International group proposes new outcome measures for patients with atrial fibrillation

By Will Boggs MD

NEW YORK (Reuters Health) - 6/2/2020

The International Consortium for Health Outcomes Measurement (ICHOM) has developed a standard set of outcome measures for patients with atrial fibrillation that could improve the quality and delivery of care.

"Modern medicine is moving away from relying solely on hard clinical outcomes and beginning to care about how patients feel with their disease or treatment," said Dr. William H. Seligman of ICHOM, in London.

"Consistent with this, our standard set includes as a core element patient-reported outcomes," told Reuters Health by email. "We've taken what patients and their representatives have told us they care about and, through a rigorous academic process, have come up with a way of measuring and tracking these features."

Atrial fibrillation (AF) affects more than 33 million people worldwide, but there is significant variation in AF care and treatment practices between institutions and countries. Several position papers have attempted to standardize care across jurisdictions, but there remains no single internationally accepted standardized approach to reporting outcomes of care in AF.

To develop a standardized minimum set of outcomes for benchmarking care delivery in clinical settings, Dr. Seligman and a working group that consisted of clinicians, registry experts, epidemiologists, research scientists and six patients and patient representatives from 11 countries held a series of teleconferences. After that they selected 18 outcome domains categorized into three major groups: long-term consequences of disease, complications of treatment, and patient-reported outcomes.

Long-term consequences measures include mortality; ischemic stroke, systemic embolism and unclassified strokes; heart failure; cardiovascular hospitalization; freedom from fast atrial arrhythmia post-treatment; and anticoagulation management.

Complications of treatment include hemorrhagic stroke, life-threatening/major bleeding, serious adverse events postintervention, and medication side effects.

Patient-reported outcomes include health-related quality of life, physical functioning, emotional functioning, exercise tolerance, symptom severity, ability to work and cognitive functioning.

Case-mix variables that should be recorded at baseline (and, for some, annually) include demographic factors, lifestyle interventions (such as smoking status and physical activity), and health status (such as comorbidities, cognitive function, and medications).

Details and timing of the standard set of outcomes appear in a report in the European Heart Journal, and a reference guide containing all consensus definitions has been published on the ICHOM website at

"Patients care about more than their latest lab results or echo findings," Dr. Seligman said. "By measuring and tracking what matters most to your patients, you can serve them and their needs better."

"Key to the process, however, is being able to measure outcomes in a standardized manner," he said. "And that's what ICHOM is doing. In our manuscript, we report the output of our project on atrial fibrillation that we expect will be implemented widely."

"Overall, successful implementation requires commitment not just from doctors and nurses, but also from colleagues in IT, data analytics, and hospital administration," Dr. Seligman said. "It takes some time to get the level of buy-in required to get a value-based program running. However, if we focus on the enormous benefits to patients, I think we'll find that the answers are there."


European Heart Journal, online January 29, 2020

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