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# 0070e; CMS145v9)

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.