ACCF/AHA/AMA-PCPI 2011 Performance Measures for Adults With Heart Failure

Abstract

. Expert peer review of AHA Scientific Statements is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit http://my.americanheart.org/statements and select the "Policies and Development" link.Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. http://www.heart.org/HEARTORG/General/Copyright-Permission-Guidelines_UCM_300404_Article.jsp. A link to the "Copyright Permissions Request Form" appears on the right side of the page.This Physician Performance Measurement Set (PPMS) and related data specifications were developed by the Physician Consortium for Performance Improvement (the Consortium), including the American College of Cardiology Foundation (ACCF), the American Heart Association (AHA), and the American Medical Association (AMA), to facilitate quality improvement activities by physicians. The performance measures contained in this PPMS are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications. While copyrighted, they can be reproduced and distributed, without modification, for noncommercial purposes-for example, use by healthcare providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the performance measures for commercial gain, or incorporation of the performance measures into a product or service that is sold, licensed, or distributed for commercial gain. Commercial uses of the PPMS require a license agreement between the user and the AMA (on behalf of the Consortium) or the ACCF or the AHA. Neither the AMA, ACCF, AHA, the Consortium, nor its members shall be responsible for any use of this PPMS. THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets.

Reasons for Guideline Nonadherence at Heart Failure Discharge

“…Although advantageous from efficiency and cost perspectives, most of the other reasons listed for incomplete decongestion represented situations in which the physical examination did not accurately reflect the patient's optimal volume status. Current guidelines also recommend the initiation or continuation and uptitration of neurohormonal doses toward target, when possible, by the time of hospital discharge for patients with HFrEF 30. In this study, we found lower rates of adherence to guidelines regarding use of β‐blockers (58%) and ACEi/ARB (53%) at discharge than have been observed in prior studies 31, 32.…”

Initiation, Continuation, or Withdrawal of Angiotensin‐Converting Enzyme Inhibitors/Angiotensin Receptor Blockers and Outcomes in Patients Hospitalized With Heart Failure With Reduced Ejection Fraction

“…This rate, however, is consistent with a prior GWTG‐HF study 20. The high rates of ACEi/ARB prescription in this study may reflect the impact of including ACEi/ARB as a performance measure9, 21 and the results of quality improvement efforts made during this time (2005‐2013). The percentage may also be high due to selection bias, and hospitals that choose to participate in GWTG may be different from those that do not.…”

“…The American College of Cardiology (ACC)/American Heart Association (AHA) clinical guidelines make it a Class I, Level A recommendation to use ACEi/ARB therapy in patients with HFrEF both to “prevent symptomatic heart failure” and to “reduce morbidity and mortality.”8 In addition, the ACC/AHA HF Performance Measures recommend ACEi/ARB for outpatients with HFrEF and ACEi/ARB therapy at the time of hospital discharge for inpatients with HFrEF 9. These clinical guidelines and quality metrics, along with their associated incentives, have led to significant improvements in the rates of ACEi/ARB use over time.…”

Decreasing Heart Failure Revisits

“…Delivery of comprehensive patient education prior to discharge is recommended in all major HF guidelines [13,14] and is a quality performance measure for hospitals [15,16]. Required topics are activity, diet, understanding medications and follow-up care, daily weight monitoring, and what to do with worsening signs or symptoms of HF.…”