ACC, AHA release measure set for preventing sudden cardiac death

The American College of Cardiology (ACC) and American Heart Association (AHA) have released performance and quality measures for preventing sudden cardiac death in adults.

The report was published online in the Journal of the American College of Cardiology and Circulation: Cardiovascular Quality and Outcomes on Dec. 19.

The ACC and AHA developed the performance measures in collaboration with the Heart Rhythm Society.

The ACC and AHA differentiate between quality measures and performance measures. They define quality measures as “those measures that may be useful for local quality improvement but are not yet appropriate for public reporting or pay-for-performance programs,” whereas performance measures are deemed appropriate for pay-for-performance programs.

They also mentioned that sudden cardiac arrest and sudden cardiac death are different. They defined sudden cardiac arrest as the “sudden cessation of cardiac activity so that the victim becomes unresponsive, with no normal breathing and no signs of circulation” and sudden cardiac death as “a natural death due to cardiac causes, heralded by abrupt loss of consciousness.”

They said sudden cardiac death often occurs in people who do not seem to be at an increased risk for the outcome. However, they mentioned a few options for treatment, including providing beta-blockers or other medications to patients with heart failure with reduced ejection fraction.

The writing committee determined the performance measures by studying five domains and dividing the measures into four sections: preventive cardiology, resuscitation/emergency cardiovascular care, heart failure/general cardiology and electrophysiology.

“This is the first comprehensive measure set in the area of sudden cardiac death prevention,” Sana Al-Khatib, MD, FACC, co-chair of the writing committee and professor of medicine at Duke University, said in a news release. “Our vision is that these measures will be developed, tested, and implemented in clinical practice and that implementation will improve patient care and outcomes.”

The committee released the following six performance measures:

• Smoking cessation intervention in patients who suffered sudden cardiac arrest, have a life-threatening ventricular arrhythmia, or are at risk for sudden cardiac death.
• Use of implantable cardioverter defibrillators (ICDs) for prevention of sudden cardiac death in patients with heart failure and reduced ejection fraction who have an anticipated survival of more than one year.
• Use of guideline-directed medical therapy for prevention of sudden cardiac death in patients with heart failure and reduced ejection fraction.
• Use of guideline-directed medical therapy for prevention of sudden cardiac death in patients with heart attack and reduced ejection fraction.
• Documenting the absence of reversible causes of ventricular tachycardia/ventricular fibrillation cardiac arrest and/or sustained ventricular tachycardia before a secondary-prevention ICD is placed.
• Counseling eligible patients about an ICD.

The committee also released the following four quality measures:

• Screening for family history of sudden cardiac death.
• Screening for asymptomatic left ventricular dysfunction among individuals who have a strong family history of cardiomyopathy and sudden cardiac death.
• Referring for cardiopulmonary resuscitation and automated external defibrillator education those family members of patients who are hospitalized with known heart conditions that increase the risk of sudden cardiac arrest.
• Counseling first-degree relatives of survivors of sudden cardiac arrest associated with an inheritable condition about the need for screening for the inheritable condition.

“The writing committee believes this new performance mea- sure set will greatly assist clinicians in providing better care to their patients at risk of [sudden cardiac arrest], and robust application of these measures will ultimately improve quality of patient care and outcomes,” the writing committee wrote. “The writing committee also recognizes that much remains to be done to develop additional measures to prevent [sudden cardiac death] and treat [sudden cardiac arrest], develop outcome measures, and further integrate shared decision making and shared accountability principles into future versions of this measure set.”