June 29, 2016
The American College of Cardiology (ACC) and American Heart Association (AHA) have released a new report on clinical performance and quality measures for atrial fibrillation (AF) or atrial flutter.
AF is the most common cardiac arrhythmia in the United States, affecting between 2.7 and 6.1 million adults, and increases the mortality rate of individuals who have other cardiovascular conditions. Furthermore, AF is associated with a 4- to 5-fold increased risk for stroke.
The report, published online in the Journal of the American College of Cardiology and Circulation: Quality and Outcomes, examines past measures of AF from 2008. The 24 total measures of the report include 6 performance measures (3 inpatient measures and 3 outpatient measures) and 18 quality measures (10 inpatient measures and 8 outpatient measures). The committee intends for the report to be used to enhance the quality of care provided to patients with AF in both the inpatient and outpatient settings.
Within the measures, three were deemed appropriate for both care settings for public reporting or pay-for-performance programs: documentation of CHA2DS2-VASc risk score (a change from CHAD2DS2); prescription of anticoagulant medication; and planning follow-up to monitor warfarin (Coumadin) prior to discharge and monthly in the outpatient setting.
The report noted of the new measures: “[S]ix of the quality measures are structured in a typical format, in which the goal is to seek a higher performance score nearing 100%. However, for several of these new measures on patient harm (safety measures; 12 in total), the goal is to approach or be near 0%, and a score of 90% is not a positive score but is effectively viewed as −90%.”
Although documentation of a bleeding score may be beneficial with regard to bleeding risk assessment, more data are needed before a bleeding score can be calculated. Further, future research is needed to determine where bleeding scores can lead to actionable risk stratification of patients. Additionally, the committee felt that there is insufficient evidence to support the use of an outcome measure as a measure of quality of AF care with the current data.
Among the many measures, centers and physicians have the flexibility to choose which they plan to adopt.
American College of Cardiology, American Heart Association. 2016 ACC/AHA Clinical Performance and Quality Measures for Adults With Atrial Fibrillation or Atrial Flutter [published online ahead of print June 27, 2016]. Circ Cardiovasc Qual Outcomes. doi: 10.1161/HCQ.0000000000000018