Strategies Proposed for Systems of Care for Valvular Heart Disease
April 22, 2019–The American College of Cardiology (ACC) announced the publication of a new expert consensus systems-of-care document that proposes strategies to optimize care for patients with valvular heart disease (VHD).
The document, which was drafted by Rick A. Nishimura, MD, and Patrick T. O'Gara, MD, et al, is available online ahead of print in Journal of the American College of Cardiology.
The proposed strategies were developed by the ACC, American Association for Thoracic Surgery, American Society of Echocardiography, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons (STS). The document will also be published in Catheterization and Cardiovascular Interventions, Journal of the American Society of Echocardiography, Journal of Thoracic and Cardiovascular Surgery, and Annals of Thoracic Surgery.
The document outlines a proposed structure for an integrated model of care. In the ACC announcement, Drs. Nishimura and O'Gara, the writing committee cochairs, explained, "Access to specialized care requires establishment of well-defined referral centers, having graduated levels of expertise, and resources. A multidisciplinary team and an emphasis on patient shared decision-making are essential. Further, transparency, public reporting, mandatory participation in national registries, ongoing analysis of processes and outcomes, and a commitment to research are also essential."
According to ACC, the document is intended to "initiate a discussion" about systems of care for patients with VHD to optimize outcomes for patients and improve the overall care of patients with VHD. It underscores best practices from the 2014 VHD guideline and the 2017 focused update, and it is a companion to the 2018 expert consensus systems-of-care document on transcatheter aortic valve replacement (TAVR) and the 2017 expert consensus decision pathway on mitral regurgitation management.
Specifically, the new document proposes common standards for (1) a comprehensive valve center that provides common and more specialized procedures and (2) a primary valve center that provides all common procedures.
The document also covers process requirements, including function of the multidisciplinary team, registry participation, research, education, and training. Additional proposals include that valve centers performing TAVR must demonstrate active participation in the STS/ACC TVT registry and that both comprehensive and primary valve centers must report outcomes of both surgery and transcatheter valve interventions (when the latter are available).
Drs. Nishimura and O'Gara explained in the ACC announcement, "The intent is...to set performance and quality goals for a valve center to meet benchmarks to be considered either comprehensive or primary in a manner that would be more objective than simple self-designation."
Finally, Drs. Nishimura and O'Gara advised, "There is a great deal of detailed work ahead to realize the goals of this proposal to the satisfaction of patients and the many other stakeholders involved."