Atrial Fibrillation or Atrial Flutter Clinical Performance and Quality Measures

Authors:
Heidenreich PA, Solis P, Estes NA III, et al.
Citation:
2016 ACC/AHA Clinical Performance and Quality Measures for Adults With Atrial Fibrillation or Atrial Flutter: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. J Am Coll Cardiol 2016;Jun 27:[Epub ahead of print].

Measure sets for performance and quality were developed by the American College of Cardiology/American Heart Association (ACC/AHA) and are intended to provide practitioners and institutions with tools to measure the quality of care provided and identify opportunities for improvement. The following are key points to remember about the 2016 ACC/AHA Clinical Performance and Quality Measures for Adults With Atrial Fibrillation or Atrial Flutter:

  1. Performance measures (inpatient) include:
    • CHA2DS2-VASc risk score documented prior to discharge.
    • Anticoagulation prescribed prior to discharge.
    • Prothrombin time (PT)/international normalized ratio (INR) planned follow-up documented prior to discharge for warfarin treatment.

  2. Performance measures (outpatient) include:
    • CHA2DS2-VASc risk score documented.
    • Anticoagulation prescribed.
    • Monthly INR for warfarin treatment.

  3. Quality measures (inpatient) include:
    • Beta-blocker prescribed prior to discharge (when left ventricular ejection fraction [LVEF] <40).
    • Angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker prescribed prior to discharge (when LVEF <40).
    • Inappropriate prescription of antiarrhythmic drugs prior to discharge to patients with permanent atrial fibrillation for rhythm control.
    • Inappropriate prescription of dofetilide or sotalol prior to discharge in patients with atrial fibrillation and end-stage kidney disease or on dialysis prior to discharge.
    • Inappropriate prescription of a direct thrombin or factor Xa inhibitor prior to discharge in patients with atrial fibrillation with a mechanical heart valve.
    • Inappropriate prescription of a direct thrombin or factor Xa inhibitor (rivaroxaban or edoxaban) prior to discharge in patients with atrial fibrillation and end-stage kidney disease or on dialysis.
    • Inappropriate prescription of antiplatelet and oral anticoagulation therapy prior to discharge for patients who do not have coronary artery disease and/or vascular disease.
    • Inappropriate prescription of nondihydropyridine calcium channel antagonist prior to discharge in patients with reduced EF heart failure.
    • Patients who underwent atrial fibrillation catheter ablation who were not treated with anticoagulation therapy during or after a procedure.
    • Shared decision making between physician and patient in anticoagulation prescription.

  4. Quality measures (outpatient) include:
    • Beta-blocker prescribed (when LVEF <40).
    • Inappropriate prescription of antiarrhythmic drugs to patients with permanent atrial fibrillation for rhythm control outpatient patient safety.
    • Inappropriate prescription of dofetilide or sotalol in patients with atrial fibrillation and end-stage kidney disease or on dialysis.
    • Inappropriate prescription of a direct thrombin or factor Xa inhibitor in patients with atrial fibrillation with mechanical heart valve.
    • Inappropriate prescription of a direct thrombin or factor Xa inhibitor (rivaroxaban or edoxaban) in patients with atrial fibrillation and end-stage kidney disease or on dialysis.
    • Inappropriate prescription of antiplatelet and oral anticoagulation therapy for patients who do not have coronary artery disease and/or vascular disease.
    • Inappropriate prescription of nondihydropyridine calcium channel antagonist in patients with reduced EF heart failure.
    • Shared decision making between physician and patient in anticoagulation prescription.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Clinical Topic Collection: Dyslipidemia, Heart Failure and Cardiomyopathies, Valvular Heart Disease, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Lipid Metabolism, Novel Agents, Acute Heart Failure

Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Atrial Flutter, Angiotensin-Converting Enzyme Inhibitors, Anti-Arrhythmia Agents, Calcium Channel Blockers, Catheter Ablation, Coronary Artery Disease, Decision Making, Factor Xa Inhibitors, Heart Failure, Heart Valve Diseases, Kidney Failure, Chronic, Platelet Aggregation Inhibitors, Risk Assessment, Renal Dialysis, Sotalol, Stroke Volume, Thrombin, Warfarin


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