Evidence behind quality of care measures for venous thromboembolism and atrial fibrillation

Abstract

Stroke and venous thromboembolism (VTE) are serious and preventable thrombotic events in patients with atrial fibrillation (AF) and who undergo surgery or hospitalization, respectively. Nevertheless, thromboprophylaxis remains greatly underused. The National Quality Forum, the Agency for Healthcare Research and Quality, and the Joint Commission have developed quality measures aimed at improving the provision of appropriate thromboprophylaxis. Reporting of these measures will increasingly become mandatory and hospitals will face financial penalties for failure to report. The approval of new oral anticoagulants (direct thrombin and factor Xa inhibitors) may simplify provision of thromboprophylaxis and eventually increase adherence to guidelines and quality measures. The primary objective of this review is to present evidence supporting the core quality measures for VTE prevention and stroke prevention in patients with AF. The secondary objective is to familiarize physicians with the new anticoagulants and their approved indications. This review concludes with a brief description of the Society of Hospital Medicine online resources for VTE prevention as well as recommendations for planning and implementation of quality improvement in the management of VTE.