Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) (NQF 0070)

eMeasure Name Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) eMeasure Id d46da643-5c8a-4c9c-a7d4-9d7ce38a793d
Version number 1 eMeasure Set Id 9135ef83-2a62-41b2-9fea-b641e1ef09ae
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 and prior MI who were prescribed beta-blocker therapy.
Copyright
© 2010 American Medical Association. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
In the absence of contraindications, beta-blocker therapy has been shown to reduce the risk of a recurrent MI and decrease mortality for those patients with a prior MI.
Clinical Recommendation Statement
Chronic Stable Angina: Class I - Beta-blockers as initial therapy in the absence of contraindications in patients with prior MI. Class I - Beta-blockers as initial therapy in the absence of contraindications in patients without prior MI (ACC/AHA/ACP-ASIM).

Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: Class I - Drugs required in the hospital to control ischemia should be continued after hospital discharge in patients who do not undergo coronary revascularization, patients with unsuccessful revascularization, or patients with recurrent symptoms after revascularization. Upward or downward titration of the doses may be required. Class I - Beta-blockers in the absence of contraindications (ACC/AHA).

Acute Myocardial Infarction: Class I - All but low-risk patients without a clear contraindication to β-adrenoceptor blocker therapy. Treatment should begin within a few days of the event (if not initiated acutely) and continue indefinitely. Class IIa - Low-risk patients without a clear contraindication to β-adrenoceptor blocker therapy. Survivors of non-ST-elevation MI. Class IIb - Patients with moderate or severe LV failure or other relative contraindications to β-adrenoceptor blocker therapy, provided they can be monitored closely (ACC/AHA).

Although no study has determined if long-term β-adrenoceptor blocker therapy should be administered to survivors of MI who subsequently have satisfactorily undergone revascularization, there is no reason to believe that these agents act differently in coronary patients who have undergone revascularization (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
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.
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 and who also have prior MI

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): Patients aged 18 years and older with a diagnosis of coronary artery disease who also have prior myocardial infarction (MI) at any time.
Definition
Denominator Exclusion(s): N/A
Definition
Numerator(s): Patients who were prescribed beta-blocker therapy.
Definition
Denominator Exception(s): Documentation of medical reason(s) for not prescribing beta blocker therapy (eg, clinical contraindication, drug allergy, drug interaction, drug intolerance, other medical reason(s)).

Documentation of patient reason(s) for not prescribing beta blocker therapy (eg, patient declined).

Documentation of system reason(s) for not prescribing beta blocker 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