Coronary Artery Disease (CAD): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Patients with CAD and Diabetes and/or Left Ventricular Systolic Dysfunction (LVSD) (NQF 0066)

eMeasure Name Coronary Artery Disease (CAD): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Patients with CAD and Diabetes and/or Left Ventricular Systolic Dysfunction (LVSD) eMeasure Id F9E7B3E8-0033-4D3D-835B-CE87BDB8B118
Version number 1 eMeasure Set Id 234DE8F9-71FB-4A88-BBF3-3D7BD71CBEF4
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 also have diabetes and/or left ventricular systolic dysfunction (LVSD) who were prescribed ACE Inhibitor or ARB 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, ACE inhibitors or ARBs are recommended for patients with coronary artery disease; especially those with diabetes and /or left ventricular systolic dysfunction.  ACE inhibitors and ARBs have shown to decrease morbidity and mortality, including significant reductions in the occurrence of myocardial infarction, stroke, and diabetic complications.
Clinical Recommendation Statement
ACE inhibitor use is recommended in all patients with CAD who also have diabetes and/or left ventricular systolic dysfunction. (ACC/AHA)

ACE inhibitor use is also recommended in patients with CAD or other vascular disease. (ACC/AHA)

In ST elevation myocardial infarction (STEMI) patients who tolerate ACE inhibitors, an angiotensin receptor blocker (ARB) can be useful as an alternative to ACE inhibitors in the long-term management of STEMI patients, provided there are either clinical or radiological signs of heart failure or LVEF less than 0.40. (ACC/AHA)
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
Gibbons RJ, Abrams J, Chatterjee K, et al. American College of Cardiology/American Heart Association 2002 Guideline Update for the Management of Patients with Chronic Stable Angina-Summary Article. 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). JACC. 2003;41(1):159-68.
Reference
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.
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 face-to-face office visits with physician, physicians' assistant, or nurse practitioner occurring during the measurement time period.
Definition
Denominator(s): All patients aged 18 years and older with a diagnosis of CAD who also have diabetes and/or LVSD.
Definition
Denominator Exclusion(s): N/A
Definition
Numerator(s): Patients who were prescribed ACE inhibitor or ARB therapy.
Definition
Denominator Exception(s): 
Documentation of medical reason(s) for not prescribing angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy (eg, clinical contraindication, drug allergy, drug interaction, drug intolerance, other medical reason(s)). 
Documentation of patient reason(s) for not prescribing angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy (eg, patient declined). 
Documentation of system reason(s) for not prescribing angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) 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