As an update to the 2005 statement, the American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Clinical Data Standards recently published key data elements and definitions for use in databases that include information on heart failure (HF). The report was published in the Journal of the American College of Cardiology.
Goals of the ACC/AHA Clinical Data Standards
Data elements compiled in the ACC/AHA statement include a set of standardized data elements and new or updated corresponding definitions that are relevant to HF. According to the writing committee, the goals of the clinical data standards are to establish a universal clinical vocabulary that is consistent and serves as a foundation for clinical care and research.
In addition, the committee developed the extensive guideline statement in the hopes that these standards could improve data exchange across systems and foster the development of clinical registries and public reporting. The settings for which the data elements might be useful, according to the writing committee, include HF clinics, transitions of care, clinical registries, and in public health policymaking.
2021 ACC/AHA Key Data Elements and Definitions for HF
Data Elements for HF Risk Factors
Several data elements for HF risk factors included diabetes, both type 1 and type 2, acutely decompensated diabetes, the duration of diabetes treatment, and prediabetes. Other HF risk factor data elements in the ACC/AHA statement included hypertension, dyslipidemia, metabolic syndrome, and tobacco use. The use of tobacco was further broken down into data elements that included quantity of cigarettes smoked, former smoking, exposure to secondhand smoke, and use of electronic nicotine delivery systems.
Data Elements for COVID-19 Infection
Under a section for non-cardiovascular (CV) history, the writing group provided several data elements for COVID-19, including acute COVID-19 infection, exposure to COVID-19, previous COVID-19 infection, as well as the date of diagnosis and hospitalization.
With regard to CV health, a data element of COVID-19-related CV complications included permissible values of acute myocardial injury caused by COVID-19, persistent sinus tachycardia with acute COVID-19 infection, ventricular arrhythmia with infection, and sudden cardiac death with corresponding infection. The permissible values for acute myocardial injury due to COVID-19 included injuries without cardiomyopathy, with left ventricular cardiomyopathy, with right ventricular cardiomyopathy, with acute coronary syndrome.
Causes of HF and Cardiomyopathy
Data elements were also added relating to the cause of HF and cardiomyopathy. According to the writing committee, these data elements emphasize the importance of specific diagnoses, including cardiac amyloidosis and peripartum cardiomyopathy. A permissible value of peripartum cardiomyopathy included a permissible value definition of “HF caused by systolic dysfunction presenting usually during the last month of pregnancy or in the first 5 [months] postpartum.” The authors additionally noted that peripartum cardiomyopathy can present throughout pregnancy and early postpartum. Risk factors for peripartum cardiomyopathy included multiparity, hypertension, advanced maternal age, and obesity.
Pharmacologic Treatment Options
Several data elements and their corresponding definitions were included in the guideline for therapies for HF. These data elements included loop diuretic and total daily dose of loop diuretic, metolazone and total daily dose of metolazone, aldosterone inhibitors and total daily dose, angiotensin converting enzyme inhibitors with total daily dose, and angiotensin II receptor blockers medication with total daily dose.
Specific therapies included as data elements were ivabradine, digoxin, oral nitrate therapy, and hydralazine. In addition to several other therapies, a “nonprescription treatments” component was also included in the guideline. Permissible values for the nonprescription therapies used by a patient with HF could include vitamins, food supplements, and homeopathic treatments.
Several data elements were added for patient education and counseling interventions to promote self-care. These data elements included smoking cessation counseling, which may include nicotine replacement therapy and referral to a smoking cessation program, as well as immunization counseling, diabetes management, anticoagulation therapy education, and outpatient HF management programs.
Referral to a dietitian for diet counseling represented another data element that was patient-specific and was defined by the referral of the patient to a dietitian for weight management and/or specialized nutritional education.
Finally, the data element transitional care was defined by the clinician-led coordination of health care during the transition from 1 care setting to another care setting. In addition, transitional care was defined by care needs that changed during the course of the disease.
Considerations of the Data Elements
The ACC/AHA writing committee noted that the presented data elements were not differentiated for decompensated HF vs chronic HF. In addition, the document does not include data elements related to cardiac transplantation and mechanical circulatory support devices, given the magnitude of these additional associated elements. Data elements presented in the paper were also not differentiated for prevalent cases vs new onset incident HF or for the number of encounters. Also, there were no data element fields for entry of calculated risk scores.
Bozkurt B, Hershberger RE, Isler ML, et al. 2021 ACC/AHA key data elements and definitions for heart failure: A report of the American College of Cardiology/American Heart Association task force on clinical data standards (writing committee to develop clinical data standards for heart failure). J Am Coll Cardiol. Published online November 26, 2020. doi:10.1016/j.jacc.2020.11.012