Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD (NQF 0067)

eMeasure Name Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD eMeasure Id CFFD2C4D-503B-43CA-A050-7893A497750F
Version number 1 eMeasure Set Id 27A45F8D-4089-4BA5-877D-B16A1EDABB2D
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward American Medical Association - Physician Consortium for Performance Improvement
Endorsed by National Quality Forum
Description Percentage of patients aged 18 years and older with a diagnosis of CAD who were prescribed oral antiplatelet therapy
Copyright
© 2010 American Medical Association. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
Oral antiplatelet therapy is recommended for all patients with coronary artery disease. By limiting the ability of clots to form in the arteries, antiplatelet agents have proven benefits in reducing the risk of non-fatal myocardial infarction, non-fatal stroke and death.
Clinical Recommendation Statement
Chronic Stable Angina: Class I – Aspirin 75-325 mg daily should be used routinely in all patients with acute and chronic ischemic heart disease with or without manifest symptoms in the absence of contraindications. Class IIa – Clopidogrel is recommended when aspirin is absolutely contraindicated. Class III – Dipyridamole. Because even the usual oral doses of dipyridamole can enhance exercise-induced myocardial ischemia in patients with stable angina, it should not be used as an antiplatelet agent (ACC/AHA/ACP-ASIM).

Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: Class I – Aspirin 75 to 325 mg/dl in the absence of contraindications. Class I – Clopidogrel 75 qd for patients with a contraindication to ASA (ACC/AHA).

Acute Myocardial Infarction (AMI): Class I – A dose of aspirin, 160 to 325 mg, should be given on day one of AMI and continued indefinitely on a daily basis thereafter. Trials suggest long-term use of aspirin in the postinfarction patient in a dose as low as 75 mg per day can be effective, with the likelihood that side effects can be reduced. Class IIb – Other antiplatelet agents such as dipyridamole, ticlopidine or clopidogrel may be substituted if true aspirin allergy is present or if the patient is unresponsive to aspirin (ACC/AHA).

Coronary Artery Bypass Graft Surgery: Aspirin is the drug of choice for prophylaxis against early saphenous graft thrombotic closure and should be considered a standard of care for the first postoperative year. In general, patients are continued on aspirin indefinitely, given its benefit in the secondary prevention of AMI. Ticlopidine is efficacious but offers no advantage over aspirin except as an alternative in the truly aspirin-allergic patient. Clopidogrel offers the potential of fewer side effects compared with ticlopidine as an alternative to aspirin for platelet inhibition. Indobufen appears to be as effective as aspirin for saphenous graft patency over the first postoperative year but with fewer gastrointestinal side effects. Current evidence suggests that dipyridamole adds nothing to the aspirin effect for saphenous graft patency (ACC/AHA).
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
Gibbons RJ, Chatterjee K, Daley J, et al. American College of Cardiology/American Heart Association/American College of Physicians-American Society of Internal Medicine guidelines for the management of patients with chronic stable angina: A report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients with Chronic Stable Angina). J Am Coll Cardiol. 1999;33:2092-2197.
Reference
Brunwald E, Antman EM, Beasley JW, et al. ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients with Unstable Angina). J Am Coll Cardiol. 2000;36:970-1062.
Reference
Ryan RJ, Antman EM, Brooks NH, et al. 1999 update: ACC/AHA guidelines for the management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on Management of Acute Myocardial Infarction). J Am Coll Cardiol. 1999;34:890-911.
Reference
Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA guidelines for coronary artery bypass graft surgery: A report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee to Revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery). J Am Coll Cardiol. 1999;34:1262-1347.
Definition
Initial Patient Population(s): Patient Age:  Patients aged 18 years and older at the beginning of the measurement period.
Diagnosis, Active:  Patient has a documented diagnosis of coronary artery disease.
Encounter:  At least 2 ambulatory visits (or 1 inpatient discharge) with the physician, physician's assistant, or nurse practitioner during the measurement period.
Definition
Denominator(s): All patients aged 18 years and older with a diagnosis of coronary artery disease.
Definition
Denominator Exclusion(s): N/A
Definition
Numerator(s): Patients who were prescribed oral antiplatelet therapy.
Definition
Denominator Exception(s): Documentation of medical reason(s) for not prescribing oral antiplatelet therapy (eg, clinical contraindication, drug allergy, drug interaction, drug intolerance, other medical reason(s).

Documentation of patient reason(s) for not prescribing oral antiplatelet therapy (eg, patient declined).

Documentation of system reason(s) for not prescribing oral antiplatelet therapy
Guidance
The denominator criteria for the measure indicates the patient must have either a  diagnosis of coronary artery disease as defined by the value set "Coronary Artery Disease includes MI" or prior cardiac surgery defined by the value set "Cardiac Surgery" at any time prior the encounter specified in the measure.  The diagnosis  of CAD or date of cardiac surgery does not need to have occurred during the measurement period. The denominator does specify that there must be the listed number of encounters during the measurement period to connect the patient to the provider being measured.
Supplemental Data Elements
Report "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"; Report "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"; Report "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"; Report "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)".

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012