmost of care inefficiencies: care that should not be provided at all. In an analysis of patients undergoing elective percutaneous coronary intervention (PCI), Yang et al call the validity of the appropriate use criteria for elective PCI into question.2 3 The reasons for this potential shortcoming of the appropriate use criteria need to be understood and addressed to help the appropriate use criteria achieve their intended aim of guiding patient selection for elective PCI to maximise patient benefit while minimising associated cost and clinical risk.

What are the appropriate use criteria?

Appropriate use criteria are a practical quality improvement tool that apply published trial evidence and the generalised recommendations of practice guidelines to specific clinical scenarios likely to be encountered in everyday practice.3 In these criteria, the clinical indication for a test or procedure is considered ‘appropriate’ when the expected clinical benefits, in terms of survival or health status (symptoms, functional status or quality of life), exceed the risks of the test or procedure and ‘inappropriate’ when the risks generally outweigh the benefits. These criteria were developed to help address perceived variation in the appropriateness of care that may be harmful to patients and generate unwarranted costs to the healthcare system. As the criteria are not intended to proscribe care for patients in specific settings, updated appropriate use criteria for coronary revascularisation modified the naming of the category ‘inappropriate’ to ‘rarely appropriate’.3

In the setting of coronary artery disease, not all patients will benefit from PCI. The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE)4 trial and the recent …

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  • Correction notice Since this editorial was first published online, the middle initial M has been added to the authors name.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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  • Provenance and peer review Commissioned; internally peer reviewed.

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