Quality indicators for the care and outcomes of adults with atrial fibrillation

Abstract

Aims To develop quality indicators (QIs) that may be used to evaluate the quality of care and outcomes for adults with atrial fibrillation (AF). Methods and results We followed the ESC methodology for QI development. This methodology involved (i) the identification of the domains of AF care for the diagnosis and management of AF (by a group of experts including members of the ESC Clinical Practice Guidelines Task Force for AF); (ii) the construction of candidate QIs (including a systematic review of the literature); and (iii) the selection of the final set of QIs (using a modified Delphi method). Six domains of care for the diagnosis and management of AF were identified: (i) Patient assessment (baseline and follow-up), (ii) Anticoagulation therapy, (iii) Rate control strategy, (iv) Rhythm control strategy, (v) Risk factor management, and (vi) Outcomes measures, including patient-reported outcome measures (PROMs). In total, 17 main and 17 secondary QIs, which covered all six domains of care for the diagnosis and management of AF, were selected. The outcome domain included measures on the consequences and treatment of AF, as well as PROMs. Conclusion This document defines six domains of AF care (patient assessment, anticoagulation, rate control, rhythm control, risk factor management, and outcomes), and provides 17 main and 17 secondary QIs for the diagnosis and management of AF. It is anticipated that implementation of these QIs will improve the quality of AF care.

2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)

“…658,1453À1455 A collaborative effort involving the ESC, EHRA, Asia Pacific Heart Rhythm Society, Heart Rhythm Society, and Latin American Heart Rhythm Society was put in place to develop quality indicators for the diagnosis and management of AF; a summary form of these quality indicators is provided in Table 22, with the full set published separately. 317 The ESC quality indicators are intended for quality improvement and performance measurement through meaningful surveillance, as well as for integration within registries that specifically aim to identify areas for improvement in clinical practice and are not intended for ranking healthcare professionals/providers or payment incentives.…”

World Heart Federation Roadmap on Atrial Fibrillation – A 2020 Update

“…Identification of deficiencies of patients’ knowledge plays a substantial role in designing and conducting evaluation of effective patient education platforms [ 195 196 ]. The following items have been identified as the most common knowledge gaps: recognizing AF presentations, AF risk factors, awareness about their diagnosis, drug and food interactions of OACs, dietary vitamin K food content and intake, meaning of INR and its interpretation, how to handle missed OAC doses, and OAC side effects [ 197 ].…”

Concomitant diabetes with atrial fibrillation and anticoagulation management considerations

“… 25 The risk for stroke increases with longer diabetes duration, as well as with more diabetes comorbidities such as retinopathy. 24 , 26 , 27 In diabetes guidelines, diabetes is also diagnosed by elevated haemoglobin A1c >6.5% or 48 mmol/L, which does not require fasting and this could be an alternative.…”