Ischemic Vascular Disease (IVD): Use of Aspirin or another Antithrombotic (NQF 0068)

eMeasure Name Ischemic Vascular Disease (IVD): Use of Aspirin or another Antithrombotic eMeasure Id e13325dc-6b27-4c5c-b8be-3202f0411fa5
Version number 1 eMeasure Set Id 491753f1-1524-4873-892f-4b44d0ac42cb
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward National Committee for Quality Assurance
Endorsed by National Quality Forum
Description The percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA) from January 1 - November 1 of the year prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to the measurement year and who had documentation of use of aspirin or another antithrombotic during the measurement year.
Copyright
© National Committee for Quality Assurance. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
This measure assesses the percentage of patients in a specific age demographic who were diagnosed with ischemic vascular disease (IVD) and demonstrated the utilization of aspirin or another antithrombotic to prevent coronary heart disease (CHD). IVD and related conditions had an estimated cost burden of $393.5 billion in 2005 (AHA 2005). The disease burden is also noteworthy, with CHD being an underlying or contributing cause of death for 451,300 people, accounting for 1 of every 5 deaths in the United States in 2004 (AHA 2008). The National Commission on Prevention Priorities (NCPP) determined that aspirin therapy is the most highly utilized and most effective clinical preventable service in preventing CHD (Maciosek 2006). Studies support this statement: aspirin therapy is shown to have directly reduced the odds of cardiovascular events among men by 14% and among women by 12% (Berger 2006). Additionally, aspirin use reduced the number of strokes by 20% and the number of myocardial infarctions and other vascular events by 30% (Weisman 2002). This measure facilitates long-term management of IVD through aspirin or another antithrombotic to prevent CHD.
Clinical Recommendation Statement
USPSTF:  The U.S. Preventive Services Task Force (USPSTF) strongly recommends that clinicians discuss aspirin chemoprevention with adults who are at increased risk (5-year risk of greater than or equal to 3 percent) for coronary heart disease (CHD). Discussions with patients should address both the potential benefits and harms of aspirin therapy. ('A' recommendation) The USPSTF recommends the use of aspirin for men age 45 to 79 years when the potential benefit due to a reduction in myocardial infarctions outweighs the potential harm due to an increase in gastrointestinal hemorrhage ('A' recommendation).  The USPSTF recommends the use of aspirin for women age 55 to 79 years when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage. ('A' recommendation)
                
ADA:  Use aspirin therapy (75-162 mg/day) as a secondary prevention strategy in those with diabetes with a history of CVD.  (Level A).  Use aspirin therapy (75-162 mg/day) as a primary prevention strategy in those with type 1 or 2 diabetes at increased cardiovascular risk, including those who are 40 years of age or who have additional risk factors (family history of CVD, hypertension, smoking, dyslipidemia, or albuminuria). (Level A)

AHA/ACC:  Start aspirin 75 to 162 mg/d and continue indefinitely in all patients with coronary and other vascular disease unless contraindicated.  (Class I, Level A)

AHA/ASA:  The use of aspirin is recommended for cardiovascular (including but not specific to stroke) prophylaxis among persons whose risk is sufficiently high for the benefits to outweigh the risks associated with treatment (a 10-year risk of cardiovascular events of 6% to 10%). (Class I: Level A)

ACCP:  For long-term treatment after PCI, the guideline developers recommend aspirin, 75 to 162 mg/day. (Grade 1A)  For long-term treatment after PCI in patients who receive antithrombotic agents such as clopidogrel or warfarin, the guideline developers recommend lower-dose aspirin, 75 to 100 mg/day. (Grade 1C+)  For patients with ischemic stroke who are not receiving thrombolysis, the guideline developers recommend early aspirin therapy, 160 to 325 mg/day. (Grade 1A)
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
American Diabetes Association. Standards of Medical Care in Diabetes - 2008. Diabetes Care 31:S12-S54, 2008.
Reference
American Heart Association. Heart Disease and Stroke Statistics - 2008 Update. http://www.americanheart.org/downloadable/heart/1200082005246HS_Stats%202008.final.pdfAccessed: Accessed 15 Jul 2008.
Reference
Aspirin for the Prevention of Cardiovascular Disease, Topic Page. December 2009. U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf/uspsasmi.htm
Definition
Initial Patient Population(s): All patients 18 years of age and older during the measurement period
Definition
Denominator(s): Patients in the initial population with an active diagnosis of ischemic vascular disease (IVD) during the measurement period or in the 12 months prior to the measurement period, or who have been discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA) on or between January 1 and November 1 of the year prior to the measurement period
Definition
Denominator Exclusion(s): N/A
Definition
Numerator(s): The number of patients who had documentation of use of aspirin or another antithrombotic during the measurement period
Definition
Denominator Exception(s): N/A
Guidance
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