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The Importance of EHR Quality Measures & Coronary Artery Disease


Mary is 58 years old and generally in good health. She doesn't smoke, but does have hypertension and a family history of myocardial infarction. Mary goes to the emergency department for prolonged left shoulder and upper back pain which had begun after dinner. The emergency department physician knows that women may have atypical symptoms during an acute coronary event and evaluates Mary’s heart as a possible source of her pain. Her electrocardiogram indicated a myocardial infarction. Mary follows up with her primary care physician who reviews her medications and prescribes her aspirin, a beta-blocker, and simvastatin.1

Which Coronary Artery Disease Quality Measures Count for Stage 1 2013 Meaningful Use?

  • Coronary Artery Disease (CAD): Antiplatelet Therapy (NQF# 0067)
  • Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol (NQF# 0074)
  • Coronary Artery Disease (CAD): Beta-Blocker Therapy — Prior Myocardial Infarction (NQF# 0070)

Which Coronary Artery Disease Quality Measures Count for Stage 1 & 2 2014 Meaningful Use?

  • Coronary Artery Disease (CAD): Beta-Blocker Therapy — Prior Myocardial Infarction (NQF# 0070; CMS145v7)

Measuring & Improving Coronary Artery Disease Care: A Real Impact on Your Patients

  • A meta-analysis of randomized trials comparing the risk of major vascular events in those with statin therapy compared to a control, with a median follow-up period of 4.8 years, found that for every 38mg/dl reduction in LDL-C there is a:2
    • 26% reduction in risk for non-fatal myocardial infarction,
    • 20% reduction in risk of death from coronary heart disease, &
    • 24% reduction in risk of any major coronary event.
  • Systematic review of 31 long-term randomized controlled trials concluded β-blockers are effective in secondary prevention after myocardial infarction3
    • A death will be prevented for every 84 patients treated in a single year, &
    • A reinfarction will be prevented for every 107 patients treated in a single year.
  • A random sample of general practitioners in the UK found4
    • 59% of patients who were treated for myocardial infarction did not receive a secondary prophylactic drug to which they had no contraindication, and
    • 6% of those patients received no treatment at all.
  • A meta-analysis of antiplatelet therapy among patients at high risk for occlusive vascular events found absolute reductions in the risk of developing a serious vascular event of:5
    • 3.6% in patients with previous myocardial infarction treated over 2 years
      • For every 100 of these patients given antiplatelet therapy, 3 serious vascular events are prevented every 2 years
    • 3.8% in patients with acute myocardial infarction over 1 month
      • For every 100 of these patients given antiplatelet therapy, 3 serious vascular events are prevented in a single month

Conclusion

Making sure Mary has the recommended medication interventions can not only prevent a future trip to the emergency room with another MI, but can also give her more healthy years to look forward to.

Clinical Quality Measure Information

Coronary Artery Disease (CAD): Antiplatelet Therapy

NQF# Description Numerator Denominator Exclusions
0067 Percentage of patients with CAD who were prescribed antiplatelet therapy All patients:
  • Prescribed Antiplatelet Therapy
    • Aspirin
    • Clopodigril
    • Aspirin/dipyridamole
All Patients with:
  • Age > 18 years, &
  • Coronary Artery Disease
  • Active bleeding in previous 6 months that resulted in hospitalization or transfusion
  • Allergy/intolerance
  • Other medical contraindication
  • Patient or System reason(s)

Coronary Artery Disease (CAD): Beta-blocker Therapy – Prior Myocardial Infarction

NQF# Description Numerator Denominator Exclusions
0070 Percentage of patients with prior myocardial infarction at any time who were prescribed beta-blocker therapy All patients:
  • Prescribed beta blocker therapy
All patients with:
  • Age > 18 years , &
  • Coronary Artery Disease, &
  • Prior Myocardial Infarction
Documentation of:
  • Bradycardia < 50 bpm (without beta-blocker therapy) on 2 consecutive readings
  • History of Class IV heart failure
  • History of 2nd or 3rd degree AV block without permanent pacemaker
  • Other medical contraindication
  • Patient or System reason(s)

Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol

NQF# Description Numerator Denominator Exclusions
0074 Percentage of patients with CAD who were prescribed a lipid-lowering therapy All patients:
  • Prescribed lipid-lowering therapy based on ACC/AHA guidelines
All patients with:
  • Aged > 18 years, &
  • Coronary Artery Disease
Documentation of:
  • Allergy/intolerance
  • Other medical contraindication
  • Patient or System reason(s)

About National Quality Forum (NQF) Endorsement

Each of the Clinical Quality Measures has an NQF number, indicating that it has received endorsement from the National Quality Forum (NQF), a nonprofit organization with the mission to improve the quality of American healthcare. NQF uses a formal Consensus Development Process (CDP) to evaluate and endorse consensus standards, including performance measures. This process includes gathering input on performance measures from a wide variety of stakeholders including consumer organizations and health care providers.6

  1. Wise, R., Wong, M., Budge, L. "Evidence Based Clinical Vignettes from the Care Management Institute: Coronary Artery Disease". The Permanante Journal. 7.2 (2003): 61-68.
  2. Cholesterol Treatment Trialists Collaboration. “"Efficacy and safety of more intensive lowering of LDL cholesterol; a meta-analysis of data from 170,000 participants in 26 randomised trials". Lancet. 376 (2010): 1670-81.
  3. Freemantle, N., Cleland, J., Young, P., Mason, J., Harrison, J. "Β-Blockade after myocardial infarction: systematic review and meta-regression analysis". BMJ. 318 (1999). 1730-7.
  4. Eccles, M., Bradshaw, C. "Use of secondary prophylaxis against myocardial infarction in the north of England". BMJ. 302 (1991): 91-92.
  5. Antithrombotic Trialists' Collaboration. "Collaborative meta-anlaysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarctin, and stroke in high risk patients". BMJ. 324 (2002): 71-86.
  6. http://www.qualityforum.org Exit Disclaimer [www.qualityforum.org]. Accessed December 6, 2011

Produced by Meaningful Use Quality Workgroup – February 14, 2013

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