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Tool Helps Guide Decision Making in Managing Anticoagulation in Nonvalvular Atrial Fibrillation

Key findings

  • Suboptimal practices of managing anticoagulation in nonvalvular atrial fibrillation are common and must be improved
  • One path to improvement is the 2017 American College of Cardiology’s Expert Consensus Decision Pathway Document
  • Chaired by cardiology leadership of Massachusetts General Hospital, it is algorithm-based, visually communicated, action-oriented and designed to help accelerate optimal clinical care
  • Decision pathways do not promote one answer. They help clinicians integrate expertise and guide actions

The challenges of periprocedural management of anticoagulation are most evident in patients with nonvalvular atrial fibrillation—the most common sustained arrhythmia worldwide, which occurs in 1 in 4 individuals over their lifetime.

An estimated 250,000 patients per year experience anticoagulation interruption while preparing for a procedure in North America. The benefits to patients is substantial when clinicians follow best-practices protocols for periprocedural management of anticoagulation. Evidence-based and standardized management protocols are unavailable or incomplete.

Consensus Documents: A New Approach

To bridge these gaps in evidence-based clinical decision-making, Massachusetts General Hospital leadership chaired the 2017 American College of Cardiology (ACC) Task Force on Clinical Expert Consensus Documents. The findings were published in JACC. “There may be multiple pathways that can be taken for treatment decisions, and the goal is to help clinicians make a more informed decision,” says James L. Januzzi, MD, Mass General cardiologist.

The format of brief Consensus Documents was adopted by the ACC in 2014 to help busy practitioners. The aim was to integrate evidence-based best practices data and use it to generate decision pathways or key points of care. Because of their high clinical utility, consensus documents have been refined and renamed “Expert Consensus Decision Pathways.”

Key Elements of Expert Consensus Decision Pathways Documents

The new decision pathway format is not designed to provide a single answer. Rather, the documents are intended to help guide clinicians in making more informed decisions as they devise treatment plans. Ideally, treatment decisions are based on each physicians’ own:

  • Robust knowledge
  • Deep experience and expertise
  • Collaborative input
  • Careful consideration of all variables and data.

Decision pathway documents help integrate and navigate this formidable wealth of resources to choose action steps.

In general, decision pathways prioritize the following elements. They are designed to bridge gaps in available clinical guidance resources to support optimal-outcome decision making, algorithm-based, with algorithms designed to be easily actionable and focused on ease of implementation to be quickly adopted into tools or applications that accelerate point-of-care use.

The Mass General leadership chairing the ACC Task force that helped produce these documents recognizes there may be multiple pathways to a given treatment. The goal of the Expert Consensus Decision Pathway Documents is to accelerate finding and taking the best one.

patients a year experience anticoagulation interruption while preparing for a procedure in North America

of individuals in the world will experience nonvalvular atrial fibrillation in their lifetime

Refer a patient to the Corrigan Minehan Heart Center

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