The American College of Cardiology and American Heart Association (ACC/AHA) has published a series of recommendations for the treatment of patients with valvular heart disease and structural heart disease, focusing on evidence-based, practical aspects of care to ensure the best treatment. Published first performance and quality indicators. Possible consequences.

According to the ACC, five performance indicators, four of which relate to proven treatments, are considered fully appropriate for public reporting and pay-for-performance programs, while six quality indicators This information may be useful for internal reviews and quality improvement efforts. /AHA Writing Committee.

“The reason we have these metrics is to measure care, track care, and importantly, compare care across facilities,” said Hani, chair of the writing committee. Dr. Junaid (University of Texas Medical Branch, Galveston) told TCMDD.

The performance and quality measures, developed in collaboration with the Society of Cardiovascular Angiography and Interventions and the American Society of Thoracic Surgeons, are the first of their kind for valvular heart disease and structural heart disease, so ACC and AHA , the indicators are “the best, or there is room for improvement,” Jenide said. “This is a dynamic process, and we will continue to observe how these metrics behave in the real world, whether they can be measured without burdening physicians, and whether there are any unintended consequences. .”

The new document has been published online. Journal of the American College of Cardiology and Circulation: cardiovascular quality and outcomes.

Speaking to TCTMD, Jneid explained that the performance measures are derived from the 2020 ACC/AHA Valvular Heart Disease Guidelines, and all measures are supported by Class 1 recommendations. “[Performance measures] “It should have a very large impact, and the benefits should far outweigh the risks,” he said, adding that it should be easy to measure. “To be a measure of performance, it must be both executable and face-valid.”

Performance measures include:

• Use of vitamin K antagonists in patients with mechanical heart valves
• Aortic valve intervention for patients with severe symptomatic aortic stenosis
• Aortic valve surgery for patients with chronic severe aortic regurgitation
• Use of transthoracic echocardiography for asymptomatic chronic severe primary mitral regurgitation (MR)
• Mitral valve intervention for chronic severe primary MR

Jneid said quality metrics are “a little loose” in that they typically don’t have a high impact and aren’t immediately measurable, but doctors and healthcare organizations are encouraged to use them for internal reviews. .

In terms of quality metrics, the first step is to document the risks and discuss them among the cardiac team before a patient undergoes surgical aortic valve replacement or TAVI. Remaining quality measures include aortic valve replacement for patients with asymptomatic aortic stenosis with left ventricular systolic dysfunction. TAVI for elderly patients (80 years and older) with severe symptomatic aortic stenosis. The use of echocardiography after aortic valve replacement serves as a baseline for future measurements. Appropriate blood pressure control in patients with aortic valve regurgitation. Treatment of symptomatic severe rheumatic mitral stenosis.

We will observe how these metrics perform in the real world, whether they can be measured without burdening physicians, and whether there are any unintended consequences. Hani Junaid

ACC/AHA performance and quality metrics primarily focus on the management and treatment of aortic and mitral valve disease and do not consider the treatment of tricuspid or pulmonic valve disease.

“Most of the class 1 recommendations in the guidelines are actually related to the aortic and mitral valves,” Jneid says. “These left-sided valves are where we have most of the evidence and are where the prevalence of valvular heart disease is currently highest.” However, the document will be updated as new data becomes available. “This is a rapidly evolving field, and tricuspid valve disease and tricuspid valve interventions are very hot topics.” [with] Much-needed technology and innovation is coming into this space. ”

Furthermore, despite evidence from the COAPT trial demonstrating the benefits of transcatheter end-to-end repair (TEER) in this setting, there are no performance or quality metrics to address patients with secondary MR. Jneid explained that TEER makes a Class 2a recommendation in its guidelines for patients with chronic severe secondary MR associated with LV systolic dysfunction. In fact, the ACC/AHA writing committee did not include the treatment as part of the performance/quality metrics because the recommendations for secondary MR interventions do not include class 1 recommendations.

“Now, this will definitely evolve as the evidence accumulates and the guidelines evolve in parallel,” Jneid said. “These metrics may be updated [in the future]”