Specifications Manual for Joint Commission National Quality Measures (v2027A)
Posted: 8/7/2026

Release Notes:
Measure Information Form
Version 2027A

**NQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE**

Measure Information Form

Measure Set: Stroke (STK)

Set Measure ID: STK-3

Performance Measure Name: Anticoagulation Therapy for Atrial Fibrillation/Flutter

Description: Ischemic stroke patients with atrial fibrillation/flutter who are prescribed anticoagulation therapy at hospital discharge.

Rationale: Atrial fibrillation (AF) is a common arrhythmia, affecting an estimated 6.6 million individuals in the United States and is expected to increase to 12.1 million by 2030, (Martin, S., et al., 2025). While the median age of patients with atrial fibrillation is 75 years, the incidence increases with advancing age (14.2 per 1000 PY at 65–69 years of age to 50.8 per 1000 PY at ≥85 years of age).

AF is also an important risk factor for stroke. Furthermore, a prior stroke or transient ischemic attack (TIA) are among a limited number of predictors of high stroke risk within the population of patients with atrial fibrillation. Nonparoxysmal AF compared to paroxysmal AF has been associated with a higher risk of stroke in this patient population. Therefore, much emphasis has been placed on identifying methods for preventing recurrent ischemic stroke as well as preventing first stroke. Prevention strategies focus on the modifiable risk factors such as hypertension, smoking, and atrial fibrillation.

Analysis of placebo-controlled clinical trials (e.g., AFASAK, BAATAF, SPAF, CAFA, SPINAF, EAFT) investigating the efficacy of warfarin in the primary prevention of thromboembolic stroke found that warfarin reduced the relative risk of thromboembolic stroke by about two-thirds (RR ≈ 0.3–0.4) for AF patients. In more recent years, direct oral anticoagulant agents have been developed and approved by the FDA for stroke prevention. The AHA/ASA guidelines now prefer direct oral anticoagulant medications over warfarin for secondary prevention in ischemic stroke patients with AF/flutter, (Kleindorfer, D., et al., 2021). Globally, the use of direct oral anticoagulant medications has continued to increase since 2018, and the prevalence of vitamin K antagonist use decreased. Clinicians still treat about 10 percent of patients with antiplatelet medications only, (Ibid.).

Type Of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Ischemic stroke patients prescribed anticoagulation therapy at hospital discharge.
Included Populations: Not applicable

Excluded Populations: None

Data Elements:

Denominator Statement: Ischemic stroke patients with documented atrial fibrillation/flutter.
Included Populations:
  • Discharges with an ICD-10-CM Principal Diagnosis Code for ischemic stroke as defined in Appendix A, Table 8.1
  • Patients with documented Atrial Fibrillation/Flutter

Excluded Populations:
  • Patients less than 18 years of age
  • Patients who have a Length of Stay greater than 120 days
  • Patients with Comfort Measures Only documented
  • Patients enrolled in clinical trials
  • Patients admitted for Elective Carotid Intervention
  • Patients discharged to another hospital
  • Patients who left against medical advice
  • Patients who expired
  • Patients discharged to home for hospice care
  • Patients discharged to a health care facility for hospice care
  • Patients with a documented Reason For Not Prescribing Anticoagulation Therapy

Data Elements:

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records. Some hospitals may prefer to gather data concurrently by identifying patients in the population of interest. This approach provides opportunities for improvement at the point of care/service. However, complete documentation includes the principal or other ICD-10 diagnosis and procedure codes, which require retrospective data entry.

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:
  • Campbell, L. A., Ammon, J. P., Kombathula, R., Muhammad, N., & Jackson, C. D. (2025). New atrial fibrillation guideline: Modify risk, control rhythm, prevent progression. Cleveland Clinic Journal of Medicine, 92 (5), 291–296. https://doi.org/10.3949/ccjm.92a.24067
  • January, C. T., Wann, S., Calkins, H., Chen, L. Y., Cigarroa, J. E., Cleveland, J. C., Ellinor, P. T., … (2019). 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation, 140 (2), e125–e151.
  • Kleindorfer, D. O., Towfighi, A, Chaturvedi, S., Cockroft, K. M., Gutierrez, J., Lombardi-Hill, D., Kamel, H., Kernan, W. N., Kittner, S. J., Leira, E. C., Lennon, O., Meschia, J. F., Nguyen, T. N., Pollak, P. M., Santangeli, P., Sharrief, A. Z., Smith, S. C., Jr., Turan, T. N., & Williams, L. S. (2021). Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline from the American Heart Association/American Stroke Association. Stroke, 52 (7), e364–e467.
  • Kornej, J., Börschel, C. S., Benjamin, E. J., & Schnabel, R. B. (2020). Epidemiology of atrial fibrillation in the 21st century: Novel methods and new insights. Circulation Research, 127 (1), 4–20.
  • Martin, S. S., Aday, A. W., Allen, N. B., Almarzooq, Z. I., Anderson, C. A. M., Arora, P., … Palaniappan, L. P. (2025). 2025 heart disease and stroke statistics: A report of US and global data from the American Heart Association. Circulation, 151, e333–e334.
  • Palaniappan, L. P., Allen, N. B., Almarzooq, Z. I., Anderson, C. A. M., Arora, P., Avery, C. L., Baker-Smith, C. M., Bansal, N., Currie, M. E., Earlie, R. S., Fan, W., Fetterman, J. L., Barone Gibbs, B., Heard, D. G., Hiremath, S., Hong, H., Hyacinth, H. I., Ibeh, C., Jiang, T., … Khan, S. S. (2026). 2026 heart disease and stroke statistics: A report of U.S. and global data from the American Heart Association. Circulation. Advance online publication. https://doi.org/10.1161/CIR.0000000000001412
  • Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., Biller, J., et al., on behalf of the American Heart Association Stroke Council. (2018). 2018 guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 49, e10–e11, e26–e30.
  • Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., Biller, J., et al. (2019). Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke—A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 50 (12), e344–e418.

Measure Algorithm:
Graphic depiction of the Measure Algorithm. Refer to the Algorithm Narrative for each detailed step.

STK-3: Algorithm Narrative

STK-3: Anticoagulation Therapy for Atrial Fibrillation/Flutter

Numerator: Ischemic stroke patients prescribed anticoagulation therapy at hospital discharge.
Denominator: Ischemic stroke patients with documented atrial fibrillation/flutter.

1. Start processing. Run cases, which are included in the Stroke Initial Patient Population and pass the edits defined in the Clinical Data Processing Flow, through this measure.

2. Check ICD-10 CM Principal Diagnosis codes
  1. If none of the ICD-10 CM Principal Diagnosis codes are on Table 8.1, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Stop processing.
  2. If at least one of the ICD-10 CM Principal Diagnosis codes is on Table 8.1, continue processing and proceed to check Discharge Disposition.

3. Check Discharge Disposition.
  1. If Discharge Disposition is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Discharge Disposition equals 2, 3, 4, 6 or 7, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Stop processing.
  3. If Discharge Disposition equals 1, 5 or 8, continue processing and proceed to check Comfort Measures Only.

4. Check Comfort Measures Only.
  1. If Comfort Measures Only is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Comfort Measures Only equals 1, 2 or 3, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Stop processing.
  3. If Comfort Measures Only equals 4, continue processing and proceed to check Clinical Trial.

5. Check Clinical Trial.
  1. If Clinical Trial is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Clinical Trial equals Y, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Stop processing.
  3. If Clinical Trial equals N, continue processing and proceed to check Elective Carotid Intervention.

6. Check Elective Carotid Interventions.
  1. If Elective Carotid Intervention is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Elective Carotid Intervention equals Y, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Stop processing.
  3. If Elective Carotid Intervention equals N, continue processing and proceed to check Atrial Fibrillation/Flutter.

7. Check Atrial Fibrillation/Flutter.
  1. If Atrial Fibrillation/Flutter is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Atrial Fibrillation/Flutter equals N, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Stop processing.
  3. If Atrial Fibrillation/Flutter equals Y, the case will proceed to check Anticoagulation Therapy Prescribed at Discharge.

8. Check Anticoagulation Therapy Prescribed at Discharge.
  1. If Anticoagulation Therapy Prescribed at Discharge is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Anticoagulation Therapy Prescribed at Discharge equals Y, the case will proceed to a Measure Category Assignment of E and will be in the Numerator Population. Stop processing.
  3. If Anticoagulation Therapy Prescribed at Discharge equals N, the case will proceed to check Reasons For Not Prescribing Anticoagulation Therapy.

9. Check Reasons For Not Prescribing Anticoagulation Therapy.
  1. If Reasons For Not Prescribing Anticoagulation Therapy is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Reasons For Not Prescribing Anticoagulation Therapy equals Y, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Stop processing.
  3. If Reasons For Not Prescribing Anticoagulation Therapy equals N, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population. Stop processing.

Measure Information Form STK-3
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Specifications Manual for Joint Commission National Quality Measures (v2027A)
Discharges 01-01-2027 (1Q27) through 06-30-2027 (2Q27)

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