Table of Contents Preamble2647 Introduction2649 Methodology and Evidence Review2649 Organization of the GWC2649 Document Review and Approval2649 Scope of the CPG2650 Overview of ACS2650 Initial ...Evaluation and Management: Recommendations2650 Clinical Assessment and Initial Evaluation2650 Emergency Department or Outpatient Facility Presentation2650 Prognosis--Early Risk Stratification2650 Cardiac Biomarkers and the Universal Definition of Myocardial Infarction2654 Biomarkers: Diagnosis2654 Biomarkers: Prognosis2654 Discharge From the ED or Chest Pain Unit2655 Early Hospital Care: Recommendations2655 Standard Medical Therapies2655 Oxygen2655 Nitrates2655 Analgesic Therapy2655 Beta-Adrenergic Blockers2656 Calcium Channel Blockers2657 Cholesterol Management2657 Inhibitors of the Renin-Angiotensin-Aldosterone System2657 Initial Antiplatelet/Anticoagulant Therapy in Patients With Definite or Likely NSTE-ACS2657 Initial Oral and Intravenous Antiplatelet Therapy in Patients With Definite or Likely NSTE-ACS Treated With an Initial Invasive or Ischemia-Guided Strategy2657 Initial Parenteral Anticoagulant Therapy in Patients With Definite NSTE-ACS2659 Ischemia-Guided Strategy Versus Early Invasive Strategies2659 Early Invasive and Ischemia-Guided Strategies2659 Risk Stratification Before Discharge for Patients With an Ischemia-Guided Strategy of NSTE-ACS2661 Myocardial Revascularization: Recommendations2661 PCI--General Considerations2661 PCI--Oral and Intravenous Antiplatelet Agents2661 PCI--GP IIb/IIIa Inhibitors2662 Anticoagulant Therapy in Patients Undergoing PCI2663 Timing of Urgent Coronary Artery Bypass Graft in Patients With NSTE-ACS in Relation to Use of Antiplatelet Agents2663 Late Hospital Care, Hospital Discharge, and Posthospital Discharge Care: Recommendations2663 Medical Regimen and Use of Medications at Discharge2663 Late Hospital and Posthospital Oral Antiplatelet Therapy2664 Combined Oral Anticoagulant Therapy and Antiplatelet Therapy in Patients With NSTE-ACS2664 Risk Reduction Strategies for Secondary Prevention2664 Plan of Care for Patients With NSTE-ACS2665 Special Patient Groups: Recommendations2665 NSTE-ACS in Older Patients2665 Heart Failure and Cardiogenic Shock2665 Diabetes Mellitus2667 Post-CABG2668 Perioperative NSTE-ACS Related to Noncardiac Surgery2668 Chronic Kidney Disease2668 Women2668 Anemia, Bleeding, and Transfusion2668 Cocaine and Methamphetamine Users2668 Vasospastic (Prinzmetal) Angina2668 ACS With Angiographically Normal Coronary Arteries2669 Stress (Takotsubo) Cardiomyopathy2669 Quality of Care and Outcomes for ACS--Use of Performance Measures and Registries: Recommendation2669 Summary and Evidence Gaps2669 References2670 Appendix 1 Author Relationships With Industry and Other Entities (Relevant)2680 Appendix 2 Reviewer Relationships With Industry and Other Entities (Relevant)2683 Preamble The American College of Cardiology (ACC) and the American Heart Association (AHA) are committed to the prevention and management of cardiovascular diseases through professional education and research for clinicians, providers, and patients. Since 1980, the ACC and AHA have shared a responsibility to translate scientific evidence into clinical practice guidelines (CPGs) with recommendations to standardize and improve cardiovascular health.
An organized and directed approach to a thorough review of evidence has resulted in the production of clinical practice guidelines that assist clinicians in selecting the best management strategy for ...an individual patient. ...clinical practice guidelines can provide a foundation for other applications, such as performance measures, appropriate use criteria, and both quality improvement and clinical decision support tools. A person is deemed to have a significant interest in a business if the interest represents ownership of >=5% of the voting stock or share of the business entity, or ownership of >=$10,000 of the fair market value of the business entity; or if funds received by the person from the business entity exceed 5% of the person's gross income for the previous year. Names are listed in alphabetical order within each category of review.According to the ACCF/AHA, a person has a relevant relationship IF: a) The relationship or interest relates to the same or similar subject matter, intellectual property or asset, topic, or issue addressed in the document; or b) The company/entity (with whom the relationship exists) makes a drug, drug class, or device addressed in the document, or makes a competing drug or device addressed in the document; or c) The person or a member of the person's household, has a reasonable potential for financial, professional or other personal gain or loss as a result of the issues/content addressed in the document.AAFP indicates American Academy of Family Physicians; ACCF, American College of Cardiology Foundation; ACCP, American College of Chest Physicians AHA, American Heart Association; DSMB, data safety monitoring board; EP, electrophysiology; HRS, Heart Rhythm Society; ISHLT, International Society for Heart and Lung Transplantation; UCLA, University of California, Los Angeles; and VA, Veterans Affairs.
...of its activities, the committee has reduced the documentation burden on clinicians and hospitals in the hope that this will thereby allow them to focus on more critical areas of quality ...measurement and improvement. ...the performance measures were extended to assess functional outcomes. Valid, reliable, disease-specific patient-reported questionnaires include the Kansas City Cardiomyopathy Questionnaire (KCCQ); Minnesota Living with Heart Failure Questionnaire (MLHFQ); and Chronic Heart Failure Questionnaire (CHFQ).2Patient symptoms have demonstrated clinically important deterioration since last assessment.3A documented plan of care may include >=1 of the following: reevaluation of medical therapy, including uptitration of doses, consideration of electrical device therapy, recommended lifestyle modifications (e.g., salt restriction, exercise training), initiation of palliative care, referral for more advanced therapies (e.g., transplant, ventricular assist device), or referral to disease management programs.4Counseling should be specific to each individual patient and include documentation of a discussion regarding the risk of sudden and nonsudden death AND the efficacy, safety, and risks of an ICD.
ACC/AHA Task Force on Performance Measures Paul A. Heidenreich, MD, MS, FACC, FAHA, Chair Nancy M. Albert, PhD, CCNS, CCRN, FAHA Paul S. Chan, MD, MSc, FACC Lesley H. Curtis, PhD T. Bruce Ferguson, ...Jr, MD, FACC Gregg C. Fonarow, MD, FACC, FAHA P. Michael Ho, MD, PhD, FACC, FAHA Corrine Jurgens, PhD, RN, ANP-BC, FAHA Sean O'Brien, PhD Andrea M. Russo, MD, FACC Randal J. Thomas, MD, MS, FAACVPR, FACC, FAHA Henry H. Ting, MD, MBA, FACC, FAHA Paul D. Varosy, MD, FACC Table of Contents Preface2134 Structure and Membership of the Writing Committee2134 Disclosure of Relationships With Industry2134 The Need for Shared Accountability2135 Shared Accountability and PMs2136 General Overview2136 Examples of Shared-Accountability Measures2136 Longitudinal Process Adherence2136 Intermediate Patient Outcome Metrics--Reaching Target Goals (Blood Pressure, Hemoglobin A1c)2137 Example of Shared Accountability for Clinical Events and Patient Outcomes2137 Methodological Challenges2138 Accountability and Attribution2138 Potential Levels of Aggregation2138 Defining Patient Attribution2138 Defining Parties Responsible for a PM2138 Defining Assessment Periods for PMs2139 Issues Relating to Patient Adherence and Self-Care2139 Defining Adherence and Self-Care2139 Challenges With Handling Patient Treatment Refusals2139 Adjusting for Patient Case Mix2140 Psychosocial Factors Impacting Patient Case Mix2140 Factors Impeding or Facilitating the Adoption of Shared-Accountability PMs2140 Health Information Systems2140 Payment Reforms, Healthcare Ownership, and ACOs2140 Special Issues Relating to Patient Accountability Metrics2140 Patient PM and Accountability2140 Patient Financial Incentives and Unintended Consequences2141 Conclusion and Key Recommendations2141 References2143 Appendix 1 Author Relationships With Industry and Other Entities (Relevant)2144 Appendix 2 Reviewer Relationships With Industry and Other Entities (Relevant)2145 Preface Structure and Membership of the Writing Committee Members of the Writing Committee included experienced clinicians and specialists in cardiology, cardiac rehabilitation, quality improvement, outcomes research, epidemiology, and performance measures (PMs) methodology, as well as patient advocates. Because the Writing Committee is defining general principles, rather than making specific PM recommendations, members' relationships with pharmaceutical and device companies were not considered relevant to the topic.
2013 ACCF/AHA Guideline for the Management of Heart Failure Yancy, Clyde W., MD, MSc, FACC, FAHA; Jessup, Mariell, MD, FACC, FAHA; Bozkurt, Biykem, MD, PhD, FACC, FAHA ...
Journal of the American College of Cardiology,
10/2013, Letnik:
62, Številka:
16
Journal Article
Recenzirano
Odprti dostop
An organized and directed approach to a thorough review of evidence has resulted in the production of clinical practice guidelines that assist clinicians in selecting the best management strategy for ...an individual patient. ...clinical practice guidelines can provide a foundation for other applications, such as performance measures, appropriate use criteria, and both quality improvement and clinical decision support tools.
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