Terms of Service

Click the Terms tab at the bottom of the app before using the ICD-CRT Appropriate Use Criteria App (“the Product”) to read the full Terms of Service and License Agreement (the “Agreement”) which governs the use of the Product. The Agreement includes, among other detailed terms and conditions, certain disclaimers of warranties by the American College of Cardiology Foundation (“ACCF”) and requires the user to agree to release ACCF from any and all liability arising in connection with your use of the Product. By using the Product, you accept and agree to be bound by all of the terms and conditions set forth in the Agreement, including such disclaimers and releases. If you do not accept the terms and conditions of the Agreement, you may not proceed to use the Product. The Agreement is subject to change from time to time, and your continued use of the Product constitutes your acceptance of and agreement to be bound by any revised terms of the Agreement.

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* Answer each question in the series below to view Advice.

 

Select intended use

Select LVEF range  

Select NYHA class  

  x

Select principal indication secondary prevention

Which of the following is associated with the CAD?

Is syncope accompanied by any of the following?

Indicate the patient's revascularization status

Select all the VT/VF indication(s) that apply

Select all the VT/VF indication(s) that apply

Select the VT/VF indications that apply

Is there evidence for any of the following reversible causes?

Select the indication that applies

Was significant CAD identified at cath performed following VF/VT?

Select the indication that best applies

Select relevant genetic disease  

Indicate the cause of sustained VT/VF

Select all other cause(s) that apply

Select an indication of pharmacologically induced sustained VT/VF

Select relevant condition associated with unexplained syncope  

Indicate EPS status

Indicate monomorphic VT status

Normal ECG and structurally normal heart?  

Prior MI?

Was prior MI acute?

Indicate result of EPS

Select all CAD and/or EPS indication(s) that apply

Indicate EPS status

Which one of the following structural heart disease does the patient have?

Select nonischemic cardiomyopathy indication

What was the outcome of EPS?

Select all the VT indication(s) that apply

Indicate the NSVT status  

Indicate an EPS status

Indicate the revascularization status

Patient revascularized for acute MI?

Is LVEF < 30% due to old infarction?

Select a cause for LVEF being < 35%

Indicate if the need for ppm post-revasc applies  

Select cardiomyopathy or ppm status  

On GDMT > 3 months before PCI/CABG?  

Select the VT/VF status(es) that apply

Select the indication that accompanies patient's nonischemic cardiomyopathy

Select relevant etiology

Need for pacemaker and LV function not felt likely to improve?

Select relevant genetic condition

Further specify the nature of the cardiomyopathy

Select an EPS outcome

Is the patient taking beta-blockers?

Patient receiving GDMT?  

On GDMT > 3 months?  

Select relevant special condition/comorbidity

Does health care proxy consent to ICD?

Is patient able to understand or provide informed consent to ICD?

Further specify renal disease

Significant psychiatric illnesses that may be aggravated by device implantation or that may preclude regular follow-up?

Indicate life expectancy

Indicate patient age

Indicate the status of ventricular arrhythmias

Is patient pacemaker-dependent?

Select all additional indication(s) that apply

Patient received primary prevention ICD when LVEF was < 35%?

Indicate the choice of device replacement

Specify ventricular arrhythmias

Indicate the type of CRT replacement

Did patient receive a CRT-ICD when LVEF was < 35%?

Did patient receive a CRT-ICD when LVEF was < 35%?

Replace with CRT-ICD or CRT-pacemaker?

Select all additional indication(s) that apply

Specify all sinus node dysfunction indication(s) that apply

Select the AV conduction disease(s) that apply

Further specify sinus rhythm

Select all post-cardiac-valve-surgery symptoms that apply

Which of the following best define the acute MI or ischemic event?

Specify the tachyarrhythmias found in the patient

Select the parameter that further indicates atrial arrhythmias

Select indication(s) that apply

Indicate the type of cardiomyopathy

Indicate presence of LBBB and/or sinus rhythm  

Indicate presence of LBBB or non-LBBB  

Select the indication(s) that apply

LBBB or non-LBBB?  

Select principal indication for dual-chamber ICD

Select principal indication for CRT

Indicate the device and prevention type at initial implant

Select an indication for primary prevention ICD

Further specify post-MI status

Indicate the patient's revascularization status

Indicate the patient's revascularization status

Evidence of post-operative valvular dysfunction?

Select other structural heart disease indication(s)  

Is CAD obstructive or nonobstructive?

Select the indication that applies

Recent PCI or CABG (< 3 months)?

How long has patient been on GDMT?  

Further specify class IV heart failure

Select relevant comorbidity

Indicate heart transplant, CRT or VAD status

Further specify conduction system abnormalities

Is CRT indicated?

Indicate the nature of the AV block

Indicate the type of bundle branch block

Select one of the following regarding atrial arrhythmias

Hypertrophic cardiomyopathy or congenital long QT syndrome?

Indicate the QRS range

Is patient on intravenous inotropic support?

Narrow or chronic wide QRS?

123. Does patient have sinus rhythm?

Is the patient active?

Does your patient meet an Appropriate or May be Appropriate AUC score for primary or secondary prevention ICD? (If unsure, use this app to determine first.)

Select principal indication secondary prevention

Select principal indication for primary prevention ICD

Further specify post-MI status

Select principal indication for CRT

Select principal indication for CRT

Select principal indication for CRT

Select principal indication for CRT

Does patient have asymptomatic NSVT?  

Was ablation attempted?

Select principal indication for primary prevention ICD

Advice

Appropriate use advice for:

M May be Appropriate May be
Appropriate
R Rarely Appropriate Rarely
Appropriate
A Appropriate Appropriate No AUC Advice No AUC Advice Not Applicable Not Applicable

CMS Coverage Advice (Medicare)

Resources

Reference Documents

  1. AUC for ICD and CRT: Russo A.M., Stainback R.F., Bailey S.R., et al. ACCF/HRS/AHA/ASE/ HFSA/SCAI/SCCT/SCMR 2013 appropriate use criteria for implantable cardioverter-defibrillators and cardiac resynchronization therapy. J Am Coll Cardiol 2013;61:1318–68.

  2. 2008 Device-Based Therapy Guideline: Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 guidelines for device based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices). J Am Coll Cardiol 2008;51:e1– 62.

  3. Expert Consensus for ICD Patients outside of the Guideline: Kusumoto F.M., calkins H., Boehmer J. et al .HRS/ACC/AHA Expert Consensus Statement on the Use of Implantable Cardioverter-Defibrillator Therapy in Patients Who Are Not Included or Not Well Represented in Clinical Trials. J Am Coll Cardiol. 2014;64:1143-77.

  4. CMS ICD National Coverage Decision: Centers for Medicare and Medicaid Services. Internet-Only Manual (IOMs).Medicare National Coverage Determinations Manual, (Part 1). Accessed 4/25/16

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In-App Disclaimer

Terms of Service and License Agreement

This Terms of Service and License Agreement constitutes a legal agreement (collectively, the "Agreement") between the American College of Cardiology Foundation ("ACCF") and You and your agents ("You") for the use of the ICD-CRT Appropriate Use Criteria App (“the Product”), whether You use the mobile application version of the Product or the web version of the Product. The Product allows You to access certain content included in the Product (“Content”).

By using the Product, You accept and agree to be bound by all of the terms and conditions set forth in this Agreement. If You do not wish to accept the terms and conditions of this Agreement, You may not proceed to use the Product.

ACCF may change the terms of this Agreement from time to time without further notice directly to You. When the terms are changed, ACCF will post a general conspicuous notice. If You do not agree with the revised terms, please discontinue use of the Product immediately. Your continued use of the Product following such notice constitutes your acceptance of and agreement to be bound by any revised terms of the Agreement. This Agreement expressly incorporates by reference and includes rules or disclaimers that may be posted and updated within the Product or communicated to You from time to time.

Term and Termination

ACCF may terminate your access and/or the Product at any time. You agree that any termination of your access to the Product shall not result in any liability or other obligation of ACCF to You, or any third party in connection with such termination.

Intellectual Property Rights

The Product, including the information, text, graphics, images, audio and video files, trademarks and other materials that may be contained therein (collectively "Content"), is owned by ACCF and/or its suppliers and is protected by patents, copyrights, trademarks, and other proprietary rights. Except as specifically provided in this Agreement, your use of the Product shall be governed and constrained by applicable patent, copyright, trademark and other intellectual property laws. ACCF grants You a limited, nonexclusive, nontransferable, revocable license to utilize and access the Product for your noncommercial, personal use according to the terms and conditions in this Agreement. You may not modify, publish, transmit, participate in the transfer or sale of, reproduce, create derivative works from, distribute, perform, display, incorporate into another website, or in any other way exploit the Service and/or any of the Content, in whole or in part. Except as expressly granted by this Agreement, You acquire no right, title or interest in the Product or the Content or other data or materials incorporated in the Product. ACCF, ACC or affiliates or licensors thereof shall retain all right, title and interest in the Product and Content.

Limitation of Liability

TO THE FULLEST EXTENT ALLOWED BY APPLICABLE LAW, ACCF HEREBY DISCLAIMS, AND IN NO EVENT SHALL ACCF OR ANY PARTY INVOLVED IN CREATING OR PRODUCING THE PRODUCT BE LIABLE FOR, ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL, OR EXEMPLARY DAMAGES, INCLUDING WITHOUT LIMITATION, DAMAGES FOR LOSS OF PROFITS, GOODWILL, USE, DATA LOSS, OR OTHER LOSSES, WHETHER IN AN ACTION OF CONTRACT, NEGLIGENCE OR OTHER TORTIOUS ACTION, EVEN IF ACCF HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES, RESULTING FROM: (i) THE USE OR INABILITY TO USE THE PRODUCT, (ii) THE COST OF ANY SUBSTITUTE PRODUCTS AND/OR SERVICES RESULTING FROM ANY PRODUCTS, DATA, INFORMATION OR SERVICES OBTAINED OR WHICH YOU WERE UNABLE TO OBTAIN OR TRANSACTIONS EFFECTED OR FAILED TO BE EFFECTED, (iii) THE USE OR INABILITY TO USE ANY THIRD PARTY APPLICATIONS CONTAINED WITHIN THE PRODUCT, OR (iv) ANY MATTER OTHERWISE RELATED TO YOUR USE OF THE PRODUCT.

Release of Liability

You assume all risks associated with use of the Product including, but not limited to any harm, injury or damages resulting directly or indirectly from the use of the Product, all such risks being known and understood by You. In consideration of your use of the Product, You, for yourself and anyone entitled to act on your behalf, waive and forever release ACCF, its officers, trustees, employees, representatives and successors from all claims and liabilities of any kind arising out of your use or misuse of the Product.

Indemnification

You hereby agree to indemnify, save and hold ACCF, its directors, officers, shareholders, parents, subsidiaries, affiliates, agents and licensors harmless from and against any and all claims, liability, losses, damages and costs, including, without limitation, reasonable attorneys' fees and costs, arising out of your use or misuse of the Product or Content, or any violation of this Agreement. ACCF assumes the right, at your expense, to assume the exclusive defense and control of any matter for which you are required to indemnify ACCF, and you agree to cooperate with ACCF’s defense of these claims. ACCF will use reasonable efforts to notify you of any such claim, action, or proceeding upon becoming aware of it.

Disclaimer of Warranties

THE PRODUCT AND CONTENT ARE PROVIDED ON AN "AS IS" AND "AS AVAILABLE" BASIS. ACCF AND ITS SUPPLIERS EXPRESSLY DISCLAIM ALL WARRANTIES OF ANY KIND WITH RESPECT TO THE PRODUCT OR CONTENT, WHETHER EXPRESS OR IMPLIED, INCLUDING IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, TITLE AND NON-INFRINGEMENT. ACCF MAKES NO WARRANTY THAT THE PRODUCT AND/OR ANY CONTENT THEREIN WILL MEET YOUR REQUIREMENTS, OR WILL BE UNINTERRUPTED, TIMELY, SECURE, CURRENT, ACCURATE, COMPLETE OR ERROR-FREE OR THE RESULTS THAT MAY BE OBTAINED BY USE OF THE PRODUCT OR ANY CONTENT THEREIN WILL BE ACCURATE OR RELIABLE. YOU UNDERSTAND AND ACKNOWLEDGE THAT YOUR SOLE AND EXCLUSIVE REMEDY WITH RESPECT TO ANY DEFECT IN OR DISSATISFACTION WITH THE PRODUCT IS TO CEASE ITS USE.

The Content on the Product is presented as an educational service intended for licensed healthcare professionals. While the Content in the Product is about specific medical and healthcare issues, the Content is not a substitute for or replacement of personalized medical advice and is not intended to be used as the sole basis for making individualized medical or health-related decisions.

The views and opinions expressed are those of the contributing authors and editors and do not necessarily represent the views of the ACCF. The material is not intended to present the only, or necessarily best, methods or procedures for the medical situations addressed, but rather is intended to represent an approach, view, statement or opinion.

Any reference to a specific therapy or commercial product in this Product does not constitute a guarantee or endorsement by ACCF of the quality or value of such therapy or product or any claims made by the manufacturer of such therapy or commercial product.

In addition, any statements about such therapy or commercial products are solely based on published clinical prediction rules and estimates of drug treatment effects from published clinical studies and do not represent an ACCF endorsement or evaluation of these products.

Force Majeure

ACCF will be excused from performance under this Agreement and will not be liable or considered in default under this Agreement in the event that the Product is unavailable for any period of time, or if ACCF is otherwise unable to perform its obligations hereunder, in whole or in part, as a result of a Force Majeure Event. For purposes of this Section, "Force Majeure Event" means an event or series of events caused by or resulting from any of the following: (1) weather conditions or other elements of nature or acts of God; (2) government regulation; (3) quarantines or embargoes; (4) telecommunications, network, computer, server or Internet downtime; (5) unauthorized access to ACCF's information technology systems by third parties; or (6) any other causes beyond the reasonable control of ACCF.

No Assignment

This Agreement is personal to You, and You may not assign your rights or obligations to anyone.

No Waiver

Neither failure nor delay on the part of any party to exercise any right, remedy, power or privilege hereunder nor course of dealing between the parties shall operate as a waiver thereof, or of the exercise of any other right, remedy, power or privilege. No term of this Agreement shall be deemed waived, and no breach consented to, unless such waiver or consent shall be in writing and signed by the party claimed to have waived or consented. No waiver of any rights or consent to any breaches shall constitute a waiver of any other rights or consent to any other breach.

Severability

If any provision in this Agreement is held invalid or unenforceable under applicable law, the remaining provisions shall continue in full force and effect.

Governing Law

This Agreement will be governed by and construed exclusively in accordance with the laws of the District of Columbia, USA, without regard to its conflicts of law principles and, to the extent applicable, the federal laws of the United States. If a dispute arises between ACCF and You, You hereby agree to submit such dispute to non-binding mediation, followed by binding arbitration, if necessary. Both the mediation and arbitration will be conducted by JAMS applying the laws of the District of Columbia without regard to its conflicts of laws principles and in the District of Columbia as venue.

Certification

I hereby certify that I understand and agree to the terms stated in this Agreement and that this Agreement applies to my initial use of the Product and all other subsequent uses of the Product. BY USING THIS PRODUCT, I HEREBY AFFIRM THAT I HAVE READ, FULLY UNDERSTAND, AND AGREE TO THE ABOVE STATEMENTS.

About

When was this App last updated?

December 2023

How can I provide feedback?

How is this App intended to be used?

The ICD/CRT Appropriate Use Criteria App provides decision and documentation support for clinicians assessing the appropriateness of device implantation for their patients.

  • Record intended device and patient’s clinical indications.
  • Obtain procedure appropriate use rating according to ACC/HRS et al’s 2013 Appropriate Use Criteria for ICD and CRT document.
  • View suggested likelihood of CMS coverage for an ICD based on 2005 CMS Coverage Determination criteria.
  • Email yourself a record of patient inputs and the corresponding AUC and CMS advice.

This app can only provide appropriateness advice for those patient scenarios explicitly covered in ACC/HRS et al’s 2013 Appropriate Use Criteria for ICD and CRT document. Please see the full document for more information on how these scenarios were derived and rated. Regarding those scenarios for which the AUC document and this app do not currently provide an appropriateness rating, sound clinical judgement should be used. The information and recommendations in this App are meant to support clinical decision making. They are not meant to represent the only or best course of care, or replace clinical judgment. Therapeutic options should be determined after discussion between the patient and their care provider. Additionally, the CMS ICD Coverage Determination advice included in this Application is for informational purposes only. User must contact CMS for appropriate qualifications.

How was this App developed?

This app was developed as part of a continuing initiative to enable clinicians to access and implement ACC clinical policy at the point of care for better patient care and outcomes.

The content for this App is derived from the 2013 ACCF/HRS/AHA/ASE/HFSA/SCAI/SCCT/SCMR 2013 Appropriate Use Criteria for Implantable Cardioverter Defibrillators and Cardiac Resynchronization Therapy document, and the 2005 Centers for Medicare and Medicaid Services National Coverage Determination for Implantable Automatic Defibrillators, links to the full content of which can be found in the Resources section of this app. App content and design was further refined and vetted by ACC member clinicians, and through user testing with clinicians practicing in relevant specialties.

Please see the Resources section of this App for links to additional references.

For Support
Call: (202) 375-6000, ext. 5603 or (800) 253-4636
Fax: (202) 375-7000
Email: resource@acc.org