Physician Requirements
Physicians performing this procedure must have a firm grasp of the
underlying principles surrounding AF, including:
e medical management and clinical course of AF
Principles of rate and rhythm control
Current tools for assessing stroke risk, such as the CHA
2
DS
2
-VASc scoring system
e indications for and management of oral anticoagulant therapy and knowledge
of the various agents available
Understanding the risks and benefits of antiarrhythmic agents used for rate and
rhythm control
Understanding the bleeding risks of oral anticoagulants and the use of bleeding risk
assessment tools such as the HAS-BLED score
Knowledge of indications, risks, and benefits of invasive surgical and catheter-based
ablation techniques
Knowledge and understanding of shared decision making
CHA
2
DS
2
-VASc Score
Centers for Medicare & Medicaid Services National Coverage Determination for
Percutaneous Left Atrial Appendage Occlusion Therapy requires a CHA
2
DS
2
-VASc
score ≥3.
a
Congestive HF
1
CHADS
2
Score Stroke Risk %
Hypertension
1 0 1.9
Age ≥75 y
2 1 1.3
Diabetes mellitus
1 2 2.2
Stroke/TIA/thromboembolic
events
2
3 3.2
4 4.0
Vascular disease
(prior MI, PAD, or aortic plaque)
1
5 6.7
6 9.8
Age 65–74 y
1 7 9.6
Sex category (i.e., female sex)
1 8 12.5
Maximum Score: 9
9 15.2
a
https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.
aspx?NCAId=281
