Sequence 7400, Indications for Cath Lab Visit, is capturing patient symptoms or conditions prompting the cath lab visit for which the patient presented. It is not coded on what is learned during or after the procedure. The intent is that the user will select all pertinent indications prompting this patient coming for a cath lab visit. This can be coded on physician diagnosis and or any documentation found in the medical record meeting the data definition of each selection. There are no automatic or implied indications. Each definition should be carefully reviewed to ensure it accurately represents the patient condition and answering the question of why is this patient presenting for a cath procedure. Each definition will be carefully reviewed to ensure sites accurately represent the patient condition. New onset angina in two months or less would be selected if the patient presents for the cath lab procedure with new onset which is defined as the patient never ever ever experienced angina in their lifetime of typical or atypical angina within two months of cath lab presentation. These patients must not have a history of prior MI, PCI or CABG as these are understood by the registry to identify the patient has a history of cardiac ischemia equivalent to angina. Typical angina can be diagnosed by the physician or described by the patient but must meet all three of the characteristics of angina also known as definite to include one, substernal chest discomfort with a characteristic quality and duration that is two, provoked by exertion or emotional stress and three, relieved by rest or nitroglycerin. Atypical angina can be diagnosed by the physician or described by the patient to meet two of the three characteristics of typical angina. This is also known as probable. Worsening angina would be selected if the patient presents for the cath lab procedure with a history of angina that has increased in severity or frequency within two months of cath lab presentation. These patients may have a history of prior MI, PCI or CABG as these are understood by the registry to identify the patient has a history of cardiac ischemia equivalent to angina. Typical angina can be diagnosed by the physician or described by the patient but must meet all three characteristics of angina also known as definite. They must have substernal chest discomfort with a characteristic quality and duration that is two, provoked by exertion or emotional stress and three, relieved by rest or nitroglycerin. Atypical angina can be diagnosed by the physician or described by the patient to meet two of the three characteristics of typical angina. Atypical angina is also known as probable. Stable known CAD would be selected if the patient presents for the cath procedure in stable condition, meaning without signs or symptoms of acute coronary syndrome, new onset or worsening angina or hemodynamic instability and has known coronary artery disease of 50% or worse in at least one vessel. This would be inclusive of patients with a history of interventions such as CABG or PCI or newly identified CAD meeting the definition. The patient may or may not be experiencing angina but if so then the angina must be stable without any change in frequency or pattern for six weeks prior to the cath lab presentation. Current CAD would be selected if the patient presents for the cath procedure for suspected coronary artery disease, meaning there is no prior documentation of CAD of 50% or worse in any vessel. Valvular disease would be selected if the patient's symptoms or conditions prompting the cath lab visit for which the patient presented is due to disease of at least one heart valve. This would be captured for a patient being evaluated for a transcatheter valve procedure such as transthoracic aortic valve repair or replacement or a mitral repair or replacement etc. Pericardial disease would be selected if the patient's symptoms or conditions prompting the cath lab visit for which the patient presented is due to pericardial disease, which is the inflammation of the pericardial sac. Cardiac arrhythmia would be selected if the patient's symptoms or conditions prompting the cath lab visit for which the patient presented is due to a cardiac arrhythmia, also known as a cardiac dysrhythmia or irregular heartbeat, which is a group of conditions in which the heartbeat is irregular, either too fast or too slow. Cardiomyopathy would be selected if the patient's symptoms or conditions prompting the cath lab visit for which the patient presented is due to cardiomyopathy, which is disease of the heart muscle. Types of cardiomyopathy include hypertrophic cardiomyopathy, dilated cardiomyopathy, restrictive cardiomyopathy, arrhythmogenic right ventricular dysplasia, and tachosubose cardiomyopathy. LV dysfunction would be selected if the patient's symptoms or conditions prompting the cath lab visit for which the patient presented is due to left ventricular dysfunction. In left-sided or left ventricular heart failure, the left side of the heart must work harder to pump the same amount of blood. The two types of LV dysfunction are systolic, which is a reduced ejection fraction or HFREF, and diastolic, which is a preserved ejection fraction or HFREF. Heart failure. Syncope would be selected if the patient's symptoms or conditions prompting the cath lab visit for which the patient presented is due to an abrupt, transient, complete loss of consciousness associated with inability to maintain postural tone with rapid and spontaneous recovery. It's also called fainting or passing out. Post-cardiac transplant would be selected if the patient's symptoms or conditions prompting the cath lab visit for which the patient presented is due to them receiving a cardiac transplant. Preoperative evaluation would be selected if the patient's symptoms or conditions prompting the cath lab visit for which the patient presented requires a cardiac evaluation of the coronary arteries and or LV function. It is specific to capturing those patients who present for cardiac clearance for a surgical intervention. Evaluation for exercise clearance would be selected if the patient's symptoms or conditions prompting the cath lab visit for which the patient presented requires clearance to participate in an exercise program or cardiac rehab. The breadth of cath lab indications will provide the registry the ability to capture the broad spectrum of reasons why patients present for a diagnostic or PCI procedure. If none of the available cath lab indications apply to the patient, then other is selected. In those instances, please email the registry letting us know the patient condition that could not be adequately accounted for. The frequency of missing cath lab indications will be monitored for future consideration. While it is possible to select all that apply of these cath lab indications, some definitions should not be selected together because they are mutually exclusive, meaning both definitions cannot be true for the patient. There are two instances where cath lab indications are conflicting and should not be selected together. The first involves the indications of new onset angina and worsening angina. New onset angina is only applicable to patients who have no history ever of angina. Their diagnosis of angina is new while worsening angina is selected when the patient has a history of angina and it has gotten worse in either severity or frequency within the last two months. Lastly, the indications of stable node CAD and suspected CAD should not be selected together. Stable node CAD identifies the patient has a history of coronary artery disease with disease of 50% or worse in a single vessel and suspected CAD is selected when the patient has no such prior documentation.

cath lab visit

patient symptoms

indications

new onset angina

worsening angina