2020 ACC/AHA Clinical Performance and Quality Measures for Adults With Heart Failure

A Report of the ACC/AHA Task Force on Performance Measures

Published 2 November 2020

Paul A. Heidenreich, Gregg C. Fonarow,  Khadijah Breathett,  Corrine Y. Jurgens,  Barbara A. Pisani,  Bunny J. Pozehl,  John A. Spertus, Kenneth G. Taylor,  Jennifer T. Thibodeau,  Clyde W. Yancy, Boback Ziaeian

Circulation: Cardiovascular Quality and Outcomes. Nov 2020;13(11).

  • Advanced Heart Failure & Transplantation
  • Cardiology
  • Endorsement
  • Joint Statement
  • Publications & Journals
  • Standards & Guidelines

American College of Cardiology (ACC) LogoAmerican Heart Association (AHA) LogoHeart failure is a major and growing public health problem in the United States with significant morbidity, mortality, and associated cost.

In 2019, a writing committee was convened to begin the process of revising the existing performance measures set for heart failure that was released in 2011.The writing committee also was charged with the task of developing new measures to evaluate the care of patients in accordance with the 2017 ACC/AHA/HFSA heart failure guideline update.

The writing committee developed a comprehensive heart failure measure set that includes 18 measures: 13 performance measures, 4 quality measures, 1 structural measure, and 2 rehabilitation performance measures addressing in-hospital and continuing care in the outpatient setting. Implementation of this measure set is intended to provide practitioners and institutions that deliver cardiovascular services with tools to measure the quality of care provided and identify opportunities for improvement.

The International Society for Heart and Lung Transplantation (ISHLT) endorsed this document in 2020.

Read at Circulation

Top 10 Take-Home Messages for Adults With Heart Failure

  1. This document describes performance measures for heart failure that are appropriate for public reporting or pay-for-performance programs.

  2. The performance measures are from the 2017 American College of Cardiology/American Heart Association/Heart Failure Society of America heart failure guideline update and are selected from the strongest recommendations (Class 1 or 3).

  3. Quality measures are also provided that are not yet ready for public reporting or pay for performance but might be useful for clinicians and healthcare organizations for quality improvement.

  4. A new safety measure (laboratory monitoring for patients treated with mineralocorticoid receptor antagonists) is paired with a new treatment measure (mineralocorticoid receptor antagonists in patients with heart failure with reduced left ventricular ejection fraction).

  5. Other additions to the performance measures include the new medication sacubitril/valsartan and use of cardiac resynchronization therapy.

  6. To address frequent lack of titration of heart failure medications, 2 new performance measures are included based on dose, either reaching 50% of the recommended dose (eg, beta blocker or angiotensin-converting enzyme inhibitor/angiotensin receptor antagonist/angiotensin receptor neprilysin inhibitor) or documenting that such a dose was not tolerated or otherwise inappropriate.

  7. For all measures, if the clinician determines the care is inappropriate for the patient, that patient is excluded from the measure.

  8. For all measures, patients who decline treatment or care are excluded.

  9. A patient-centered discussion of the benefits and risks of implantable cardioverter-defibrillator treatment remains a performance measure.

  10. To reflect the increasing importance of patient-reported outcome measures, 2 patient-reported outcomes quality measures were added that use heart failure patient-reported outcomes questionnaires currently accepted by the US Food and Drug Administration.