Measure Information Form

Measure Set: Comprehensive Cardiac Center-Inpatient (CCCIP)

Set Measure ID: CCCIP-01

Performance Measure Name: High-intensity Statin Prescribed at Discharge

Description: Patients who are hospitalized with a diagnosis of an acute myocardial infarction (AMI) and were prescribed a high-intensity statin at hospital discharge.

Rationale: The 2013 ACC/AHA Guidelines on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults recommends that “high-intensity statin therapy should be initiated or continued as first-line therapy in women and men ≤75 years of age who have clinical atherosclerotic cardiovascular disease (ASCVD), unless contraindicated” (individualized treatment for patients over 75 years old is recommended). Despite this Class I, Level A guideline recommendation and that statins have been shown to reduce morbidity and mortality (Jneid et al., 2017), only 23% of AMI patients are discharged on maximal statin therapy (Arnold et al., 2014). Prescribing rates are also low for patients with acute coronary syndromes. A 2010 study found that only 38.3% of these patients are discharged with intensive lipid-lowering therapy (Javed et al., 2014).

Type Of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Patients prescribed a high-intensity statin at hospital discharge (i.e. Atorvastatin 40-80mg OR Rosuvastatin 20-40mg).

Included Populations: Not applicable
Excluded Populations: Not applicable
Data Elements:

High-intensity Statin at Discharge

Denominator Statement: Patients who are discharged from the hospital with a diagnosis of an AMI.

Included Populations:

Patients ≥18 years of age and ≤75 years of age

Patients with a ICD-10-CM Principal Diagnosis Code for MI as defined in Appendix A, Table 2.3.

Excluded Populations:

Patients less than 18 years of age

Patients greater than 75 years of age

Patients with a documented Reason for Not Prescribing a High Intensity Statin

Patients who expired

Patients who left against medical advice (AMA)

Patients who are discharged to another hospital

Patients who are discharged to hospice

Patients who are discharged to a healthcare facility for hospice care

Patients who have a Length of Stay greater than 120 days

Patients enrolled in a Clinical Trial

Patients with Comfort Measures Only documented

Patients who had a left ventricular assist device (LVAD) or heart transplant procedure (ICD-10-PCS Procedure Code for LVAD or heart transplant as defined in Appendix A, Table 2.2 or Table 2.13)

Data Elements:

Admission Date

Birthdate

Clinical Trial

Comfort Measures Only

Discharge Date

ICD-10-CM Other Diagnosis Codes

ICD-10-CM Principal Diagnosis Code

ICD-10-PCS Other Procedure Codes

ICD-10-PCS Other Procedure Dates

ICD-10-PCS Principal Procedure Code

ICD-10-PCS Principal Procedure Date

Reason for Not Prescribing a High-Intensity Statin

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records.

Data Accuracy: Variation may exist in the assignment of ICD-10 codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: None

Sampling: Yes. Please refer to the measure set specific sampling requirements and for additional information see the Population and Sampling Specifications section.

Data Reported As: Aggregate rate generated from count data reported as a proportion.

Selected References:

Arnold, S., Kosiborod, M., Tang, F., Zhao, Z., Maddox, T. McCollam, P., et al. (2014). Patterns of Statin Initiation, Intensification, and Maximization Among Patients Hospitalized with an Acute Myocardial Infarction. Circulation. 2014 March 25; 129(12): 1303–1309.
Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation, American Society for Preventive Cardiology, American Society of Hypertension, Association of Black Cardiologists, National Lipid Association, Preventive Cardiovascular Nurses Association, and Women Heart: The National Coalition for Women with Heart Disease. (2014). 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 63(25 0 0), 2935–2959.
Javed, U., Deedwania, P., Bhatt, D., Cannon, C., Dai, D., Hernandez, A., et al. (2010). Use of intensive lipid-lowering therapy in patients hospitalized with acute coronary syndrome: An analysis of 65,396 hospitalizations from 344 hospitals participating in Get With The Guidelines (GWTG). Am Heart J.160(6):1130-6, 1136.e1-3
Jneid, H., Addison, D., Bhatt, D., Fonarow, G., Gokak, S., Grady, K., et. al. (2017). 2017 AHA/ACC Clinical Performance and Quality Measures for Adults With ST-Elevation and Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. J Am Coll Cardiol. 2017 Oct 17;70(16):2048-2090.

Original Performance Measure Source / Developer: Jneid, H., Addison, D., Bhatt, D., Fonarow, G., Gokak, S., Grady, K. et.al. (2017). 2017 AHA/ACC Clinical Performance and Quality Measures for Adults with ST-Elevation and Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. J Am Coll Cardiol. Oct 17;70(16):2048-2090.

Measure Algorithm:

Specifications Manual for Joint Commission National Quality Measures (v2021A)
Discharges 01-01-21 (1Q21) through 06-30-21 (2Q21)

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