McNamara Robert L, Spatz Erica S, Kelley Thomas A, Stowell Caleb J, Beltrame John, Heidenreich Paul, Tresserras Ricard, Jernberg Tomas, Chua Terrance, Morgan Louise, Panigrahi Bishnu, Rosas Ruiz Alba, Rumsfeld John S, Sadwin Lawrence, Schoeberl Mark, Shahian David, Weston Clive, Yeh Robert, Lewin Jack
Yale University School of Medicine, New Haven, CT (R.L.M.N., E.S.S.) American Heart Association, Dallas, TX (R.L.M.N., L.M., L.S., M.S.).
Yale University School of Medicine, New Haven, CT (R.L.M.N., E.S.S.) International Consortium for Health Outcomes Measurement, Cambridge, MA (E.S.S., T.A.K., C.J.S.).
J Am Heart Assoc. 2015 May 19;4(5):e001767. doi: 10.1161/JAHA.115.001767.
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.
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.
ICHOM recommends that this set of outcomes and other patient information be measured for all patients with CAD.
当冠状动脉疾病(CAD)的治疗结果得到常规测量并反馈给医生和医院时,其治疗效果会持续改善。然而,全球很少有中心系统地跟踪治疗结果,且不存在全球统一标准。此外,以患者为中心的结果和纵向结果在当前评估中未得到充分体现。
非营利性组织国际健康结果测量协会(ICHOM)召集了一个国际工作组,以定义一套用于跟踪、比较和改善CAD治疗结果的共识性标准结局指标和风险因素。成员来自四大洲的6个国家。通过改良的德尔菲法,ICHOM工作组确定了应该跟踪哪些患者、应该测量哪些指标以及何时进行这些测量。ICHOM CAD共识指标旨在适用于所有被诊断为CAD的患者,包括急性心肌梗死、心绞痛和无症状CAD患者。选择了13项具体结果,包括急性心肌梗死、冠状动脉搭桥手术或经皮冠状动脉介入治疗后30天内发生的急性并发症;以及长达5年的纵向结果,包括患者报告的健康状况(西雅图心绞痛问卷[SAQ-7]、罗斯呼吸困难评分要素和患者健康问卷[PHQ-2])、心血管疾病住院、心血管手术、肾衰竭和死亡率。纳入基线人口统计学、心血管疾病和合并症信息以提高比较的可解释性。
ICHOM建议对所有CAD患者测量这组结果和其他患者信息。