Clinical Guidelines & Documents
- Coronavirus disease 2019 (COVID-19) has presented substantial challenges to patient care and impacted health care delivery, including cardiac electrophysiology practice throughout the globe. Based upon the undetermined course and regional variability of the pandemic, there is uncertainty as to how and when to resume and deliver electrophysiology services for arrhythmia patients. This joint document from representatives of the Heart Rhythm Society, American Heart Association, and American College of Cardiology seeks to provide guidance for clinicians and institutions reestablishing safe electrophysiological care.
- Glenn N. Levine, MD, FACC, FAHA, Chair
- Glenn N. Levine, MD, FACC, FAHA, Chair
- The Medicare Access and CHIP Reauthorization Act (MACRA), passed by Congress in 2015, establishes the Quality Payment Program (QPP), which represents a significant change in how physicians are paid by the Centers for Medicare and Medicaid Services (CMS).1 Since the introduction of Medicare, there have been concerns about financial sustainability. In 1997, the Sustainable Growth Rate (SGR) formula was established to match physician expenditures to economic growth.2 Under the SGR law, if total expenditures exceeded the calculated SGR, reductions in physician payment would be triggered.
- Although large randomized clinical trials have found that primary prevention use of an implantable cardioverter-defibrillator (ICD) improves survival in patients with cardiomyopathy and heart failure symptoms, patients who receive ICDs in practice are often older and have more comorbidities than patients who were enrolled in the clinical trials. In addition, there is a debate among clinicians on the usefulness of electrophysiological study for risk stratification of asymptomatic patients with Brugada syndrome.
- Document Reviewers: Adrian M. Baranchuk, MD, FACC, FRCPC, FCCS; Carina Blomström-Lundqvist, MD, PhD; Frank A. Fish, MD; James M. Horton, MD; Roberto Keegan, MD; Miguel A. Leal, MD, FACC, FHRS; Nigel Lever, MBChB, FRACP; Aman Mahajan, MD, PhD, MBA; Marc R. Moon, MD; Siva K. Mulpuru, BS, MB, MBBS, MD, FHRS, CCDS
- Physicians are in an excellent position to significantly contribute to medical device innovation, but the process of bringing an idea to the bedside is complex. To begin to address these perceived barriers, the Heart Rhythm Society convened a forum of stakeholders in medical device innovation in conjunction with the 2015 Heart Rhythm Society Annual Scientific Sessions. The forum facilitated open discussion on medical device innovation, including obstacles to physician involvement and possible solutions.
- Ischemic stroke remains a significant risk for patients with atrial fibrillation (AF). The Food and Drug Administration (FDA) approval of the WATCHMAN device for percutaneous closure of the left atrial appendage (LAA) represents an important addition to the physician’s armamentarium to help mitigate this problem. The evolution of LAA occlusion technology has spanned nearly two decades and three FDA panel hearings, leading to FDA approval in 2015. As this technology becomes clinically available to a broader population of patients, it is essential that physician stakeholders establish criteria for the performance of these procedures that will be used in granting initial and ongoing privileges.
- The implantable cardioverter defibrillator (ICD) has emerged as an important treatment option for selected patients who are at risk of sudden cardiac death. Randomized trials have consistently shown that ICD implantation reduces mortality in patients with heart failure and reduced left ventricular function, as well as in patients who have suffered a cardiac arrest.1–3 Recommendations on the use of the ICD in clinical practice have been provided in four important guideline documents sponsored by the American College of Cardiology (ACC), the American Heart Association (AHA), Heart Rhythm Society (HRS), and the European Society of Cardiology (ESC).