In response to the increasing complexity of health care, combined with insufficient high-quality evidence to support high-value diagnostic and procedural medical decision making, the Rand/UCLA Appropriateness Criteria were developed in the 1980s to address the overutilization of health care provision [1]. Over time, procedural overutilization has been recognized increasingly as a significant cause of patient harm and waste [2] in the United States [3,4]. Notably, “appropriateness” of procedures (in which “the expected health benefit exceeds the expected negative consequences by a sufficiently wide margin that the procedure is worth doing, exclusive of cost”) [1] in cardiovascular disease treatment has gained widespread interest throughout the medical community and beyond. For example, inappropriate procedural treatment of peripheral artery disease (PAD) with high early intervention rates in patients with intermittent claudication (IC) after procedures that are not recommended for the treatment of IC [5] has received national attention from mainstream media outlets [6]. These procedures are costly [7,8], and are associated with higher rates of reintervention and disease progression [9] in this vulnerable patient population.

Multiple specialties, including dermatology [10], radiology [11], and orthopedic surgery [12], have widely adopted “appropriate use criteria” (AUC). The intent of AUC are to address the rational use of a study or procedure, provide practical standards to assess practice variability, and evaluate overall patterns of care [13]. AUC are applied in both a retrospective manner to determine current overuse and a prospective manner as a decision-making aid. AUC application for procedural care in cardiovascular disease processes is unique because various specialties care for these complex patients, including interventional cardiology, interventional radiology, and vascular surgery. Each discipline provides a unique perspective and skill set to patient care. This allows for a broad selection of care providers for patients, but adds nuance to developing and applying guidelines and AUC. With multiple societal objectives and motivations within each specialty, collaboration is imperative. However, many AUCs have been developed and updated over time within specialty silos. This leads to confusion and division regarding the adoption of AUC for patients with cardiovascular disease.

Our aim was to comprehensively present the existing AUC concerning therapeutic cardiovascular procedural care and compare the historical development of AUCs in each disease-specific area.