Thank you for viewing the EP Device Implant Registry Case Scenario for October of 2022, where we will discuss appropriate use criteria metrics. When reviewing the AUC metrics, it is important to remember every scenario is not addressed. The most common scenarios are mapped and classified, which are 130 of the 369 AUC indications. Additionally, when the DQR submission status is yellow, the metric summary and patient level detail report will be blank for that specific quarter. Metric 117 evaluates the proportion of initial secondary prevention ICD CRTD procedures not classified for the AUC. The numerator is the total number of initial secondary prevention ICD, SICD single or dual, and CRTD implants identified as not classifiable. The denominator is the total number of initial secondary prevention ICD and CRTD implant devices. The denominator exclusions are those patients enrolled in a pre-market clinical trial, sequence 7020, and those patients younger than 18 years of age. The numerator is the total number of all initial ICD implant devices, which have been coded as subcutaneous ICD, single-chamber ICD, and dual-chamber ICD in sequence number 7625, and have been classified as appropriate, maybe appropriate, or rarely appropriate. The total number of all ICDs classified is obtained by adding the numerators of metrics 118, 119, and 120 together. In this example, the total number of secondary prevention initial ICD implants classified is eight. Of note, when drilling down to the patient level detail report, only those patients included in the numerator will be displayed. This is different from the guideline metrics in which there is the ability to display all patients in the numerator and denominator. The denominator is the total number of initial ICD implants classified, which is the same for metrics 118, 119, and 120. In our example, the denominator is eight. The denominator exclusions are those patients enrolled in a pre-market clinical trial, sequence 7020, and those patients younger than 18 years of age. Now let's review the case scenario. A 49-year-old patient was admitted for a subcutaneous ICD implant on March 1, 2022, for secondary prevention. Her LVEF was 64%. A 30-day event recorder revealed several episodes of sustained monomorphic VT associated with lightheadedness and one episode of syncope. Her ECG has been read as sinus rhythm with no abnormalities noted. She was prescribed a beta blocker and no class 1 or class 3 antiarrhythmic drugs at discharge. Are we sure this cannot be mapped? Our question, is this patient included in the numerator of metrics 117, 118, 119, or 120? Is the answer number one, 117, proportion of secondary prevention procedures not classifiable for AUC? Number two, 118, proportion of secondary prevention procedures classified as appropriate. Number three, metric 119, proportion of secondary prevention procedures classified as maybe appropriate. Or number four, metric 120, proportion of secondary prevention procedures classified as rarely appropriate. Please take a few moments to review the documentation and question before making your final answer. And the answer is number one, metric 117, proportion of secondary prevention procedures not classifiable for AUC. As AUC 30, non-torsade to point VTVF in the setting of antiarrhythmic drug use is not able to be captured as the registry does not capture home medications. Of note, this patient would be classified in metric 26 as class 1 indication for an ICD. Please remember, patients with straightforward unstable monomorphic VT cannot be mapped as it is not addressed in the 2013 appropriate use criteria. To locate the AUC document, log in to the home page of the EP device implant registry and select resources, then documents. Scroll down to quality tools and reference documents and download the 2013 AUC for ICD and CRTD devices. Now identify which section applies to this patient. Her device was implanted for secondary prevention, which is addressed in section one on page 1329. Next, review the patient's comorbidities to identify the correct table or tables. The patient does not have CAD. However, she does have hemodynamically unstable sustained VT and her LVEF was 64%, which is addressed in table 1.5. She does not have NICM, thus she cannot be mapped to indication 15. The EP device implant registry does not capture indications 16 to 21, as these factors do not have individual data elements assigned. Looking further, the patient does not have structural heart disease or a genetic cause of the sustained VT, and her LVEF was 64%, which is addressed in table 1.7. However, she was not on any class one or three antiarrhythmic medications, and the EP device implant registry does not capture home medications. Additionally, she does not have any of the risk factors listed in indications 31 through 34, and the registry does not map to indication 35, as a patient history of WPW is not captured. Consequently, she cannot be classified. Thank you for viewing the EPDI registry case scenario for October of 2022, where we discussed appropriate use criteria.

appropriate use criteria metrics

EP Device Implant Registry

AUC metrics

Metric 117

initial secondary prevention ICD CRTD procedures