The following are key points to remember about the 2018 update to the American College of Cardiology (ACC) Appropriate Use Criteria (AUC) Methodology:

1. The ACC, along with other relevant organizations, have developed AUC for multiple procedures and testing modalities to improve the utilization of cardiovascular procedures in an efficient and contemporary fashion.
2. AUC are developed by a diverse group, usually composed of a variety of physicians and experts in clinical trial design and statistical analysis. AUC rating panels include a majority of members who do not perform the procedure primarily featured in the AUC.
3. Reviewers are selected by the AUC Task Force to provide feedback to the writing group. The same nomination process is used to select physicians for the rating panel, which rates each case scenario.
4. AUC development and evaluation is an ongoing process, with frequent updates and content creation.
5. AUC should be viewed as an evaluation of the evidence base and rational use of cardiovascular technologies in patient populations, rather than as a judgment of those ordering and delivering the use of such technologies. It is also important to note that physician judgment remains paramount, with the AUC serving an advisory function.
6. The judgments rendered in AUC documents reflect a group decision, as opposed to the opinion of an individual.
7. The primary objective is to provide an unbiased consensus for the most appropriate management of patients with complex heart disease.
8. AUC are not intended to be used for decisions regarding payment/reimbursement.
9. Using AUC in clinical practice for decision making is supported by reliable and reproducible data illustrating that AUC identify low-value care.
10. The process of AUC development and implementation continues to evolve based on professional, societal, and regulatory needs. The ACC and its AUC Task Force continue to respond to concerns and queries from the clinician and payer community so as to produce a fair, evidence-based, and practical means of guiding procedural utilization to optimize outcomes.

Keywords: Advisory Committees, Consensus, Decision Making, Diagnostic Imaging, Heart Diseases, Judgment, Methods, Outcome and Process Assessment, Health Care, Secondary Prevention

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