ACC/AHA Adopt New Clinical Lexicon for Heart Failure

Updated heart failure (HF) data elements and definitions from the American College of Cardiology (ACC) and American Heart Association (AHA) no long differentiate between chronic and acute decompensated HF; inpatient and outpatient; or medical management with and without palliative care or hospice.

“Since HF is a chronic condition, not an episodic event, and a patient can transition from one status to the other through his/her lifetime, the writing committee considered data elements that are pertinent to the full range of care provided to these patients and intended to be useful for all care venues,” Biykem Bozkurt, MD, PhD, cochair of the writing group, told | Medscape Cardiology.

The 2021 ACC/AHA Key Data Elements and Definitions for Heart Failure was published online March 23 in the Journal of the American College of Cardiology and in Circulation: Cardiovascular Quality and Outcomes .

The document was developed in collaboration with the Heart Failure Society of America, the International Society for Heart and Lung Transplantation, and the Society of Thoracic Surgeons.

It replaces the 2005 ACC/AHA Key Data Elements and Definitions for Measuring the Clinical Management and Outcomes of Patients With Chronic Heart Failure.

The new document provides a comprehensive and updated list of data standards, including data elements for medical history; risk factors for HF; and patient assessment, including history and physical, HF stages, ejection fraction (EF) classification, functional assessment and exercise performance, and overall health status.

It also updates laboratory and diagnostic procedures, including new modalities such as remote monitoring; therapeutic procedures, including new percutaneous interventions; pharmacological therapy, including newer agents for treatment of HF; and components on patient education and counseling to promote self-care.

“We believe the document will be very useful for clinical programs, such as HF clinics, where many clinicians work together to achieve specific goals for the care and care coordination of HF patients,” said Bozkurt, from the DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston.

It will also help with transitions of care when HF patients move through different locations and levels of care, and for clinical registries and clinical research, particularly prospective randomized clinical trials where eventual pooled analysis or meta-analysis is anticipated, Bozkurt said.

He further noted that the updated document has value for quality performance measurement initiatives; for data elements to be incorporated in electronic health records, pharmacy databases, computerized decision support, and cloud technologies incorporating health information; as well as for public health policy, healthcare coverage, and legislation development to provide appropriate and timely care for HF patients and prevent disparities in HF care.

COVID-19 and the Heart

The writing committee also addressed the impact of COVID-19 on the heart.

“COVID-19 is an important cause of myocardial injury and cardiac complications and we are also becoming aware of postacute COVID-19 effects in the heart,” Bozkurt told | Medscape Cardiology.

“As we globally fight this pandemic, we felt it was critical for us to include data elements related to COVID-19 infection, potential cardiovascular complications, and treatment strategies. We believe incorporation of these elements was critical for HF,” he added.  

Bozkurt emphasized that some of the definitions and terminologies will change with evolving science and epidemiology around COVID-19.

Summing up, Bozkurt said HF data standards are of “critical importance” to clinicians, investigators, administrators, healthcare services, institutions, legislators, and payers.

This is true “now more than ever” because of the increasing prevalence and burden of HF, increasing mortality trends in the past years related to HF, and lack of improvement in the use of guideline-directed medical therapies in real-world patients in the past 2 decades, Bozkurt said.

Members of the writing committee have indicated no relevant conflicts of interest.

J Am Coll Cardiol. Published March 23, 2021. Full text

Circ Cardiovasc Qual Outcomes. Published March 23, 2021. Full text

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