ACC, AHA recommend shared decision-making for lipid performance measures

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Physicians and patients should share in the decision-making and should each be held accountable for adhering to medications, according to updated performance measures the American College of Cardiology (ACC) and American Heart Association (AHA) released on Dec. 14 for lipid management in secondary prevention.

The measures were simultaneously published online in Circulation and the Journal of the American College of Cardiology.

The writing committee members updated five lipid performance measures based on 2013 guidelines from ACC and AHA for treating blood cholesterol to reduce atherosclerotic cardiovascular risk in adults.

Four of the five were updates to existing measures: peripheral artery disease, ST-elevation and non-ST-elevation MI, PCI and coronary artery disease and hypertension. The fifth measure had to do with patients with clinical atherosclerotic cardiovascular disease.

Joseph P. Drozda, Jr., MD, FACC, director of outcomes research at Mercy Health in St. Louis, was the chair of the seven-member writing committee, which included clinicians specializing in interventional cardiology and general cardiology and people with experience in developing guidelines and performance measures.

Paul A. Heidenreich, MD, MS, FACC, FAHA, of VA Palo Alto Medical Center, was the chair of the 12-member ACC/AHA task force on performance measures.

The committee members emphasized the importance of clinicians and patients discussing statin therapy for secondary prevention. They added that shared decision-making could improve the patients’ chances of adhering to guideline-recommended care.

They defined shared decision-making as clinicians recommending evidence-based treatments and patients deciding how the treatments fit with their preferences, values and personal context.

“By incorporating patient preferences, values, and personal context to decision making, clinicians strengthen their implementation of evidence-based medicine and guidelines in a patient-centered manner to improve outcomes that matter to patients,” they wrote. “A [performance measure] that integrates patient values, preferences, and personal context with evidence-based medicine and guidelines is novel and changes the focus from recommending and prescribing statins based on strong evidence to promoting choice by an informed patient whether or not to initiate statins.”

The writing committee said that it considered measuring patient adherence to statins, but they said that the measures would not be helpful in assessing the performance of providers and improving the quality of care.

"Measures of adherence oversimplify complex human behaviors, and when used in provider incentive and public reporting programs, put the onus for adherence entirely on the clinician,” they wrote. “Additionally, measuring adherence is quite difficult, particularly when using clinical data from the electronic health record.”