2016 ACC/AHA Clinical Performance and Quality Measures for Adults With Atrial Fibrillation or Atrial Flutter

BySteven Lome, MD

Year Released: 2016

Societies: American College of Cardiology (ACC), American Heart Association (AHA)

Collaboration: Heart Rhythm Society (HRS)

Summary:

Atrial fibrillation (AF) and atrial flutter are recognized as the most common cardiac arrhythmias in the United States and are associated with increased mortality in individuals who have other cardiovascular (CV) conditions and procedures, such as heart failure (HF), myocardial infarction (MI), stroke and hypertension, according to the guidelines.

Additionally, the arrhythmias are associated with a four- to fivefold increased risk for stroke. Approximately 2.7 million to 6.1 million American adults are affected with AF, and the number of individuals with the condition is expected to double by 2050.

The current measure set revises the existing AF and atrial flutter measure set that was released in 2008 and for which implementation notes had been issued in 2011. This measure set is intended to provide tools to measure the quality of care rendered and identify opportunities for improvement in managing AF or atrial flutter.

Quality, Performance Measures

The committee developed a comprehensive AF measure that includes 24 measures, including six performance and 18 quality measures.

The joint task force identifies the differences between quality and performance measures.

Quality measures are considered metrics that may be useful for local quality improvement but are not yet appropriate for public reporting or pay-for-performance programs. New measures are initially evaluated for potential inclusion as performance measures. Occasionally, a measure is insufficiently supported by the guidelines. In other instances, when the guidelines support a measure, the committee wrote that it may decide it is necessary to have the measure tested to identify the consequences of measure implementation. Quality measures may then be promoted to the status of performance measures as supporting evidence becomes available, according to the guidelines.

Some of the suggested performance measures include:

anticoagulation prescribed before discharge;

prothrombin time (PT)/international normalized ratio (INR) planned follow-up documented before discharge for warfarin treatment; and

monthly INR for warfarin treatment.

Some of the suggested quality measures include:

beta-blocker prescribed before discharge (when left ventricular ejection fraction [LVEF] ≤ 40);

patients who underwent AF catheter ablation who were not treated with anticoagulation therapy during or after a procedure;

shared decision-making between physician and patient in anticoagulation prescription before discharge; and

inappropriate prescription of antiplatelet and oral anticoagulation therapy for patients who do not have coronary artery disease (CAD) and/or vascular disease.

Future Reassessment

The committee wrote that it is hopeful that the clinical performance and quality measure set will be reassessed as new science is developed, and as electronic health record (EHR) data standards are more broadly implemented.

Adopting Measures

The committee acknowledges that a site may not adopt all the quality measures, but the committee wrote that it wanted to ensure that the quality measures were developed based on guideline recommendations and were made available to sites that may choose to implement them to look at the quality of care rendered to patients with AF.