Standardized Outcome Measurement for Patients With Coronary Artery Disease: Consensus From the International Consortium for Health Outcomes Measurement (ICHOM)

Robert L McNamara, Erica S Spatz, Thomas A Kelley, Caleb J Stowell, John Beltrame, Paul Heidenreich, Ricard Tresserras, Tomas Jernberg, Terrance Chua, Louise Morgan, Bishnu Panigrahi, Alba Rosas Ruiz, John S Rumsfeld, Lawrence Sadwin, Mark Schoeberl, David Shahian, Clive Weston, Robert Yeh, Jack Lewin, Robert L McNamara, Erica S Spatz, Thomas A Kelley, Caleb J Stowell, John Beltrame, Paul Heidenreich, Ricard Tresserras, Tomas Jernberg, Terrance Chua, Louise Morgan, Bishnu Panigrahi, Alba Rosas Ruiz, John S Rumsfeld, Lawrence Sadwin, Mark Schoeberl, David Shahian, Clive Weston, Robert Yeh, Jack Lewin

Abstract

Background: Coronary artery disease (CAD) outcomes consistently improve when they are routinely measured and provided back to physicians and hospitals. However, few centers around the world systematically track outcomes, and no global standards exist. Furthermore, patient-centered outcomes and longitudinal outcomes are under-represented in current assessments.

Methods and results: The nonprofit International Consortium for Health Outcomes Measurement (ICHOM) convened an international Working Group to define a consensus standard set of outcome measures and risk factors for tracking, comparing, and improving the outcomes of CAD care. Members were drawn from 4 continents and 6 countries. Using a modified Delphi method, the ICHOM Working Group defined who should be tracked, what should be measured, and when such measurements should be performed. The ICHOM CAD consensus measures were designed to be relevant for all patients diagnosed with CAD, including those with acute myocardial infarction, angina, and asymptomatic CAD. Thirteen specific outcomes were chosen, including acute complications occurring within 30 days of acute myocardial infarction, coronary artery bypass grafting surgery, or percutaneous coronary intervention; and longitudinal outcomes for up to 5 years for patient-reported health status (Seattle Angina Questionnaire [SAQ-7], elements of Rose Dyspnea Score, and Patient Health Questionnaire [PHQ-2]), cardiovascular hospital admissions, cardiovascular procedures, renal failure, and mortality. Baseline demographic, cardiovascular disease, and comorbidity information is included to improve the interpretability of comparisons.

Conclusions: ICHOM recommends that this set of outcomes and other patient information be measured for all patients with CAD.

Keywords: coronary artery disease; outcomes; patient‐centered.

© 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Figures

Figure 1
Figure 1
A, Example timeline for a patient diagnosed with asymptomatic CAD without any subsequent events. B, Example timeline for a patient initially diagnosed at time of an AMI and who subsequently undergoes a PCI one and a half years later. A new revascularization procedure or a new diagnosis of AMI constitutes a new index event, and tracking of PROMs should reset from this point, tracking again at 30 days, and then annually for 5 years. Given that longitudinal outcomes are obtained from administrative data, they are collected for both the entry event (eg, AMI) and the new event (eg, PCI). AMI indicates acute myocardial infarction; CAD, coronary artery disease; PCI, percutaneous coronary intervention; PROMs, patient-reported outcome measures.

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