ACC, AHA Release First-Ever Performance and Quality Measures For VHD and SHD

A new comprehensive set of clinical performance and quality measures released by the ACC and American Heart Association (AHA) aim to help measure, compare and ultimately improve care and outcomes in adults with valvular (VHD) and structural heart disease (SHD).

Published in JACC, the 2024 ACC/AHA Clinical Performance and Quality Measures For Adults With Valvular and Structural Heart Disease include 11 total measures (five performance measures and six quality measures), the majority of which pertain to the outpatient setting.

Of the five performance measures, three pertain to the implementation of an appropriate valve intervention in patients with severe symptomatic aortic valve stenosis; chronic severe aortic regurgitation; and chronic severe primary mitral regurgitation, while a fourth pertains to "TTE for Asymptomatic Chronic Severe Primary MR." The fifth measure addresses the prescription of a vitamin-K antagonist in patients with mechanical prosthetic valves – a treatment that has been proven to prevent valve thrombosis and thromboembolic events, according to the Writing Committee.

In all cases, the five performance measures are high impact, actionable, target meaningful gaps in care, and would require a relatively low abstraction burden in terms of cost, effort and time. The authors note that they are also "unlikely to have unintended consequences with their implementation," are based on Class I clinical guideline recommendations, and are appropriate for public reporting or pay-for-performance programs.

The six quality measures, while not ready for public reporting or pay for performance, "may be useful for clinicians and health care organizations for internal review and quality improvement," according to the authors. Of the measures, four pertain to medical, percutaneous or surgical intervention strategies, while two address patient education or monitoring. Of note, one of the measures involves documenting risk assessment and having a shared decision-making discussion with patients and a multidisciplinary heart valve team whenever a valvular procedure or surgical intervention is being considered.

According to the Writing Committee, chaired by Hani Jneid, MD, FACC, and Joanna Chikwe, MD, FACC, the new performance and quality measures are the first set to address VHD and SHD. The measures were developed in collaboration with the American Association for Thoracic Surgery and the Society for Cardiovascular Angiography and Interventions and were endorsed by the American Society of Echocardiography and the Heart Rhythm Society.

Going forward, the authors recommend that the measures be added to future clinical registries and examined for their performance in real-world clinical practice. In addition, they stress that "new care processes and diagnostic and therapeutic strategies should continue to be examined and considered, especially with the emergence of new transcatheter therapies or new indications of existing transcatheter therapies in the fields of VHD and SHD."

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Valvular Heart Disease, Interventions and Imaging, Interventions and Structural Heart Disease, Angiography, Nuclear Imaging

Keywords: Valvular Diseases, Aortic Valve Disease, Heart Valve Diseases, Structural Intervention, Coronary Angiography

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