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ACC, AHA release updated clinical performance, quality measures for adults with AF
The American College of Cardiology and the American Heart Association have released updated clinical performance and quality measures for adults with atrial fibrillation or atrial flutter.
Previous measures were set in 2008 for which implementation notes were added in 2011.
Paul A. Heidenreich
“[AF] is the most common cardiac arrhythmia in the United States,” Paul A. Heidenreich, MD, MS, FACC, FAHA, professor and vice-chair for clinical, quality and analytics in the department of medicine at Stanford University School of Medicine, and chair of the writing committee, said in a press release. “This condition impacts between 2.7 million and 6.1 million American adults, and this number is expected to double by 2050. Updating the measure set was a priority for the ACC and AHA.”
The original report only included three measures for treatment in the outpatient setting. The update revises the three measures and includes 24 total measures, including six performance measures (three inpatient and three outpatient) and 18 quality measures (10 inpatient and eight outpatient). The new measures also address patient safety, effective clinical care, communication and care coordination.
Some of the new measures include:
Quality measures
Patients with AF and kidney disease or on dialysis should not be prescribed sotalol or dofetilide in the inpatient or outpatient setting.
Patients with AF who do not have CAD or vascular disease should not be prescribed both antiplatelet and anticoagulation therapy.
There should be shared decision making between physician and patient in anticoagulation prescription before discharge.
Performance measures
CHA2DS2-VASc risk score should be documented before discharge.
Anticoagulation should be prescribed before discharge.
Monthly INR measurement should be required for warfarin treatment in outpatient setting.
“The writing committee believes that implementation of this clinical performance and quality measure set by providers, physician practices and hospital systems will help to enhance the quality of care provided to patients with [AF] in both the inpatient and outpatient settings, and thereby improve their quality of life,” Heidenreich said in the release.
The clinical performance and quality measure set laid out in this report will serve as an ACC/AHA AF measures library. The committee wrote in the document that some providers or facilities may choose to adopt some but not all of the measures.
The committee stated that, in future updates, it hopes to explore concepts like the feasibility of integration of pharmacokinetic guides for dose adjustment for novel oral anticoagulants, prevention of reoccurrence of AF or atrial flutter by controlling BP in patients with hypertension, and toxicity from amiodarone screening every 6 to 12 months. – by Tracey Romero
Disclosure: Heidenreich reports no relevant financial disclosures. Please see the full report for a list of the relevant financial disclosures of the other authors and reviewers.