Strategies to Reduce Low-Value Cardiovascular Care: A Scientific Statement From the American Heart Association

Abstract

Low-value health care services that provide little or no benefit to patients are common, potentially harmful, and costly. Nearly half of the patients in the United States will receive at least 1 low-value test or procedure annually, creating risk of avoidable complications from subsequent cascades of care and excess costs to patients and society. Reducing low-value care is of particular importance to cardiovascular health given the high prevalence and costs of cardiovascular disease in the United States. This scientific statement describes the current scope and impact of low-value cardiovascular care; reviews existing literature on patient-, clinician-, health system–, payer-, and policy-level interventions to reduce low-value care; proposes solutions to achieve meaningful and equitable reductions in low-value care; and suggests areas for future research priorities.

Leveling the playing field: The utility of coronary artery calcium scoring in cardiovascular risk stratification in South Asians

“…CAC testing is a cost-effective, actionable, and reproducible tool that can accurately detect subclinical atherosclerosis and thereby guide preventive therapies. CAC scoring in patients at intermediate risk of ASCVD in whom the decision about statin use is uncertain has been listed as a high-value care test [47] . Beyond traditionally recommended indications, CAC screening may be considered in individuals who are at a higher risk than that estimated by traditional risk stratification tools including those classified as low risk, but with a family history of premature ASCVD.…”

Reglas de aplicación clínica

“…Decision-making in the daily settings of medical practice incorporates data derived from investigations that are proven effective under some rules that are not universal and leave much room for improvement. 1 Stephen Jay Gould, an anthropologist from Harvard University, wrote many years ago that nature is not conformed by clearly defined entities but works in many different levels that interact diffusely in their borders. Now the concept is named «complexity», and in the words of the German scientist Hans-Peter Dürr, «the whole is greater than the sum of its parts and the new paradigm is complexity instead of reductionism».…”

Evolution of Value in American College of Cardiology/American Heart Association Clinical Practice Guidelines

“…1 This message was reinforced in the 2022 AHA statement to reduce low-value care in cardiovascular disease care. 2 In contrast to less quantitative definitions of value in health care, CEA provides a systematic and generalizable approach to weigh health gains against the costs required to achieve them. 3…”

“…1 This message was reinforced in the 2022 AHA statement to reduce low-value care in cardiovascular disease care. 2 In contrast to less quantitative definitions of value in health care, CEA provides a systematic and generalizable approach to weigh health gains against the costs required to achieve them. 3 It is unclear, however, whether subsequent clinical guidelines changed how they incorporated such concepts before and after the 2014 ACC/AHA policy statement.…”