2023 AHA/ACC Clinical Performance and Quality Measures for Coronary Artery Revascularization

A Report of the American College of Cardiology/American Heart Association Joint Committee on Performance Measures

Published 7 July 2023

Gregory J. Dehmer, Cindy L. Grines, Faisal G. Bakaeen, Dorian L. Beasley, Theresa M. Beckie, Jack Boyd, Joaquin E. Cigarroa, Sandeep R. Das, Rebecca L. Diekemper, Jennifer Frampton, Connie N. Hess, Nkechinyere Ijioma, Jennifer S. Lawton, Binita Shah, Nadia R. Sutton

Circulation: Cardiovascular Quality and Outcomes. 2023;16 | J Am Coll Cardiol. 2023 Sep;82 (11):1131–1174

  • Advanced Heart Failure & Transplantation
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More than 20 million Americans are affected by coronary artery disease (CAD), with a prevalence of 7.2% in adults ≥20 years of age having CAD. Many factors have contributed to the declining death rate from CAD, including optimization of medications for the control of risk factors such as dyslipidemia and a persistent decrease in adult and youth cigarette use in the United States. Unfortunately, other forms of tobacco use are becoming increasingly common, especially among young individuals, as the incidence of obesity and diabetes in the population continues to increase. Despite the decline in CAD deaths, and a substantial number of deaths related to the COVID-19 (coronavirus disease-2019) pandemic, CAD was the leading cause of death in the United States in 2020.

Given the substantial burden of CAD and the recent publication of the “2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization,” it was deemed appropriate to develop a new set of performance and quality measures related to coronary artery revascularization.

In 2022, a writing committee was convened to begin developing performance and quality measures for coronary artery revascularization. This document includes new measures to evaluate the use of coronary artery revascularization in accordance with the “2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization."

The writing committee developed a comprehensive coronary artery revascularization measure set that includes 22 measures comprising 15 performance measures, 5 quality measures, and 2 structural measures, and believes that implementation of this measure set by clinicians and health care facilities will enhance safe, cost-efficient, patient-centered, and culturally sensitive care for individual patients.

The International Society for Heart and Lung Transplantation (ISHLT) endorsed this document in 2023.

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Top 10 Take-Home Messages for Coronary Artery Revascularization

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

  2. This is the first joint American Heart Association/American College of Cardiology document developing measures related to coronary artery revascularization.

  3. Most performance measures were developed from the “2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization” and are selected from the strongest recommendations (Class 1 or 3).

  4. Quality measures are included as metrics that may be useful for local quality improvement programs but are not yet appropriate for public reporting or pay-for-performance programs.

  5. Structural measures are useful to assess infrastructure, systems, and processes of care. Two structural measures were developed. One structural measure is related to the presence and function of the Heart Team and the other structural measure is related to registry participation.

  6. For all measures, if the clinician determines the guideline-recommended care is inappropriate for the patient, that patient is excluded from the measure.

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

  8. Where possible, these measures were aligned with those developed by other organizations such as the National Quality Forum, Centers for Medicare & Medicaid Services, and the Society of Thoracic Surgeons.

  9. Performance measurement sets serve as vehicles to accelerate translation of scientific evidence into clinical practice and are intended to provide practitioners and institutions with tools to measure the quality of care provided and identify opportunities for improvement.

  10. Coronary artery revascularization is not static, but continues to evolve as new techniques, therapies, and treatment strategies emerge, which will require ongoing review and revision of these measures.