Summary Of ACCF/AHA 2009

Monday, 11 January 2010 13:49

Summary of ACCF/AHA 2009 Performance Measures for Primary Prevention of Cardiovascular Disease in Adults (JACC 2009; 54: 1364-1405) issued on September 29, 2009

• CVD is the underlying cause of 36.3% of all deaths, or 1 of every 2.8 deaths, in the United States, according to data from 2004. In 2008, an estimated 770,000 Americans suffered a first coronary attack (this includes myocardial infarction and unstable angina). Another 175,000 had a silent, or unrecognized, myocardial infarction. The total cost of CVD and stroke in the United States for 2007 is estimated at $ 448.5 billion
• Despite advances and wide publication and dissemination of prevention guidelines in the cardiovascular literature, the inconsistent application of best practices does a disservice to patients and leaves many opportunities for improvement in care and systems.
• The development of performance systems involves identification of a set of measures that target a specific patient population observed over a particular time period.
• The target population consists of patients 18 years of age or older.
• These performance measures are intended for primary prevention in the adult population and do not address prevention specific to children and adolescents.
• The Writing Committee recommends identical screening and advice for men and women for most cardiovascular risk factors, including lifestyle, diet, physical activity, smoking, and blood pressure.
• In general, a comprehensive assessment of risk factors should be performed at least every 5 years starting at 18 years of age, and a global risk score should be calculated at least every 5 years starting at the age of 35 years for men and 45 years for women.
• Consuming a heart-healthy diet (lower in animal products and rich in fruits and vegetables, whole grains, low-fat or nonfat dairy products, fish, legumes, poultry, and lean meats; calorie controlled; and moderate in sodium intake), as well as engaging in regular physical activity, lowers an individual’s risk for CVD. Therefore, the Writing Committee strongly believes that diet and physical activity counseling is the foundation of primary prevention.
• Body mass index and waist circumference are the designated measures for assessment of obesity and abdominal obesity, respectively.
• The Writing Committee elected to use the recommendations of the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, which recommends screening beginning at 18 years of age. The Writing Committee chose 140/90 mm Hg as the threshold for satisfactory blood pressure control.
• The Writing Committee had an extensive discussion about the appropriate age at which lipid screening should be initiated.
• Decisions about lipid-lowering therapy should be based on an individual’s risk for CVD rather than solely on sex or age.
• Among men and women without CVD, there has been little or no benefit for aspirin in reducing CVD death or all-cause death. In a recent meta-analysis of primary prevention studies, there was a significant 12% relative risk reduction in CVD events with aspirin
• Aspirin reduced the risk of myocardial infarction in men and the risk of stroke in women; however, aspirin significantly increased the risk of bleeding in both men and women.
• The use of aspirin for prevention of CVD in patients with diabetes mellitus or peripheral arterial disease remains unclear.
• There is strong evidence that tight control of glucose in type 1 diabetes mellitus reduces the risk of developing nonfatal myocardial infarction, stroke, and CVD by up to 57%.
• The Writing Committee believe that these measures will provide a useful tool for the shared goal of improving care in the critical arena of primary prevention of CVD. Cardiac risk factor reduction has the added benefit of promoting overall good health, in addition to cardiovascular health. Current federal mandates have made prevention a priority area in health care, recognizing the pivotal role of prevention in good health. The Writing Committee hopes that these ACCF/AHA metrics and discussion will help the nation achieve the goal of improving health and health care for all Americans.

December 10, 2009

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