New Expert Consensus Document Proposes Optimal Strategies For VHD Systems of Care

A new expert consensus system of care document proposes strategies to optimize care for patients with valvular heart disease (VHD). The document was developed by the ACC, American Association for Thoracic Surgery, American Society of Echocardiography, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons, and published April 19 in the Journal of the American College of Cardiology.

The document is intended to "initiate a discussion" about systems of care for patients with VHD in order to optimize outcomes for patients and improve the overall care of patients with VHD. It underscores best practices from the 2014 VHD guideline and 2017 focused update, and is a companion to the 2018 expert consensus systems of care document on TAVR and the 2017 ACC Expert Consensus Decision Pathway on the Management of Mitral Regurgitation.

Specifically, the document proposes common standards for two types of valve centers: a comprehensive (provides common and more specialized) and a primary (provides all common procedures) valve center. "The intent is … to set performance and quality goals for a valve center to meet benchmarks to be considered either comprehensive or primary in a manner that would be more objective then simple self-designation," the authors explain.

A proposed structure for an integrated model of care is outlined. Writing Committee Co-Chairs Rick A. Nishimura, MD, MACC, and Patrick T. O'Gara, MD, MACC, et al., explain that "access to specialized care requires establishment of well-defined referral centers, having graduated levels of expertise, and resources." In addition, "a multidisciplinary team and an emphasis on patient shared decision-making are essential. Further, transparency, public reporting, mandatory participation in national registries, ongoing analysis of processes and outcomes, and a commitment to research are also essential."

The document also covers process requirements, including function of the multidisciplinary team, registry participation, research, education and training. "Valve centers performing TAVR must demonstrate active participation in the STS/ACC TVT Registry," the authors add.

Regarding public reporting, the authors explain that "it is expected that both Comprehensive and Primary Valve Centers will report outcomes of both surgery and transcatheter valve interventions (when the latter are available)." The authors note that moving forward, "there is a great deal of detailed work ahead to realize the goals of this proposal to the satisfaction of patients and the many other stakeholders involved."

The document will also be co-published in the Catheterization and Cardiovascular Interventions, the Journal of the American Society of Echocardiography, the Journal of Thoracic and Cardiovascular Surgery, and the Annals of Thoracic Surgery.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Valvular Heart Disease, Cardiac Surgery and Arrhythmias, Cardiac Surgery and VHD, Interventions and Imaging, Interventions and Structural Heart Disease, Angiography, Echocardiography/Ultrasound, Nuclear Imaging, Mitral Regurgitation

Keywords: Mitral Valve Insufficiency, Consensus, Thoracic Surgery, Benchmarking, Transcatheter Aortic Valve Replacement, Heart Valve Diseases, Echocardiography, Registries, STS/ACC TVT Registry, Catheterization, Surgeons, Referral and Consultation, Angiography, Patient Care Team


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