The American College of Cardiology will stop using the word "inappropriate" to describe cases in which people do not need coronary stent implantation, according to a Bloomberg report.
The ACC has used "inappropriate" to describe these types of cases since 2009. The cardiologist who led the term change said the ACC is updating its guidelines and terminology because "inappropriate" has become a liability in treatment disputes with insurers and regulators, according to the report.
The group will replace "inappropriate" with "rarely appropriate." There is another word swap, too. Cases in which there is medical doubt over the need for stent implantation will be described as "may be appropriate" — not the former term, "uncertain."
Questions over patients' need for cardiac stents have become a pressing issue in cardiology. A 2011 study in the Journal of the American Medical Association found up to 12 percent of elective stent cases to be "inappropriate" under the ACC's guidelines, with another 38 percent "uncertain."
Cardiologists aren't bounded by the ACC's guidelines, but insurers, civil courts and state medical boards pay close attention to them when controversies arise, according to the report. Since 2008, three interventional cardiologists have been convicted of federal fraud and sentenced to prison over unnecessary stenting. Medical licensing boards in several states have also disciplined physicians accused of needlessly implanting stents.
William Boden, MD, led the Courage Trial, which was the first large study to scrutinize stents, in 2007. He is highly skeptical of the rate in which stents are implanted into stable patients. "You can call anything 'appropriate.' They're gilding the lily to justify what's being done too frequently and shouldn't be done at all," Dr. Boden said in the Bloomberg report.
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