Top Things to Know: 2024 ACC/AHA Clinical Performance and Quality Measures for Adults With Valvular and Structural Heart Disease
Published: March 14, 2024
- The current document includes a comprehensive list of 11 measures (5 performance measures and 6 quality measures) that can be clinically used in patients with valvular heart disease.
- All 5 performance measures fulfill the attributes of performance measures (eg, high impact, targeting meaningful gaps in care, actionable, relatively low abstraction burden [in terms of cost, effort, and time], unlikely to have unintended consequences with their implementation), and are based on Class 1 clinical practice guideline recommendations.
- The 5 performance measures listed are appropriate for public reporting or pay-for-performance programs.
- The quality measures are not ready for public reporting or pay for performance but may be useful for clinicians and health care organizations for internal review and quality improvement. Quality measures may be upgraded in the future to a performance measure status after being assessed in real-world clinical practice, or can be completely retired in certain instances. For example, instances in which performance measures could be retired include very high levels of performance ("topping out") or new evidence showing marginal clinical impact or unforeseen adverse consequences, such as risk aversion.
- All measures pertain to the outpatient setting except 1 quality measure that applies predominantly to the inpatient setting.
- The measures are well defined and include definite exclusions (eg, hospice, palliative care, comfort care) and relative exceptions, which may be medical- or patient-related (eg, active bleeding, patient refusal).
- Of the performance measures, 4 are related to proven therapies (1 is a medical treatment and 3 are surgical or catheter-based interventions), and 1 pertains to a diagnostic modality.
- The 1 performance measure pertinent to medical treatment pertains to the prescription of a vitamin K antagonist (eg, warfarin) in patients with mechanical prosthetic valves, which has been proven to prevent valve thrombosis and thromboembolic events.
- Three performance measures pertain to the implementation of an appropriate valve intervention in patients with (1) severe symptomatic aortic valve stenosis, (2) chronic severe aortic regurgitation (symptomatic, or asymptomatic with left ventricular systolic dysfunction), and (3) chronic severe primary mitral regurgitation (symptomatic, or asymptomatic with left ventricular systolic dysfunction).
- A notable quality measure is the objective documentation of risk while using a procedural risk score (eg, the web-based Society of Thoracic Surgeons Risk Calculator), and documentation of a multifaceted heart valve team discussion whenever a valvular procedure or surgical intervention is being considered.
Citation
Jneid H, Chikwe J, Arnold SV, Bonow RO, Bradley SM, Chen EP, Diekemper RL, Fugar S, Johnston DR, Kumbhani DJ, Mehran R, Misra A, Patel MR, Sweis RN, Szerlip M. 2024 ACC/AHA clinical performance andquality measures for adults with valvular and structural heart disease: a report of the American HeartAssociation/American College of Cardiology Joint Committee on Performance Measures. Circ Cardiovasc Qual Outcomes. 2024;17:e000129. doi: 10.1161/HCQ.0000000000000129