Performance Measures for CAD & Hypertension

Performance Measures for CAD & Hypertension

During the past decade, there has been increased awareness of the need to improve the quality of care delivered to patients with coronary artery disease (CAD) and hypertension. In keeping consistent with this focus, the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) have developed guidelines and related performance measures that focus on these areas of care. In the July 12, 2011 issue of Circulation, the ACCF and AHA revised their original performance measures for adults with CAD and hypertension, which were developed in conjunction with the Physician Consortium for Performance Improvement (PCPI) and previously released in 2005. More Than a “Routine” Update for CAD & Hypertension With a general policy to revise performance measures no more than every 3 years, the AHA, ACCF, and PCPI had been working on revising the measurement sets for more than a year before they were published. “These new measurements represent a change in the science and methodology of how per­formance measures are typically developed,” says Joseph Drozda, Jr, MD, FACC, who co-chaired the PCPI panel. “The new mea­surements bring a focus on the outcomes of treatment rather than purely measures of process. We’re focusing on the things that make a difference and doing it in a way that will allow physicians to track their own per­formance in these key areas.” The 2011 ACCF/AHA performance measure sets consist of 10 total measures derived from several professional guidelines. It includes revisions to measures that were released in the 2005 document and five new measures (Table 1). “There are robust guidelines for CAD, supported by strong levels of evidence with respect...

Beta-Blockade: Minimizing Cardiac Risk During Non-Cardiac Surgery

An estimated 6 million people undergo non-cardiac surgery each year, and up to a quarter of these procedures (eg, major intra-abdominal, thoracic vascular, and orthopedic procedures) are associated with significant risk of perioperative cardiovascular morbidity and mortality. The American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) issued a practice guideline for the utilization of β-blockade in non-cardiac surgery. The update, published in the November 24, 2009 issue of Circulation and the Journal of the American College of Cardiology, identifies important new information regarding the risks and benefits of perioperative β-blockade. “Non-cardiac surgery represents a stress to the heart, particularly if the procedure is high risk or if patients have underlying risk factors for cardiac complications,” says Kirsten E. Fleischmann, MD, MPH, who chaired the committee that generated the focused update. As the aging population rises and the number of non-cardiac surgeries performed in them continues to increase, steps must be taken to minimize the risk of cardiac complications associated with these surgeries. Clinical Trial Evidence Drives Update Another impetus for the ACCF/AHA update was the publication of new randomized trial data, most notably the POISE (PeriOperative Ischemic Evaluation) and DECREASE (Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography)-IV trials. POISE confirmed that β-blocker therapy reduces perioperative cardiac events, but also clarified that routine perioperative β-blockade—particularly in fixed, higher-dose regimens initiated the day of surgery—was associated with risk. In POISE, the reduction in cardiac events was offset by a higher risk of stroke and death when using fixed higher-doses of metoprolol started on the day of surgery. The DECREASE-IV trial assigned intermediate cardiac risk patients to...