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................................................................................................. 10. Quality indicators

Quality indicators (QIs) are tools that may be used to evaluate care quality, including that of processes of care and clinical outcomes.730 They may also serve as a mechanism for enhancing adherence to guideline recommendations, through quality assurance endeavours and benchmarking of care providers.831 As such, the role of QIs in driving quality improvement is increasingly recognized and attracts interest from healthcare authorities, professional organizations, payers, and the public.832 The ESC recognizes the need for measuring and reporting the quality and outcomes of CV care. One aspect of this is the development and implementation of QIs for CVD. The methodology by which the ESC QIs are developed has been published832 and, to date, a suite of QIs for an initial tranche of CV conditions has been produced.833,834 To facilitate quality improvement initiatives, the diseasespecific ESC QIs are included in corresponding ESC Clinical Practice Guidelines.215,680 This is further enhanced by way of their integration into the EORP (EURObservational Research Programme) and the EuroHeart (European Unified Registries On Heart Care Evaluation and Randomized Trials) project.835 For CVD prevention, QIs are available for specific conditions, such as the management of high BP836 and secondary lipid prevention.837 However, a comprehensive set of QIs that encompasses the depth and breadth of CVD prevention is lacking. Such a set may evaluate the adoption of, and adherence to, the guideline recommendations provided in this document, and may be applied retrospectively to assess the delivery of evidence-based care. Thus, and in line with other ESC Clinical Practice Guidelines, the process of developing and defining QIs for CVD prevention has been initiated during the writing of this guideline and the results will be published in a separate document. 11 Supplementary data

Supplementary data with additional Supplementary Figures, Tables, and text complementing the full text are available on the European Heart Journal website and via the ESC website at https://www.escar dio.org/guidelines.

12 Author information

Author/Task Force Member Affiliations: Yvo M. Smulders, Internal Medicine, Amsterdam University Medical Center, Amsterdam, Netherlands; David Carballo, Cardiology, Geneva University Hospitals, Geneva, Switzerland; Konstantinos C. Koskinas, Cardiology, Bern University Hospital  INSELSPITAL, Bern, Switzerland; Maria B€ack, Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linko ̈ping University, Linko ̈ping, Sweden, and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden; Athanase Benetos, Geriatric Department CHRU de Nancy and ISERM DCAC, Universite ́ de Lorraine, Nancy, France; Alessandro Biffi, Cardiology, FIMS and EFSMA, Rome, Italy; Jose ́- Manuel Boavida, APDP  Diabetes Portugal, IDF-E International Diabetes Federation  Europe, Lisbon, Portugal; Davide Capodanno, Cardiothoracic, Vascular and Transplants, Policlinico “G. Rodolico-San Marco”, University of Catania, Catania, Italy; Bernard Cosyns, Cardiology, Centrum voor Hart en vaatziekte (CHVZ) Universitair Ziekenhuis Brussel, Brussels, Belgium; Carolyn A. Crawford, (Northern Ireland), ESC Patient Forum, Sophia Antipolis, France; Constantinos H. Davos, Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of

Recommendations in patients with chronic kidney disease: best medical therapy Treatment with an ACE inhibitor or an ARB is recommended in patients with DM, hypertension, and albuminuria. These medications should be titrated to the highest approved dose that is tolerated. I B Combination treatment with ACE inhibitors and ARBs is not recommended. III C Recommendations for lifestyle interventions and management of risk factors and concomitant diseases in patients with atrial fibrillation Identification and management of risk factors and concomitant diseases are recommended to be considered an integral part of treatment. I B Modification of unhealthy lifestyle and targeted therapy of intercurrent conditions is recommended to reduce AF burden and symptom severity. I B Attention to good BP control is recommended in AF patients with hypertension to reduce AF recurrences and risk of stroke and bleeding. I B

ABPM = ambulatory blood pressure monitoring; ACE = angiotensin-converting enzyme; ACR = albumin-to-creatinine ratio; ACS = acute coronary syndromes; AF = atrial fibrillation; ARB = angiotensin receptor blocker; ARNI = angiotensin receptor neprilysin inhibitor; ASCVD = atherosclerotic cardiovascular disease; BP = blood pressure; CAC = coronary artery calcium; CCB = calcium channel blocker; CCS = chronic coronary syndromes; CKD = chronic kidney disease; COPD = chronic obstructive pulmonary disease; CR = cardiac rehabilitation; CV = cardiovascular; CVD = cardiovascular disease; DAPT = dual antiplatelet therapy; DBP = diastolic blood pressure; DM = diabetes mellitus; EBCR = exercise-based cardiac rehabilitation; ECG = electrocardiogram; eGRF = estimated glomerular filtration rate; FH = familial hypercholesterolaemia; GLP-1RA = glucagon-like peptide-1 receptor agonist; HbA1c = glycated haemoglobin; HBPM = home blood pressure monitoring; HF = heart failure; HFrEF = heart failure with reduced ejection fraction; HMOD = hypertension-mediated organ damage; LDL-C = low-density lipoprotein cholesterol; LEAD = lower extremity artery disease; LV = left ventricular; MRA = mineralocorticoid receptor antagonist; PA = physical activity; PCSK9 = proprotein convertase subtilisin/kexin type 9; PM = particulate matter; RAS = renin-angiotensin system; SBP = systolic blood pressure; SCORE2 = Systematic Coronary Risk Estimation 2; SCORE2-OP = Systematic Coronary Risk Estimation 2-Older Persons; SGLT2 = sodium-glucose cotransporter 2; SNRI = serotonin-noradrenaline reuptake inhibitor; SSRI = selective serotonin reuptake inhibitor; TIA = transient ischaemic attack; TOD = target organ damage. ESC 2021 Downloaded from academic.oup.com/eurheartj/article/42/34/3227/6358713 by guest on 07 October 2026