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Quality Improvement Topics
Guidelines for the Prevention of Stroke in Women: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association (Bushnell et al, Stroke 2014)
Guidelines/Clinical Documents: Purpose—The aim of this statement is to summarize data on stroke risk factors that are unique to and more common in women than men and to expand on the data provided in prior stroke guidelines and cardiovascular prevention guidelines for women. This guideline focuses on the risk factors unique to women, such as reproductive factors, and those that are more common in women, including migraine with aura, obesity, metabolic syndrome, and atrial fibrillation. Methods—Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council’s Scientific Statement Oversight Committee and the AHA’s Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through May 15, 2013. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA Stroke Council methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. Results—We provide current evidence, research gaps, and recommendations on risk of stroke related to preeclampsia, oral contraceptives, menopause, and hormone replacement, as well as those risk factors more common in women, such as obesity/metabolic syndrome, atrial fibrillation, and migraine with aura. Conclusions—To more accurately reflect the risk of stroke in women across the lifespan, as well as the clear gaps in current risk scores, we believe a female-specific stroke risk score is warranted. (Stroke. 2014;45:1545-1588.)
Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report (Lip et al, Chest 2018)
Guidelines/Clinical Documents: These guidelines for best practices provides recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios.
2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation
Guidelines/Clinical Documents: 2021 Position paper from the European Heart Rhythm Association to serve as a guide for providers when using Non-Vitamin K Antagonist OACs in AFib patients. Published on behalf of the European Society of Cardiology.
2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)
Guidelines/Clinical Documents: 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)
2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation
Guidelines/Clinical Documents: This best practices clinical document is a 2017 update to the 2012 consensus statement on catheter and surgical AF ablation, to reflect the many advances in tools, techniques and outcomes of AF ablation. The document is a collaborative effort with HRS, EHRA, ECAS, APHRS, and SOLAECE.
Quality Improvement Essentials Toolkit
Tools: IHI’s QI Essentials Toolkit includes the tools and templates you need to launch a successful quality improvement project and manage performance improvement. Each of the ten tools can be used with the Model for Improvement, Lean, or Six Sigma, and includes a short description, instructions, an example, and a blank template.
Rationale, considerations, and goals for atrial fibrillation centers of excellence: A Heart Rhythm Society perspective
Guidelines/Clinical Documents: This manuscript builds on the work of a diverse, multiple-stakeholder Think Tank meeting and multidisciplinary Inter-pro Forum educational activity held in January 2019, both led by the Heart Rhythm Society (HRS). When examining the current clinical landscape, the Think Tank concluded that there is a clear need for AF CoEs to improve AF care and its delivery. In this manuscript, HRS hopes to accelerate this evolution by reviewing the rationale for AF CoEs, the available evidence for integrated and multidisciplinary care, and future challenges and opportunities. The document also defines the key priorities to be used as a guide for HRS and its diverse stakeholders to build consensus on defining the core components of an AF CoE.
Early Rhythm-Control Therapy in Patients with Atrial Fibrillation
Journal Articles: In this international, investigator-initiated, parallel-group, open, blinded-outcome assessment trial, we randomly assigned patients who had early atrial fibrillation (diagnosed ≤1 year before enrollment) and cardiovascular conditions to receive either early rhythm control or usual care. Early rhythm control included treatment with antiarrhythmic drugs or atrial fibrillation ablation after randomization. Usual care limited rhythm control to the management of atrial fibrillation–related symptoms. The first primary outcome was a composite of death from cardiovascular causes, stroke, or hospitalization with worsening of heart failure or acute coronary syndrome; the second primary outcome was the number of nights spent in the hospital per year. The primary safety outcome was a composite of death, stroke, or serious adverse events related to rhythm-control therapy. Secondary outcomes, including symptoms and left ventricular function, were also evaluated.
Harmonized outcome measures for use in atrial fibrillation patient registries and clinical practice
The purpose of this project was to develop a minimum set of standardized outcome measures that could be collected in AF patient registries and clinical practice.