Appropriateness rating for the application of optimal medical therapy and multidisciplinary care among heart failure patients.
ESC Heart Fail
; 8(1): 300-308, 2021 02.
Article
in En
| MEDLINE
| ID: mdl-33201597
ABSTRACT
AIMS:
Clinical guidelines for improving the patients' quality of care vary in clinical practice, particularly in super-aging societies, like in Japan. We aimed to develop a set of appropriate-use criteria (AUC) for contemporary heart failure (HF) management to assist physicians in decision making. METHODS ANDRESULTS:
With the use of the RAND methodology, a multidisciplinary writing group developed patient-based clinical scenarios in 10 selected key topics, stratified mainly by HF stage, age, and renal function. Nine nationally recognized expert panellists independently rated the clinical scenario appropriateness twice on a scale of 1-9, as 'appropriate' (7-9), 'may be appropriate' (4-6), or 'rarely appropriate' (1-3). Decisions were based on clinical evidence and professional opinions in the context of available resource use and costs. An interactive round-table discussion was held between the first and second ratings; the median score of the nine experts was then assigned to an appropriate-use category. Most clinical scenarios without strong evidence were evaluated as 'may be appropriate'. Frailty assessments in elderly patients (age ≥ 75 years), regardless of the HF stage, and advanced care planning in patients with stage C/D HF, regardless of age, were considered 'appropriate'. For HF with reduced ejection fraction, beta-blocker administration in elderly patients (age ≥ 75 years) with heart rate < 50 b.p.m. and mineral corticosteroid receptor antagonist use in elderly patients (age ≥ 75 years) with an estimated glomerular filtration rate < 30 mL/min/1.73 m2 were considered 'rarely appropriate'.CONCLUSIONS:
The HF management AUC provide a practical guide for physicians regarding scenarios commonly encountered in daily practice.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Heart Failure
Type of study:
Guideline
/
Prognostic_studies
/
Qualitative_research
Limits:
Aged
/
Humans
Country/Region as subject:
Asia
Language:
En
Journal:
ESC Heart Fail
Year:
2021
Document type:
Article
Affiliation country:
Japan