2016 ACC/AHA Clinical Performance and Quality Measures for Adults With Atrial Fibrillation or Atrial Flutter

Heidenreich, Paul A.; Solis, Penelope; Estes, N.A. Mark; Fonarow, Gregg C.; Jurgens, Corrine Y.; Marine, Joseph E.; McManus, David D.; McNamara, Robert L.

doi:10.1161/hcq.0000000000000018

Cited by 39 publications

(15 citation statements)

References 123 publications

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“…Although not all measures are developed with the intention for integration into Medicare programs, there still exists an opportunity for stakeholders to advocate for inclusion of these validated measures into CMS’ quality programs. For example, such measures include the American Academy of Neurology’s “Patient/Caregiver Nutritional Preferences” [ 28 ] and “Patient Counseled About Advanced Health Care Decision-Making, Palliative Care, or End-Of-Life Issues,” [ 29 ] the American College of Cardiology/American Heart Association’s “SDM Between Physician and Patient in Anticoagulation Prescription Prior to Discharge” [ 30 ] and “SDM Between Physician and Patient in Anticoagulation Prescription,” [ 30 ] and the Society for Interventional Radiology’s “Communication and SDM with Patients and Families for Interventional Oncology Procedures” [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Personalizing Value in Cancer Care: The Case for Incorporating Patient Preferences Into Routine Clinical Decision Making

Seidman¹,

Masi²,

Gomez-Rexrode³

2019

J Participat Med

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Despite growing research demonstrating the potential for shared decision making (SDM) to improve health outcomes, patient preferences—including financial trade-offs—are still not routinely incorporated into health care decision making. As the US health care delivery system transitions to rewarding value-based care, the question of “value to whom?” assumes greater importance. To achieve the goals of value-based care, the patient voice must be incorporated into clinical decision making by embedding SDM as a routine part of clinical practice. Identified as a priority by the Centers for Medicare & Medicaid Services (CMS), SDM-related measures and initiatives have already been integrated into CMS’ Center for Medicare and Medicaid Innovation (Innovation Center) demonstration projects (eg, the Oncology Care Model and Transforming Clinical Practice Initiative) and value-based payment programs (eg, the Merit-based Incentive Payment System, Medicare Shared Savings Program) to incentivize more proactive SDM engagement between patients and their providers. Furthermore, CMS has also integrated formal shared decision-making encounters into coverage and reimbursement policies (eg, for implantable cardioverter defibrillators), demonstrating a growing interest in SDM and its potential for eliciting and promoting the integration of patient preferences into the clinical decision-making process. In addition to increasing policy efforts to promote SDM, we need more research investments aimed at understanding how to optimize the science and practice of meaningful SDM. The current landscape and proposed road map for next steps in research, outlined in this review article, will help ensure the transition of pilots and research projects regarding the implementation of SDM into sustainable solutions.

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Section: Discussionmentioning

confidence: 99%

Personalizing Value in Cancer Care: The Case for Incorporating Patient Preferences Into Routine Clinical Decision Making

Seidman¹,

Masi²,

Gomez-Rexrode³

2019

J Participat Med

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“…With warfarin, physicians recommend dose control, frequent monitoring, and bleeding assessment when prescribing concomitant drugs, such as NSAIDs. 13 32 Although NOACs may increase the risk of bleeding events, the use of NOACs is suggested in guidelines, and there is insufficient evidence about interactions with concomitant drugs. 13 For these reasons, physicians may have given less attention to the risk of concomitant drugs in prescribing NOACs, and they need to consider concomitant drugs when prescribing NOACs.…”

Section: Discussionmentioning

confidence: 99%

Concomitant Use of NSAIDs or SSRIs with NOACs Requires Monitoring for Bleeding

et al. 2020

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Purpose Non-vitamin K antagonist oral anticoagulants (NOACs) are widely used in patients with atrial fibrillation (AF) because of their effectiveness in preventing stroke and their better safety, compared with warfarin. However, there are concerns for an increased risk of bleeding associated with concomitant use of non-steroidal anti-inflammatory drugs (NSAIDs) or selective serotonin reuptake inhibitors (SSRIs) with NOACs. In this study, we aimed to evaluate the risk of bleeding events in individuals taking concomitant NSAIDs or SSRIs with NOACs after being diagnosed with AF. Materials and Methods A nested case-control analysis to assess the safety of NSAIDs and SSRIs among NOAC users with AF was performed using data from Korean National Health Insurance Service from January 2012 to December 2017. Among patients who were newly prescribed NOACs, 1233 cases hospitalized for bleeding events were selected, and 24660 controls were determined. Results The risk of bleeding events was higher in patients receiving concomitant NSAIDs [adjusted odds ratio (aOR) 1.41; 95% confidence interval (CI) 1.24–1.61] or SSRIs (aOR 1.92; 95% CI 1.52–2.42) with NOACs, compared to no use of either drug, respectively. The risk of upper gastrointestinal bleeding was higher in patients receiving concomitant NSAIDs or SSRIs without proton pump inhibitors (PPIs) (NSAIDs: aOR 2.47; 95% CI 1.26–4.83, SSRI: aOR 10.8; 95% CI 2.41–2.48) compared to no use. Conclusion When NSAIDs or SSRIs are required for NOAC users with AF, physicians need to monitor bleeding events and consider the use of PPIs, especially for combined use of both drugs or when initiating NOACs treatment.

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“…Patient perceptions of the burdens and benefits of anticoagulation are important in the context of AF management, since treatment is generally life‐long, often requires behavior change (ie, change in diet), and is associated with potential harm. In addition to their associations with clinical outcomes, assessment of patient beliefs and preferences surrounding anticoagulation is a critical component of anticoagulation shared decision making, a process endorsed for providers and patients by the 2016 American College of Cardiology AF Quality Guidelines . In parallel with increasing recognition of its importance, treatment satisfaction has become increasingly integrated into health care research …”

Section: Discussionmentioning

confidence: 99%

“…In addition to their associations with clinical outcomes, assessment of patient beliefs and preferences surrounding anticoagulation is a critical component of anticoagulation shared decision making, a process endorsed for providers and patients by the 2016 American College of Cardiology AF Quality Guidelines. 28 In parallel with increasing recognition of its importance, treatment satisfaction has become increasingly integrated into health care research. 29 We observed that visual impairment, depression, and anxiety were independently associated with higher self-reported burden of anticoagulation among elderly participants with AF.…”

Section: Discussionmentioning

confidence: 99%

Physical, cognitive, and psychosocial conditions in relation to anticoagulation satisfaction among elderly adults with atrial fibrillation: The SAGE‐AF study

Wang

Saczynski

Lessard

et al. 2019

Cardiovasc electrophysiol

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Background Successful anticoagulation is critical for stroke prevention in adults with atrial fibrillation (AF). Anticoagulation satisfaction is a key indicator of treatment success. While physical, cognitive, and psychosocial limitations are common in elderly AF patients, their associations with anticoagulation satisfaction are unknown. Objective Examine whether anticoagulation satisfaction differs among AF patients with and without physical, cognitive, and psychosocial conditions. Methods The study comprised AF patients greater than or equal to 65 years old who were prescribed an oral anticoagulant (warfarin 57%; direct oral anticoagulant [DOAC] 43%). Frailty, cognitive function, social support, depressive symptoms, vision, hearing, and anxiety were assessed using validated measures. Anticoagulation satisfaction was measured using the anticlot treatment scale. Results Participants (n = 1037, 50% female) were on average 76 years old. The following conditions were prevalent: frailty (14%), cognitive impairment (42%), social isolation (13%), vision impairment (35%), hearing impairment (36%), depression (29%), and anxiety (24%). Average anticlot treatment burden scale was 55 out of 60 (lower burden scales indicating higher perceived burden). Patients with high perceived burden were older, more likely to be female, and receive warfarin. After adjusting for confounders, visual impairment (adjusted odds ratio [95% confidence interval]: 1.7 [1.2‐2.4]), depressive symptoms (2.4 [1.6‐3.7]), and anxiety (1.8 [1.2‐2.7]) were significantly associated with high perceived burden. Different conditions were associated with high perceived burden in warfarin vs DOAC users. Conclusion Physical, cognitive, and psychosocial limitations are prevalent and associated with high perceived anticoagulation burden among elderly AF adults. These conditions merit consideration in anticoagulation prescribing.

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2016 ACC/AHA Clinical Performance and Quality Measures for Adults With Atrial Fibrillation or Atrial Flutter

Cited by 39 publications

References 123 publications

Personalizing Value in Cancer Care: The Case for Incorporating Patient Preferences Into Routine Clinical Decision Making

Personalizing Value in Cancer Care: The Case for Incorporating Patient Preferences Into Routine Clinical Decision Making

Concomitant Use of NSAIDs or SSRIs with NOACs Requires Monitoring for Bleeding

Physical, cognitive, and psychosocial conditions in relation to anticoagulation satisfaction among elderly adults with atrial fibrillation: The SAGE‐AF study

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