ACC, AHA release updated measure sets for atrial fibrillation

The American College of Cardiology (ACC) and American Heart Association (AHA) released updated clinical performance and quality measure sets on June 27 for adults with atrial fibrillation or atrial flutter.

The measures were simultaneously published online in the Journal of the American College of Cardiology and Circulation: Quality and Outcomes. The measure sets for atrial fibrillation and atrial flutter was last released in 2008. The ACC and AHA also issued implantation notes on the topic in 2011.

Paul A. Heidenrich, MD, chair of the ACC/AHA task force on performance measures, noted that the committee differentiated between quality and performance measures. The group defined quality measures as “metrics that may be useful for local quality improvement but are not yet appropriate for public reporting or pay-for-performance programs (i.e., contexts in which performance measures are used).”

The writing committee developed a set that includes 24 measures, including six performance measures (three inpatient and three outpatient) and 18 quality measures (10 inpatient and eight outpatient). The group reviewed recent guidelines and other clinical guidance documents and examined available information on gaps in care.

The researchers noted that between 2.7 million and 6.1 million adults in the U.S. have atrial fibrillation, which is the country’s most common cardiac arrhythmia. The rate is expected to double by 2050. They added that atrial fibrillation is associated with increased mortality for adults with other cardiovascular conditions or procedures such as heart failure, MI, CABG, stroke and hypertension.

From 1996 to 2001, hospitalizations with atrial fibrillation listed as the primary diagnosis increased 34 percent, according to the researchers. Meanwhile, the prevalence of atrial fibrillation increased 5 percent per year from 1993 to 2007 among Medicare patients.

Further, the writing committee mentioned the costs of caring for patients with atrial fibrillation were between $6 billion and $26 billion per year.

The writing committee mentioned that it did not include a bleeding score as a performance or clinical measure because more data was needed. The group noted that bleeding risk assessments are not included in guideline recommendations, either. 

“Future research is needed to determine whether bleeding scores can lead to actionable risk stratification of patients,” the committee wrote.

The committee also said there was insufficient evidence to support the use of an outcome measure of quality for atrial fibrillation.

“It is not clear that patient outcomes will be improved by having patients select providers on the basis of outcome metrics when measures of process of care are equivalent,” the committee wrote.

In addition, the committee cited a few areas it hopes to evaluate in the future, including shared decision making between physicians and patients on whether a rhythm or rate control strategy should be pursued, toxicity from amiodarone screening every six to 12 months, inappropriate use of anticoagulation in patients with extreme low risk of stroke, prevention of re-occurrence of atrial fibrillation or flutter by controlling blood pressure in patients with hypertension, and evaluating the integration of pharmacokinetic guides for dose adjustments for new oral anticoagulants.