Effect of Compliance to Updated AHA/ACC Performance and Quality Measures among Patients with Atrial Fibrillation on Outcome (From Japanese Multicenter Registry)

• Published in: The American journal of cardiology Vol. 120; no. 4; pp. 595 - 600
• Main Authors: Inohara, Taku, MD, Kimura, Takehiro, MD, Ueda, Ikuko, PhD, Ikemura, Nobuhiro, MD, Tanimoto, Kojiro, MD, Nishiyama, Nobuhiro, MD, Aizawa, Yoshiyasu, MD, Nishiyama, Takahiko, MD, Katsumata, Yoshinori, MD, Fukuda, Keiichi, MD, Takatsuki, Seiji, MD, Kohsaka, Shun, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15-08-2017; Elsevier Limited
• Subjects: Adhesion; Aged; Anticoagulants; Atrial Fibrillation - psychology; Atrial Fibrillation - therapy; Cardiac arrhythmia; Cardiology; Cardiovascular; Clinical outcomes; Disease Management; Documentation; Female; Fibrillation; Follow-Up Studies; Heart; Heart failure; Humans; Japan; Male; Middle Aged; Outpatients; Patient Compliance; Patients; Prognosis; Prospective Studies; Quality Assurance, Health Care; Quality of Life; Registries; Rhythm; Risk Assessment; Risk Factors; Scaling; Studies; Surveys and Questionnaires; Thrombosis; Warfarin; atrial fibrillation; quality measure; performance measure; quality of care
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2017.05.029

Abstract Performance measures are used to accelerate translation of scientific evidence into clinical practice. However, it remains unknown how they are applied in the real-world, and whether the compliance to these metrics will lead to improved patient’s outcome in atrial fibrillation (AF). Within the Japanese multicenter AF registry (n=1874), adherence of the AF performance measures (based on 2016 AHA/ACC criteria) and its association with quality of life scaling and clinical outcomes were evaluated. The patient was deemed ‘adherent’ when all applicable components of the performance measures for outpatient settings (CHA2 DS2 -VASc risk score documentation [PM-4], anticoagulation prescribed [PM-5], and monthly INR for warfarin treatment [PM-6]) were satisfied. The Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire was assessed at baseline and 1-year. About a half of patients (46.1%) were adherent to the AF performance measures. Performance measures were more frequently achieved in patients managed with rhythm control compared with rate control. The achievement rate for each component was 53.9% for PM-4, 85.6% for PM-5, and 90.3% for PM-6, respectively. Although AFEQT global scores at baseline were similar (median 79.2 [interquartile ranges 66.7 - 88.5] vs. 77.1 [64.8 - 88.0], p=0.227), AFEQT global scores at 1-year follow-up were significantly higher in adherence group than those in non-adherence group (89.2 [78.5 - 96.6] vs. 86.7 [76.7-95.0], p=0.021). This tendency was consistent regardless of therapeutic strategies. There remains an important opportunity to improve the quality of care in AF patients. Adherence to the AF performance measures might lead to the improvement of patient’s quality of life.