January 21st, 2014

A Clinical Decision-Making Toolkit from Europe

The Acute Cardiovascular Care Association (ACCA), one of the six scientific associations of the European Society of Cardiology, has designed a toolkit for non-experts and experts in training who care for patients with acute cardiovascular conditions. The ACCA Clinical Decision-Making Toolkit, available in PDF format on the ESC’s website, includes algorithms, tables, and other guidance that, according to the preface, “are based either on the latest clinical practice guidelines or the clinical experience of a number of European experts in each field when guidelines are not available.” CardioExchange’s Harlan Krumholz interviewed the toolkit’s editor, Héctor Bueno, about this new instrument.

Krumholz: You embarked on an ambitious project. Why did you do it?

Bueno: Managing patients with acute cardiovascular diseases has become increasingly complex during the past several years. Several of these syndromes, some life-threatening, require immediate diagnosis and treatment. The best acute care relies not only on specialists but on systems that involve many non-cardiologists. Critical decisions often must be made quickly by professionals with different backgrounds and levels of expertise in environments with limited resources. This poses a significant clinical challenge.

We realized that there was not a unified guide to help clinicians making the right decision rapidly for patients with different cardiovascular problems. We designed the toolkit to help guide the clinical decision making of non-experts who are involved in the initial management of patients with acute CV conditions. Our aim is to help improve the quality of acute cardiovascular care. As our preface describes, our work will be worthwhile if it saves even only one life or improves one outcome.

Krumholz: This is an ESC initiative. Tell us about your working group and about how this effort was funded.

Bueno: ACCA is the latest of the ESC’s scientific groups. Its mission is “to improve the quality of care and outcomes of patients with acute cardiovascular diseases.” We have established a multidisciplinary community of professionals who are involved in acute cardiovascular care, and we are building a platform for disseminating pertinent knowledge (learning & science) and skills (training & certification). ACCA has reached more than 4100 members in its first year and is currently the third largest association in the ESC. The Toolkit was funded by unrestricted grants to ACCA from AstraZeneca and Novartis, to develop an ambitious multidisciplinary educational program. Those companies did not participate at all in the selection of topics, authors, or (of course) content.

Krumholz: What is the most important message from your product?

Bueno: The toolkit is an instrument to help providers make initial decisions correctly when managing patients who present with the most common CV symptoms or acute CV syndromes. It is based on guideline recommendations or, when there is not enough evidence to guide decisions, on the clinical experience of experts in different fields. The quality of acute cardiovascular care can be improved, and we need tools and interventions to achieve that goal. The toolkit is just one of the instruments that the ACCA has developed for quality improvement.

Krumholz: How do you hope that the toolkit will be used? What is happening so far?

Bueno: We decided to design the toolkit, on the one hand, as a comprehensive resource and, on the other hand, as a simple instrument that is easy to use in environments where initial acute cardiovascular care is typically provided. That is why the toolkit is constituted mostly of algorithms and tables. We would like it to be used in ambulances, emergency departments, CCUs, ICUs, and so on. For instance, the Emergency Systems in Madrid (SAMUR) adopted it immediately and asked for a copy for each of its physicians who work in medical ambulances. We would like all professionals in these settings to have access to the toolkit (and soon the ACCA Toolkit App, which is currently under development). We also believe that the toolkit can be extremely useful as a teaching resource for trainees and students.

Review the ACCA’s Clinical Decision-Making ToolKit, and share your thoughts about it here on CardioExchange.

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