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Release Notes:
Measure Information Form
Version 2010A1

Measure Information Form

Measure Set: Acute Myocardial Infarction(AMI)

Set Measure ID: AMI-T2

Performance Measure Name: Lipid-Lowering Therapy at Discharge (Optional Test Measure)

Description: Acute myocardial infarction (AMI) patients with elevated low-density lipoprotein cholesterol (LDL-c  100 mg/dL or narrative equivalent) who are prescribed a lipid-lowering medication at hospital discharge

Rationale: The reduction of LDL-c reduces mortality and morbidity in patients with coronary artery disease (CAD). Placebo-controlled trials demonstrate a 30 to 40% relative risk reduction in cardiovascular endpoints with lipid-lowering therapy in a broad range of patients with established CAD (Collins, 2003 and Shepherd, 2002). The National Cholesterol Education Panel and the ACC/AHA recommend lipid screening and lipid-lowering, particularly LDL-c reduction, in patients with CAD and hyperlipidemia (NCEP ATP III, 2001; Antman, 2004; and Smith, 2001). Despite the increasing evidence to support lipid testing to direct therapy, many eligible older patients hospitalized with AMI do not receive treatment for dyslipidemia at the time of hospital discharge (Foody, 2005).

This test measure will help us determine the feasibility of reliably ascertaining LDL-c treatment data from the medical record and the acceptability of this quality measure to practicing clinicians.

Type of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: AMI patients who are prescribed lipid-lowering medication at hospital discharge
Included Populations: Not applicable

Excluded Populations: None

Data Elements:

Denominator Statement: AMI patients with elevated LDL-c

Included Populations: Discharges with:
  • An ICD-9-CM Principal Diagnosis Code for AMI as defined in Appendix A, Table 1.1
  • Patients with one or more of the following documented in the medical record:
    • LDL-c ≥ 100 mg/dL (or narrative equivalent) on test performed during hospital stay
    • If no in-hospital test result, LDL-c > 100 mg/dL (or narrative equivalent) on test performed prior to arrival

Excluded Populations:

  • Patients less than 18 years of age
  • Patients who have a Length of Stay >120 days
  • Patients with Comfort Measures Only documented
  • Patients enrolled in clinical trials
  • Patients discharged/transferred to another hospital for inpatient care
  • Patients who left against medical advice or discontinued care
  • Patients who expired
  • Patients discharged/transferred to a federal health care facility
  • Patients discharged/transferred to hospice
  • Patients who were not prescribed a lipid-lowering medication at discharge and had one or more of the following contraindications/reasons for not prescribing a lipid-lowering medication documented in the medical record:
    • Lipid-lowering medication allergy
    • Other reasons documented by a physician/advanced practice nurse/physician assistant for not prescribing a lipid-lowering medication at discharge

Data Elements:

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-9-CM codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: None

Sampling: Yes. For additional information see the Sampling Section.

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

Selected References:

  • Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, Chavey WE II, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, American College of Physicians, Society for Academic Emergency Medicine, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2007;50:e1–157.
  • Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC Jr. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). 2004.
  • Cannon CP, Braunwald E, McCabe CH et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med. 2004;350:1495-1504.
  • Collins R, Armitage J, Parish S, Sleigh P, Peto R. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomized placebo-controlled trial. Lancet. 2003;361:2005-2016.
  • Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486-2497.
  • Foody JM, Roe MT, Chen AY, Smith SC Jr, Brindis RG, Peterson ED, Gibler WB, Ohman EM; CRUSADE Investigators. Lipid management in patients with unstable angina pectoris and non-ST-segment elevation acute myocardial infarction (from CRUSADE). Am J Cardiol. 2005 Feb 15;95(4):483-5.
  • Grundy SM, Cleeman JI, Merz CNB et al. Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation. 2004;110:227-239.
  • Jencks SJ, Cuerdon T, Burwen DR, Fleming B, Houck PM, Kussmaul AE, Nilasena DS, Ordin DL, Arday DR. Quality of medical care delivered to Medicare beneficiaries: a profile at state and national levels. JAMA 2000;284:1670-1676.
  • Krumholz HM, Anderson JL, Brooks NH, Fesmir FM, Lambrew CT, Landrum MB, Weaver WD, Whyte J. ACC/AHA Clinical Performance Measures for Adults With ST-Elevation and Non–ST-Elevation Myocardial Infarction: a report of the ACC/AHA Task Force on Performance Measures (ST-Elevation and Non–ST-Elevation Myocardial Infarction Performance Measures Writing Committee). J Am Coll Cardiol 2006;47:236–65. Available at http://www.acc.org and http://www.americanheart.org.
  • Shepherd J, Blauw GJ, Murphy MB et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomized controlled trial. Lancet. 2002;360:1623-1630.
  • Smith SC, Blair SN, Bonow RO, Brass LM, Cerqueira MD, Dracup K, Fuster V, Gotto A, Grundy SM, Houston Miller N, Jacobs A, Jones D, Krauss RM, Mosca L, Ockene I, Pasternak RC, Pearson T, Pfeffer MA, Starke RD, Taubert KA. AHA/ACC guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 Update. Circulation 2001;104:1577-1579.

Measure Algorithm:

Attach file

Related Topics

Measure Information Form AMI-T2
Specifications Manual for Joint Commission National Quality Core Measures (2010A1)
Discharges 04-01-10 (2Q10) through 09-30-10 (3Q10)