Every day in clinical practice, cardiovascular professionals and members of the cardiovascular care team must make treatment decisions for aspects of care where the knowledge is either lacking or equivocal or there is no clear guidance from clinical practice guidelines because of the lag time between knowledge generation and assimilation into a guideline.

The ACC is addressing this need for practical guidance, particularly in areas of emerging science where the evidence is limited and “gray areas” exist, through its Clinical Pathway efforts that include Heart House Roundtables, Expert Consensus Decision Pathway (ECDP) documents, and educational tools and decision aids.

Envisioned to be a catalyst for action, the Heart House Roundtables serve as a springboard for the development of the decision pathway documents and other solution sets for ACC members. To date, several Heart House Roundtables have been held on topics that provide high value for patients and clinicians: anticoagulation, lipid management, emerging valve management strategies, heart failure, cardiovascular risk in diabetes, and prior authorization.

"The Heart House Roundtables are a powerful way to rapidly obtain a view of the always-changing cardiovascular health care environment." — James L. Januzzi Jr., MD, FACC

“The Heart House Roundtables are a powerful way to rapidly obtain a view of the always-changing cardiovascular health care environment,” says James L. Januzzi Jr., MD, FACC, chair of the ACC Task Force on Expert Consensus Decision Pathways.

The Anticoagulation Consortium Roundtable is a model of the variety of these products. ECDPs on Periprocedural Management of Anticoagulation in Patients with Nonvalvular Atrial Fibrillation, as well as Management of Bleeding in Patients on Anticoagulants, have been published. A state-of-the art review paper on the practical management of anticoagulation in patients with atrial fibrillation was also released, along with a survey of current bridging practices. Two mobile apps have been developed – the AnticoagEvaluator and the BridgeAnticoag App – that translates the periprocedural pathway.

More recently, an ECDP on novel therapies for the diagnosis of heart failure was recently published following the Heart Failure Roundtable. The new document complements the 2017 ACC/AHA/HFSA Focused Update of the 2013 ACC/AHA Guideline for the Management of Heart Failure by addressing new medical therapies, prevention and comorbidities relevant to heart failure with reduced ejection fraction (HFrEF) for which data are available.

“These are the objectives that the everyday provider wants addressed,” said Clyde W. Yancy, MD, MACC, chair of the writing committee. “Achieving not just optimal therapy for HFrEF but an appropriate regimen for each patient given the prevailing clinical scenario is the goal.”

This document will be followed soon by an online application to help clinicians understand, apply and titrate these therapies, according to Januzzi. “Other efforts from the Heart Failure Roundtable continue to be queued up,” he said.

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Click here to learn more about Heart House Roundtables and decision pathways.

Keywords: ACC Publications, ACC Scientific Session Newspaper, ACC Annual Scientific Session

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