The EP device implant registry case scenario for July of 2022 will review how metric 26 and the AUC can be used to evaluate patient care. This 47-year-old health care professional is admitted for an initial ICD implant on April 28, 2022. She has had multiple episodes of unexplained syncope that the clinician feels are due to ventricular arrhythmias. She has ischemic cardiomyopathy, secondary to an MI in 2020, as a complication of COVID-19. She has been on the guideline-directed medical therapy for more than one year. Her current LVEF is 35% with an NYHA class of 1. The abstractor codes as follows, NYHA class of 1, the most recent LV ejection fraction 35%, ICM is yes, guideline-directed medical therapy is yes, syncope is yes, prior MI is yes, and the most recent MI date is January 26 of 2020. A question for you is, will this patient be included in metric number 26? Number one, no, or number two, yes. Please take a few moments to review the documentation and the question before determining your answer. The answer is number one, no, as this patient is not included in the numerator of metric 26. Let's investigate further using our drill down and the Executive Summary Measures and Metrics Companion Guide. Looking at the Executive Summary Measures and Metric Companion Guide located under Resources, Documents, we see that class 1 recommendation number 3 requires both syncope and clinically relevant arrhythmias induced. The patient is missing clinically relevant arrhythmias induced. Let's look at it further. As we continue our review, we see that the class 1 recommendation number 4 requires an LVEF less or equal to 35% due to an MI greater than 40 days prior and an NYHA class of 2 or 3. The patient has an NYHA class of 1. Our continued search reveals that class 1 recommendation of number 6 requires an LVEF less than or equal to 30% due to an MI greater than 40 days ago and an NYHA class of 1. The patient has an LVEF of 35%. Let's see what the appropriate use criteria has to say. The abstractor codes NYHA class equals 1, the most recent LVEF is 35%, ICM equals yes, GDMT equals yes, syncope equals yes, prior MI equals yes with the most recent MI date of January 26, 2020. Our question is what AUC rating will this patient receive? Number 1, appropriate with a score of 7 to 9. Number 2, maybe appropriate with a score of 4 to 6. Number 3, rarely appropriate with a score of 1 to 3. Or number 4, the AUC does not address this type of scenario. Please take a few moments to review the documentation and question and selections before determining your answer. The answer is number 1, appropriate. Let's review the 2013 AUC document. Due to the unexplained syncope with a prior MI which is not acute and an LVEF of 35%, this patient meets indication 53 with an AUC rating of 9. In this scenario, a positive EPA study is not required. Thank you for viewing the EP device implant registry case scenario for July of 2022, which highlights metric 26 and appropriate use criteria.

EP device implant registry

ICD implant

ventricular arrhythmias

appropriate use criteria

ischemic cardiomyopathy