Performance Measurement Network

Question: Why does a patient treated with another lipid-lowering agent and with LDL < 100 fail the statin measure?

This is follow up to a prior question: "Why does a patient on another lipid-lowering medication qualify and fail statin prescribed at discharge?";.

If the patient was on a fibrate medication for cholesterol management prior to admission and had a LDL value of 84 within the required timeframe, why does the case fail STK-6? The patient was discharged on the same fibrate medication rather than a statin.

Answer:

The clinical practice guidelines supporting STK-6 recommend intensive statin therapy for the management of hyperlipidemia in stroke patients. If the MD felt that the patient was well controlled on fibrates and decided not to prescribe statin therapy, dcoumentation reflecting such needs to be present in the medical record to exclude the case, "Reason for Not Prescrbing Statin Medication at Discharge".

"Update to the AHA/ASA Recommendations for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack. Stroke Vol 39(5), May 2008."

Class I Recommendations: Ischemic stroke or TIA patients with elevated cholesterol, comorbid coronary artery disease, or evidence of an atherosclerotic origin should be managed according to NCEP III guidelines, which include lifestyle modification, dietary guidelines, and medication recommendations. Statin agents are recommended, and the target goal for cholesterol lowering for those with CHD or symptomatic atherosclerotic disease is an LDL-C level of < 100 mg/dL. An LDL-C < 70 mg/dL is recommended for very high-risk persons with multiple risk factors. New Recommendation: On the basis of the SPARCL trial, administration of statin therapy with intensive lipid-lowering effects is recommended for patients with atherosclerotic ischemic stroke or TIA and without known CHD to reduce the risk of stroke and cardiovascular events.

Question Details
Focus area(s): Chart Abstracted Measure Specifications – Clinical
Related documents: STK-06, Appendix: Medication tables
File:

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