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The Opportunity
The human and financial costs of cardiovascular disease are enormous. Heart disease is the leading cause of death for men and women in the United States and will cost the United States $316.4 billion in 2010. Hypertension affects 1 in 3 Americans, increasing their risk for heart disease, stroke, or kidney disease and will cost $76.6 billion in healthcare services, medications, and missed days of work.1 Over the past nine years, NQF has endorsed a large number of consensus standards to evaluate the quality of care for cardiovascular conditions in the ambulatory and hospital settings. Evaluating all NQF-endorsed cardiovascular measures and considering new measures will ensure the currency of NQF's portfolio of voluntary consensus standards.
As the quality measurement enterprise has matured, better data from clinical registries and electronic health records can support the demand for meaningful performance measures. There also has been a shift to focus on outcomes and composite measures.
NQF has endorsed consensus standards applicable to cardiovascular conditions in a number of other projects, including Hospital Care-Initial Performance Set 2003; National Voluntary Consensus Standards for Hospital Care: Additional Priority Areas 2005-2006; National Voluntary Consensus Standards for Ambulatory Care, and National Voluntary Consensus Standards for Emergency Care.
NQF Endorsed Cardiovascular Consensus Standards and their Respective Projects (PDF)
About the Project
The project began in September 2010.
This project seeks to identify and endorse measures for public reporting and quality improvement that specifically address cardiovascular conditions including hypertension, coronary artery disease, acute myocardial infarction, PCI, heart failure, atrial fibrillation, or any other heart disease and any treatments, diagnostic studies, interventions, or procedures associated with these conditions. NQF will solicit measures applicable to any healthcare setting and utilizing any data sources. Measures that are harmonized across settings (e.g., outpatient and hospital) are preferred.
Measures will be solicited for the following topics in two "phases":
Phase 1 coronary artery disease, AMI, PCI, and treatments, diagnostic studies, interventions, or procedures associated with these conditions.
Phase 2 hypertension, heart failure, atrial fibrillation, and other heart disease and treatments, diagnostic studies, interventions, or procedures associated with these conditions.
Additionally, as part of this process, cardiovascular consensus standards that were endorsed by NQF before June 2008 will be evaluated under the maintenance process. Endorsement maintenance provides the opportunity to harmonize specifications and to ensure that an endorsed measure represents the "best in class."
NQF Process
The candidate measures will be considered for NQF endorsement as voluntary consensus standards. Agreement around the recommendations will be developed through NQF's formal Consensus Development Process (CDP). This project will involve the active participation of representatives from across the spectrum of healthcare stakeholders and will be guided by a multiple-stakeholder Cardiovascular Steering Committee.
Funding
This project is supported under a contract provided by the Department of Health and Human Services.
For information about the availability of auxiliary aids and services for NQF’s federally funded projects, please visit: http://www.medicare.gov/about-us/nondiscrimination/nondiscrimination-notice.html.
Related NQF Work
Contact Information
For more information, contact Reva Winkler, MD, MPH or Ashley Morsell, MPH at 202-783-1300 or via e-mail at cardiovascular@qualityforum.org.
Notes
1. Lloyd-Jones D, Adams RJ, Brown TM, et al., Heart disease and stroke statistics—2010 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee , Circulation, 2010;121:e1-e170.
This NQF project seeks to identify and endorse measures that specifically address cardiovascular conditions for public reporting and quality improvement applicable to all settings of care. In addition, NQF-endorsed® cardiovascular consensus standards that were endorsed prior to June 2008 will undergo maintenance review.
The Call for Nominations for Steering Committee members closed on October 28, 2010.
For information on the Steering Committee formation process, please refer to the Call for Nominations. (PDF)
In an effort to further identify expertise for inclusion on the Steering Committee, NQF had an additional 10-day nominations period for the Cardiovascular Endorsement and Maintenance 2010 project.
The additional Call for Nominations for Steering Committee members closed on November 19, 2010. For more information on the Steering Committee formation process, please refer the Additional Call for Nominations (PDF) document.
The 21-day review period for submitted nominees closed on January 6, 2011. Members and the public were able to provide feedback on the proposed roster and identified gaps in the committee representation. NQF has identified and is working to ensure representation from purchasers, Medicaid and pharmacy.
Cardiovascular Endorsement Maintenance 2010 is a phased project, encompassing two separate Calls for Measures, Phase 1 and Phase 2. NQF issued a Call for Candidate Standards for Phase 1 and Phase 2 of this project.
This project includes maintenance review of 47 cardiovascular consensus standards. As a part of the maintenance review process, NQF sought comments on the implementation and use of these measures, particularly all stakeholders' experiences with the measures. For additional information, refer to the Call for Implementation Comments document.
The Steering Committee began meeting in January 2011 to evaluate the submissions and prepare the draft report.
Coronary Artery Disease - Secondary Prevention
- 0076 optimal vascular care (MNCM)
- 0073 IVD: blood pressure management (NCQA
- 1486 Chronic stable coronary artery disease: blood pressure control
- 0068 IVD: use of aspirin or antithrombotics (NCQA)
- 0067 CAD: antiplatlet therapy (PCPI)
- 0075 IVD- complete lipid profile and LDL control <100 (NCQA)
- 0074 Chronic stable coronary artery disease: lipid control (PCPI)
- 0066 CAD: ACEI/ARB therapy (PCPI)
- 0071 AMI --persistence of BB therapy (NCQA)
- 0070 CAD: beta blocker – prior MI (PCPI)
- 0065 CAD: symptoms and assessment (PCPI)
Coronary Artery Disease - Acute Phase: Acute Myocardial Infarction and Percutaneous Coronary Intervention
- 0289 Median to ECG [ for patients being transferred] (CMS)
- 0286 Aspirin at arrival [ for patients being transferred] (CMS)
- 0288 Fibrinolytic therapy received within 30 minutes of ED arrival
- 0287 Median time to fibrinolysis [for patients being transferred] (CMS)
- 0290 Median time to transfer to another facility (CMS)
- 0132 Aspirin at arrival for AMI (CMS)
- 0163 Primary PCI within 90 minutes of arrival (CMS)
- 0164 Fibrinolytic therapy received within 30 minutes (CMS)
- 0137 ACEI/ARB at discharge for AMI (CMS)
- 0160 Beta blocker prescribed at discharge (CMS)
- 0142 Aspirin prescribed at discharge for AMI (CMS)
- 0961 AMI hospital composite (CMS)
- 0230 AMI 30-day mortality (CMS) (revised)
- 0355 Bilateral cardiac cath rate (IQI 25) (AHRQ)
- 1495 P2Y12 inhibitor at discharge for PCI (ACCF)
- 1493 Aspirin at discharge for PCI (ACCF)
- 1498 Statins at discharge for PCI (ACCF)
- 0964 Therapy with aspirin, P2Y12 inhibitor and statin at discharge (ACCF)
- 0133 PCI mortality (ACC)
- 0282 Angina without procedure (PQI 13) (AHRQ)
Coronary Artery Disease - Cardiac Rehabilitation
- 1496 Cardiac rehab – safety standards (AACVPR/ACCF/AHA)
- 1494 Cardiac rehab – response to therapy (AACVPR/ACCF/AHA)
- 1497 Cardiac rehab – risk for adverse events (AACVPR/ACCF/AHA)
- 0960 Cardiac rehab composite (AACVPR/ACCF/AHA)
Atrial Fibrillation
- 1524 Assessment of Thromboembolic Risk (PCPI)
- 1525 Chronic anticoagulation therapy (PCPI)
- 1505 Adult patients with atrial fibrillation taking amiodarone that had serum ALT or AST test in last reported 12 months (Ingenix)
ICD Implants
- 1522 ACE/ARB Therapy at Discharge for ICD implant patients with LVSD (ACCF)
- 1528 Beta blocker at discharge for ICD implant patients with a previous MI (ACCF)
- 1529 Beta blocker at discharge for ICD implant patients with LVSD (ACCF)
- 0965 Therapy with ACE/ARB and beta blocker at discharge following ICD implantation (ACCF)
- 1530 Prophylactic antibiotics prior to ICD (lead or implant) procedure (ACCF)
Heart Failure
- 0079 Heart Failure: Left Ventricular Ejection Fraction Assessment (outpatient setting) (PCPI)
- 0077 Heart Failure: Symptom and Activity Assessment (PCPI)
- 0081 Heart Failure: ACEI or ARB therapy for left ventricular systolic dysfunction (PCPI)
- 0136 Heart Failure: Discharge instructions
- 0083 Heart Failure: Beta-blocker therapy for left ventricular systolic dysfunction (PCPI)
- 0135 Evaluation of left ventricular systolic dysfunction (CMS)
- 0162 ACEI or ARB for left ventricular (CMS)
- 0277 CHF admission (PQI 8) (AHRQ)
- 0358 Heart failure in-patient mortality (AHRQ)
- 0229 Hospital 30-day, all-cause, risk standardized mortality rate (RSMR) following heart failure hospitalization (CMS) (revised)
- 0330 30-day, all-cause risk standardized readmission rate following heart failure hospitalization (risk adjusted) (CMS) (revised)
- 0962 Composite Measure of Hospital Quality for Heart Failure (CMS)
Hypertension
- 0018 Controlling high blood pressure (NCQA)
- 0013 Hypertension: Blood Pressure Control (PCPI/ACC)
- 0276 Hypertension (PQI 7) (AHRQ)
The Steering Committee met on February 15-16, 2011. The meeting was open to NQF Members and public. It was held at the Conference and Meeting Center of the American Immigration Lawyers Association, in Washington, DC.
Measures reviewed:
The Steering Committee met on April 7-8, 2011 to review Phase 2 measures.
Measures Reviewed:
The Steering Committee met via conference call on May 11, 2011.
The Steering Committee met via conference call on June 7, 2011.
The draft report has been revised based on the comments received during the Public and Member Comment and consultation with the Steering Committee. The member voting period closed on October 20, 2011.
Project
staff will host a voting webinar on Wednesday, October 5 from
2:00 - 4:00 pm with a member of CSAC and a co-chair from the committee.
Members and the public will have another opportunity to voice their
opinions about the measures and ask the Committee co-chair questions.
This meeting is open to members and the public.
The measure specifications for Acute Myocardial Infarction Mortality (0230), Heart Failure Mortality (0229) and Heart Failure Readmission (0330) have been revised based on the comments received during the Public and Member Comment and consultation with the Steering Committee. The member voting period closed on December 5, 2011.
CSAC met November 2-3; during this meeting, it considered endorsement of the cardiovascular measures.
CSAC met via conference call on December 12 to consider endorsement of the three revised measures.
Review the CSAC Meetings
The public had 30 days to appeal the final decision to endorse the 39 cardiovascular measures. No appeals were filed during this time.
