By AMERICAN HEART ASSOCIATION NEWS
New treatment performance and quality measures released Monday will be used to assess quality of care and identify areas for improvement for patients with atrial fibrillation.
As many as 6.1 million Americans were living with atrial fibrillation in 2010. Also known as AFib, the condition involves a quivering, irregular heartbeat that can lead to blood clots causing stroke, heart failure and other complications.
The number of Americans with AFib is expected to rise to 12.1 million by 2030.
The new performance and quality measures update the last version released in 2008, along with related implementation notes issued in 2011. They also reflect the most current AFib guidelines published in 2014, said Gregg Fonarow, M.D., member of the task force that developed the new performance measures, a University of California Los Angeles cardiologist and director of the Ahmanson-UCLA Cardiomyopathy Center.
Despite being intended for medical professionals, patients may notice changes in their care.
A “shared decision-making measure” could mean physicians will take more time to explain anti-coagulant therapy options and consider a patient’s personal goals and values, Fonarow said.
Anti-coagulants, or blood thinners, decrease the blood’s ability to clot, which can help prevent stroke-causing clots in people with atrial fibrillation.
For medical professionals, one of the most important measures includes the use of a comprehensive assessment test known as “CHA2DS2-VASc” to determine patients’ eligibility for anti-coagulation therapy, he said.
The test takes into account prior blood vessel disease, age of 65 to 74 and gender, in addition to previous considerations: congestive heart failure, high blood pressure, being 75 or older, diabetes and prior stroke.
“Using CHA2DS2-VAScis absolutely critical for identifying those patients at risk of stroke and other events,” Fonarow said.
Another measure calls for treating other heart conditions, such as reduced left ventricular ejection fraction, a measure of the heart’s ability to contract and pump blood and an indicator of heart failure.
A number of safety measures protect patients from receiving therapies that are either ineffective, or that could lead to “dire consequences,” Fonarow said. These include the inappropriate use of antiarrhythmic drugs, or prescribing certain drugs to people with kidney disease or mechanical heart valves.
Six performance measures — three inpatient and three outpatient — were backed by science used to develop AFib guidelines and are appropriate for public reporting or pay-for-performance programs, wrote Paul Heidenreich, M.D., chair of the task force that developed the new performance measures.
- Documented use of CHA2DS2-VAScrisk score in or out of the hospital.
- Prescription of anticoagulant medication in or out of the hospital.
- Planned follow-up for patients taking warfarin after leaving the hospital; and monthly follow-up outside the hospital.
The task force acknowledged that it may be difficult for some systems to implement all 13 inpatient or 11 outpatient measures.
However, the use of the AFib performance and quality measures “will improve patient care and substantially lower the risk of death or a permanently disabling stroke,” Fonarow said.
The performance and quality measures were published online in the Journal of the American College of Cardiology and Circulation: Quality and Outcomes.