The ACC has released a new list of “Five Things Physicians and Patients Should Question” in cardiology as part of the Choosing Wisely campaign, led by the ABIM Foundation. Choosing Wisely has worked with national medical societies like the ACC since 2012 to stimulate conversations between and among clinicians and patients about potentially unnecessary tests, treatments and procedures.

“The new ACC Choosing Wisely recommendations are designed to broadly represent the field of cardiology,” said Friederike K. Keating, MD, FACC, chair of ACC’s Choosing Wisely Work Group. “They include statements regarding heart failure, atrial fibrillation, near-syncope, and atherosclerosis, spanning modalities from invasive hemodynamic assessment and arrhythmia ablation to cardiac imaging.” The list, which is based on published national guidelines, includes five recommendations to:

1. Avoid the routine use of invasive hemodynamic monitoring with pulmonary artery catheters in patients with uncomplicated acute decompensated heart failure who are hemodynamically stable and responding to treatment
2. Avoid performing atrial fibrillation ablation for the sole purpose of discontinuing chronic anticoagulation
3. Avoid routine imaging stress tests or coronary CT angiography for the workup of palpitations or presyncope
4. Avoid obtaining a coronary artery calcium score in patients with known clinical atherosclerotic cardiovascular disease
5. Avoid obtaining routine serial echocardiograms for chronic heart failure if there has been no change in signs, symptoms or management

According to Keating, ACC’s Choosing Wisely Work Group sought broad input during the drafting process, including from ACC’s Board of Governors and Science and Quality Committee. The mission of Choosing Wisely, she notes, is to advance dialogue that helps patients choose care that is: supported by evidence, not duplicative of other tests or procedures already received, free from harm, and truly necessary. The new ACC list can be found here.

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