Journal Publications
Quality Indicators for the Care and Outcomes of Adults With Atrial Fibrillation (Arbelo et al, Europace 2021)
The Atrial Fibrillation Quality Indicators Working Group of the European Heart Rhythm Association (EHRA) has proposed quality indicators for the diagnosis and management of adults with AF. Anticoagulation was identified as one of the 6 domains of AF care, and quality indicators of anticoagulation control are presented. These proposed quality indicators of anticoagulation may help clinicians to assess adherence to practice guidelines and to monitor, compare, and improve the quality of care in patients with AF.
Atrial Fibrillation Dashboard Evaluation Using the Think Aloud Protocol (de Lusignan et al, BMJ Health Care Inform 2020)
Clinical dashboards can assist clinicians in monitoring and improving the quality of care of patients with atrial fibrillation (AF). An AF dashboard was developed as a tool for general practitioners to assess quality of care and receive feedback. The usability of the dashboard was evaluated in a primary care setting. The dashboard sections on AF management choices (eg, decisions on whether to use anticoagulant therapy and which type) and anticoagulation dosing were the most useful indicators of the quality of AF management.
European Society of Cardiology (ESC): Quality Indicators for the Care and Outcomes of Adults with Atrial Fibrillation: Task Force for the Development of Quality Indicators in Atrial Fibrillation (AF) of the European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC): Developed in Collaboration with the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and the Latin-American Heart Rhythm Society (LAHRS) (Arbelo et al, Europace 2020 and SUPPL)
The EHRA of the ESC developed quality indicators (QIs) that may be used to evaluate the quality of care and outcomes for adults with atrial fibrillation (AF). Six domains for the diagnosis and management of AF were identified: patient assessment, anticoagulation, rate control, rhythm control, risk factor management, and outcomes, including patient-reported outcome measures.
European Society of Cardiology (ESC): 2020 ESC Guidelines for the Diagnosis and Management of Atrial Fibrillation Developed in Collaboration with the European Association of Cardio-Thoracic Surgery (EACTS): The Task Force for the Diagnosis and Management of Atrial Fibrillation of the European Society of Cardiology (ESC) Developed with the Special Contribution of the European Heart Rhythm Association (EHRA) of the ESC (Hindricks et al, Eur Heart J 2020 and SUPPL)
The ESC, in collaboration with the EACTS and developed with the EHRA, updated its 2016 guidelines for the screening, diagnosis, assessment, and management of atrial fibrillation (AF) in patients with or without comorbid cardiovascular disease (CVD), including valvular heart disease (direct oral anticoagulants [DOACs] are not indicated for use in patients with mechanical heart valves). Options for rate and rhythm control are described. Strategies for minimizing bleeding risk and managing bleeding episodes (including reversal options) are included, as are recommendations for periprocedural management of anticoagulation, including in patients undergoing ablation or cardioversion. Risks and benefits of DOACs and vitamin K antagonists (VKAs) are highlighted. Sample pathways to help guide decision-making are included for various clinical scenarios. These guidelines also include quality and performance indicators that may be used to evaluate the level of implementation of the guidelines and identify opportunities for improvement.
Screening Tool to Reduce Anticoagulant Clinic Encounters (Holleman et al, Fed Pract 2020)
A quality improvement project at the Fayetteville Veterans Affairs Health Care Center implemented a screening tool to determine eligibility for switching patients from warfarin to direct oral anticoagulant (DOAC) therapy. This study reports data on the effectiveness of the screening tool in reducing the average number of per-person visits to a centralized Anticoagulation Clinic for the veterans each month.
An Atrial Fibrillation Transitions of Care Clinic Improves Atrial Fibrillation Quality Metrics (Abadie et al, JACC Clin Electrophysiol 2020 and SUPPL)
A novel care pathway that included an atrial fibrillation (AF)-specialized transition-of-care-clinic was developed at the University of North Carolina Hospital System to reduce admissions and improve the quality of care for AF. This study assessed whether the pathway led to improvement in and greater adherence to American College of Cardiology/American Heart Association (ACC/AHA) measures of clinical performance and quality compared with the standard of care for adults with AF.
Adherence to Guideline-Directed Stroke Prevention Therapy for Atrial Fibrillation Is Achievable: First Results From Get With The Guidelines-Atrial Fibrillation (GWTG-AFIB) (Piccini et al, Circulation 2019)
This article describes adherence to anticoagulation guidelines and inpatient outcome measures among hospitals in the American College of Cardiology (ACC)/American Heart Association (AHA)’s Get With The Guidelines program AFIB registry between January 1, 2013, and September 31, 2017.
Agency for Healthcare Research and Quality: Stroke Prevention in Patients With Atrial Fibrillation: A Systematic Review Update (Sanders et al, 2018)
This systematic review is a comprehensive assessment of available data on various risk stratification tools for stroke and bleeding prediction and treatment options for stroke prevention in patients with atrial fibrillation, including in specific patient subgroups (eg, renal impairment, elderly).
2016 ACC/AHA Clinical Performance and Quality Measures for Adults With Atrial Fibrillation or Atrial Flutter: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Heidenreich et al, J Am Coll Cardiol [JACC] 2016)
The American College of Cardiology (ACC) and American Heart Association (AHA) developed clinical performance and quality measures specifically focused on anticoagulation for nonvalvular atrial fibrillation (NVAF) in both the inpatient and outpatient settings. Inpatient performance measures include documentation of stroke risk assessment, initiation of anticoagulation, and planned follow-up prior to discharge. Inpatient quality measures include prescription of an appropriate oral anticoagulant in patients with NVAF and select comorbidities and shared decision making between physician and patient prior to discharge.
Quality Measures for Anticoagulation Care (Sobieraj et al, Curr Med Res Opin [CMRO] 2016 and SUPPL)
This article provides an overview of quality measures of anticoagulation care in atrial fibrillation (AF) established by various US organizations.
Abstract only; purchase required to view full text.
American Heart Association/Heart Rhythm Society (AHA/HRS): Get With The Guidelines AFIB: Novel Quality Improvement Registry for Hospitalized Patients With Atrial Fibrillation (Lewis et al, Circ Cardiovasc Qual Outcomes [CIRC CQO] 2014)
Get With The Guidelines-AFib is a hospital-based quality improvement initiative developed by the AHA and the HRS to help improve adherence to evidence-based AF treatment guidelines. Anticoagulation-specific performance measures include documentation of stroke risk assessment, initiation of anticoagulation, and planned follow-up prior to discharge. Anticoagulation-specific quality measures include patient education and prescription of oral anticoagulation prior to discharge in appropriate patients. The program offers online tools and resources to help improve processes and maximize effectiveness.