Statin Therapy for the Prevention and Treatment of Cardiovascular Disease
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| Measure Information | 2023 Performance Period | 2024 Performance Period | 2025 Performance Period |
|---|---|---|---|
| Title | Statin Therapy for the Prevention and Treatment of Cardiovascular Disease | Statin Therapy for the Prevention and Treatment of Cardiovascular Disease | Statin Therapy for the Prevention and Treatment of Cardiovascular Disease |
| CMS eCQM ID | CMS347v6 | CMS347v7 | CMS347v8 |
| CBE ID* | Not Applicable | Not Applicable | Not Applicable |
| MIPS Quality ID | 438 | 438 | 438 |
| Measure Steward | Centers for Medicare & Medicaid Services (CMS) | Centers for Medicare & Medicaid Services (CMS) | Centers for Medicare & Medicaid Services (CMS) |
| Description |
Percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period: *All patients with an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD) or ever had an ASCVD procedure; OR *Patients aged >= 20 years who have ever had a low-density lipoprotein cholesterol (LDL-C) level >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia; OR *Patients aged 40-75 years with a diagnosis of diabetes |
Percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period: - All patients who were previously diagnosed with or currently have a diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD), including an ASCVD procedure; OR - Patients aged 20 to 75 years who have ever had a low-density lipoprotein cholesterol (LDL-C) level >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia; OR - Patients aged 40-75 years with a diagnosis of diabetes; OR - Patients aged 40 to 75 with a 10-year ASCVD risk score of >= 20 percent |
Percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period: - All patients who were previously diagnosed with or currently have a diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD), including an ASCVD procedure; OR - Patients aged 20 to 75 years who have ever had a low-density lipoprotein cholesterol (LDL-C) level >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia; OR - Patients aged 40-75 years with a diagnosis of diabetes; OR - Patients aged 40 to 75 with a 10-year ASCVD risk score of >= 20 percent. |
| Measure Scoring | Proportion measure | Proportion measure | Proportion measure |
| Measure Type | Process | Process | Process |
| Stratification | *See CMS347v6.html |
None |
None |
| Risk Adjustment | *See CMS347v6.html |
None |
None |
| Rationale | *See CMS347v6.html |
"Cardiovascular disease (CVD) is the leading cause of death in the United States, causing approximately 1 of every 3 deaths in the United States in 2015. In 2015, stroke caused approximately 1 of every 19 deaths in the United States and the estimated annual costs for CVD and stroke were $329.7 billion, including $199.2 billion in direct costs (hospital services, physicians and other professionals, prescribed medications, home health care, and other medical durables) and $130.5 billion in indirect costs from lost future productivity (cardiovascular and stroke premature deaths). CVD costs more than any other diagnostic group" (Benjamin et al., 2018). Data collected between 2011 and 2014 indicates that more than 94.6 million U.S. adults, 20 years or older, had total cholesterol levels equal to 200 mg/dL or more, while almost 28.5 million had levels 240 mg/dL or more (Benjamin et al., 2018). Elevated blood cholesterol is a major risk factor for CVD and statin therapy has been associated with a reduced risk of CVD. Numerous randomized trials have demonstrated that treatment with a statin reduces LDL-C and reduces the risk of major cardiovascular events by approximately 20 percent (Ference, 2015). In 2018, updated guidelines on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults were published (Grundy et al., 2019). This guideline was published by an Expert Panel, which synthesized evidence from randomized controlled trials to identify people most likely to benefit from cholesterol-lowering therapy. The American College of Cardiology (ACC)/American Heart Association (AHA)/Multi-society (MS) Guideline recommendations are intended to provide a strong evidence-based foundation for the treatment of blood cholesterol for the primary and secondary prevention and treatment of ASCVD in patients of all ages. The document concludes that the addition of statin therapy reduces the risk of ASCVD among high-risk individuals, defined as follows: individuals with clinical ASCVD, with LDL-C >= 190 mg/dL, with diabetes, or individuals with >= 20% risk of ASCVD as determined via use of an ASCVD risk estimator derived from the Pooled Cohort Equations (Grundy et al., 2019). One study surveying U.S. cardiology, primary care, and endocrinology practices found that 1 in 4 guideline-eligible patients were not on a statin and less than half were on the recommended statin intensity. Untreated and undertreated patients had significantly higher LDL-C levels than those receiving guideline-directed statin treatment (Navar et al., 2017). In a follow-up study authored by Nanna et al., the same clinics were divided into tertiles based on the percentage of patients with guideline-recommended statin use. The researchers found that patients in the high-tertile clinics were more likely to achieve target LDL-C levels than patients at the low- or mid-tertile clinics, and this held true when patients were stratified by primary and secondary prevention (Nanna et al., 2019a). Research also indicates that certain populations are far less likely to receive guideline-recommended statin therapy than others. A retrospective study of the National Health and Nutrition Examination Survey found that Black and Hispanic race or ethnicity, low income, lack of health insurance coverage, poor health care access, young age, and female gender are predictors of lower statin utilization (Gu et al., 2018). In particular, there is extensive evidence that women are far less likely than men to be prescribed guideline-recommended statin therapy (Nanna et al., 2019b), despite research showing that female patients with cardiovascular disease derive the same or greater benefit from statin therapy as male patients with cardiovascular disease (Puri et al., 2014). The Statin Safety Expert Panel that participated in a National Lipid Association (NLA) Statin Safety Task Force meeting in October 2013 reaffirms the general safety of statin therapy. The panel members concluded that for most patients requiring statin therapy, the potential benefits of statin therapy outweigh the potential risks. In general terms, the benefits of statins to prevent non-fatal myocardial infarction, revascularization, stroke, and CVD mortality, far outweigh any potential harm related to the drug (Jacobson, 2014). |
"Cardiovascular disease (CVD) is the leading cause of death in the United States, causing approximately 1 of every 3 deaths in the United States in 2015. In 2015, stroke caused approximately 1 of every 19 deaths in the United States and the estimated annual costs for CVD and stroke were $329.7 billion, including $199.2 billion in direct costs (hospital services, physicians and other professionals, prescribed medications, home health care, and other medical durables) and $130.5 billion in indirect costs from lost future productivity (cardiovascular and stroke premature deaths). CVD costs more than any other diagnostic group" (Benjamin et al., 2018). Data collected between 2011 and 2014 indicates that more than 94.6 million U.S. adults, 20 years or older, had total cholesterol levels equal to 200 mg/dL or more, while almost 28.5 million had levels 240 mg/dL or more (Benjamin et al., 2018). Elevated blood cholesterol is a major risk factor for CVD and statin therapy has been associated with a reduced risk of CVD. Numerous randomized trials have demonstrated that treatment with a statin reduces LDL-C and reduces the risk of major cardiovascular events by approximately 20 percent (Ference, 2015). In 2018, updated guidelines on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults were published (Grundy et al., 2019). This guideline was published by an Expert Panel, which synthesized evidence from randomized controlled trials to identify people most likely to benefit from cholesterol-lowering therapy. The American College of Cardiology (ACC)/American Heart Association (AHA)/Multi-society (MS) Guideline recommendations are intended to provide a strong evidence-based foundation for the treatment of blood cholesterol for the primary and secondary prevention and treatment of ASCVD in patients of all ages. The document concludes that the addition of statin therapy reduces the risk of ASCVD among high-risk individuals, defined as follows: individuals with clinical ASCVD, with LDL-C >= 190 mg/dL, with diabetes, or individuals with >= 20 percent risk of ASCVD as determined via use of an ASCVD risk estimator derived from the Pooled Cohort Equations (Grundy et al., 2019). One study surveying U.S. cardiology, primary care, and endocrinology practices found that 1 in 4 guideline-eligible patients were not on a statin and less than half were on the recommended statin intensity. Untreated and undertreated patients had significantly higher LDL-C levels than those receiving guideline-directed statin treatment (Navar et al., 2017). In a follow-up study authored by Nanna et al., the same clinics were divided into tertiles based on the percentage of patients with guideline-recommended statin use. The researchers found that patients in the high-tertile clinics were more likely to achieve target LDL-C levels than patients at the low- or mid-tertile clinics, and this held true when patients were stratified by primary and secondary prevention (Nanna et al., 2019a). Research also indicates that certain populations are far less likely to receive guideline-recommended statin therapy than others. A retrospective study of the National Health and Nutrition Examination Survey found that Black and Hispanic race or ethnicity, low income, lack of health insurance coverage, poor health care access, young age, and female gender are predictors of lower statin utilization (Gu et al., 2018). In particular, there is extensive evidence that women are far less likely than men to be prescribed guideline-recommended statin therapy (Nanna et al., 2019b), despite research showing that female patients with cardiovascular disease derive the same or greater benefit from statin therapy as male patients with cardiovascular disease (Puri et al., 2014). The Statin Safety Expert Panel that participated in a National Lipid Association (NLA) Statin Safety Task Force meeting in October 2013 reaffirms the general safety of statin therapy. The panel members concluded that for most patients requiring statin therapy, the potential benefits of statin therapy outweigh the potential risks. In general terms, the benefits of statins to prevent non-fatal myocardial infarction, revascularization, stroke, and CVD mortality, far outweigh any potential harm related to the drug (Jacobson, 2014). |
| Clinical Recommendation Statement | *See CMS347v6.html |
This electronic clinical quality measure is intended to align with the 2018 ACC/AHA/MS Guideline on the Management of Blood Cholesterol (Grundy et al., 2019), which indicates the use of statins as the first line of cholesterol-lowering medication therapy to lower the risk of ASCVD among at-risk populations. Recommendations for Management of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults - Statin Treatment: Secondary Prevention: 1. In patients who are 75 years of age or younger with clinical ASCVD, high-intensity statin therapy should be initiated or continued with the aim of achieving a 50% or greater reduction in LDL-C levels (Class I Recommendation), (Grundy et al., 2019). 2. In patients with clinical ASCVD in whom high-intensity statin therapy is contraindicated or who experience statin-associated side effects, moderate-intensity statin therapy should be initiated or continued with the aim of achieving a 30% to 49% reduction in LDL-C levels (Class I Recommendation), (Grundy et al., 2019). 3. In patients older than 75 years of age with clinical ASCVD, it is reasonable to initiate moderate- or high-intensity statin therapy after evaluation of the potential for ASCVD risk reduction, adverse effects, and drug–drug interactions, as well as patient frailty and patient preferences (Class IIa Recommendation), (Grundy et al., 2019). Primary Prevention 1. In patients 20 to 75 years of age with an LDL-C level of 190 mg/dL or higher (>= 4.9 mmol/L), maximally tolerated statin therapy is recommended. (Class I Recommendation), (Grundy et al., 2019). 2. In adults 40 to 75 years of age with diabetes mellitus, regardless of estimated 10-year ASCVD risk, moderate-intensity statin therapy is indicated (Class I Recommendation), (Grundy et al., 2019). 3. To facilitate decisions about preventive interventions, it is recommended to screen for traditional ASCVD risk factors and apply the race- and sex-specific Pooled Cohort Equations (PCE) to estimate 10-year ASCVD risk for asymptomatic adults 40 to 75 years of age. The higher the estimated risk, the more likely the patient is to benefit from statin treatment (Grundy et al., 2019). The US Preventive Services Task Force (USPSTF) concludes with moderate certainty that statin use for the prevention of CVD events and all-cause mortality in adults aged 40 to 75 years with no history of CVD and who have 1 or more of these CVD risk factors and an estimated 10-year CVD event risk of 7.5% to less than 10% has at least a small net benefit (USPSTF 2022). Statin Safety and Statin-Associated Side Effects A clinician–patient risk discussion is recommended before initiation of statin therapy to review net clinical benefit, weighing the potential for ASCVD risk reduction against the potential for statin-associated side effects, statin–drug interactions, and safety, while emphasizing that side effects can be addressed successfully (Class I Recommendation), (Grundy et al., 2019). |
This electronic clinical quality measure is intended to align with the 2018 ACC/AHA/MS Guideline on the Management of Blood Cholesterol (Grundy et al., 2019), which indicates the use of statins as the first line of cholesterol-lowering medication therapy to lower the risk of ASCVD among at-risk populations. Recommendations for Management of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults - Statin Treatment: Secondary Prevention: 1. In patients who are 75 years of age or younger with clinical ASCVD, high-intensity statin therapy should be initiated or continued with the aim of achieving a 50 percent or greater reduction in LDL-C levels (Class I Recommendation), (Grundy et al., 2019). 2. In patients with clinical ASCVD in whom high-intensity statin therapy is contraindicated or who experience statin-associated side effects, moderate-intensity statin therapy should be initiated or continued with the aim of achieving a 30 to 49 percent reduction in LDL-C levels (Class I Recommendation), (Grundy et al., 2019). 3. In patients older than 75 years of age with clinical ASCVD, it is reasonable to initiate moderate- or high-intensity statin therapy after evaluation of the potential for ASCVD risk reduction, adverse effects, and drug–drug interactions, as well as patient frailty and patient preferences (Class IIa Recommendation), (Grundy et al., 2019). Primary Prevention 1. In patients 20 to 75 years of age with an LDL-C level of 190 mg/dL or higher (>= 4.9 mmol/L), maximally tolerated statin therapy is recommended. (Class I Recommendation), (Grundy et al., 2019). 2. In adults 40 to 75 years of age with diabetes mellitus, regardless of estimated 10-year ASCVD risk, moderate-intensity statin therapy is indicated (Class I Recommendation), (Grundy et al., 2019). 3. To facilitate decisions about preventive interventions, it is recommended to screen for traditional ASCVD risk factors and apply the race- and sex-specific Pooled Cohort Equations (PCE) to estimate 10-year ASCVD risk for asymptomatic adults 40 to 75 years of age. The higher the estimated risk, the more likely the patient is to benefit from statin treatment (Grundy et al., 2019). The US Preventive Services Task Force (USPSTF) concludes with moderate certainty that statin use for the prevention of CVD events and all-cause mortality in adults aged 40 to 75 years with no history of CVD and who have 1 or more of these CVD risk factors and an estimated 10-year CVD event risk of 7.5 percent to less than 10 percent has at least a small net benefit (USPSTF 2022). Statin Safety and Statin-Associated Side Effects A clinician–patient risk discussion is recommended before initiation of statin therapy to review net clinical benefit, weighing the potential for ASCVD risk reduction against the potential for statin-associated side effects, statin–drug interactions, and safety, while emphasizing that side effects can be addressed successfully (Class I Recommendation), (Grundy et al., 2019). |
| Improvement Notation |
Higher score indicates better quality |
Higher score indicates better quality |
Higher score indicates better quality |
| Definition | *See CMS347v6.html |
Clinical atherosclerotic cardiovascular disease (ASCVD) includes: - Acute coronary syndromes - History of myocardial infarction - Stable or unstable angina - Coronary or other arterial revascularization - Stroke or transient ischemic attack (TIA) - Peripheral arterial disease of atherosclerotic origin Lipoprotein density cholesterol (LDL-C) result: - A fasting or non-fasting LDL-C laboratory test performed and direct or calculated test result documented in the medical record. When both direct and calculated test results are available on the same day, the direct LDL-C test result should be used. Statin therapy: - Administration of one or more of a group of medications that are used to lower plasma lipoprotein levels in the treatment of hyperlipoproteinemia. Statin Medication Therapy List (NOTE: List does NOT include dosage): [Generic name] (Brand or trade name) and (-) Medication type, if applicable: [Atorvastatin] (Lipitor) - Statin [Fluvastatin] (Lescol XL or Lescol) - Statin [Lovastatin (Mevinolin)](Mevacor or Altoprev) -Statin [Pitavastatin] (Livalo or Zypitamag or Nikita) - Statin [Pravastatin Sodium] (Pravachol) - Statin [Rosuvastatin Calcium] (Crestor) - Statin [Simvastatin] (Zocor) - Statin [Amlodipine Besylate/Atorvastatin Calcium] (Caduet) – Fixed Dose Combination [Ezetimibe / Rosuvastatin] (Roszet) – Fixed Dose Combination [Ezetimibe/Simvastatin] (Vytorin) – Fixed Dose Combination Statin-Associated Muscle Symptoms (SAMS) – The 2018 ACC/AHA/MS Guideline (Grundy et al., 2019) includes the following SAMS: myalgias, myositis, myopathy, or statin-associated autoimmune myopathy. Patients who experience significant or repeated statin-associated muscle symptoms may prefer not to take or continue statin therapy and therefore may be removed from the denominator. |
Clinical atherosclerotic cardiovascular disease (ASCVD) includes: - Acute coronary syndromes - History of myocardial infarction - Stable or unstable angina - Coronary or other arterial revascularization - Stroke or transient ischemic attack (TIA) - Peripheral arterial disease of atherosclerotic origin Lipoprotein density cholesterol (LDL-C) result: - A fasting or non-fasting LDL-C laboratory test performed and direct or calculated test result documented in the medical record. When both direct and calculated test results are available on the same day, the direct LDL-C test result should be used. Statin therapy: - Administration of one or more of a group of medications that are used to lower plasma lipoprotein levels in the treatment of hyperlipoproteinemia. Statin Medication Therapy List (NOTE: List does NOT include dosage): [Generic name] (Brand or trade name) and (-) Medication type, if applicable: [Atorvastatin] (Lipitor) - Statin [Fluvastatin] (Lescol XL or Lescol) - Statin [Lovastatin (Mevinolin)](Mevacor or Altoprev) - Statin [Pitavastatin] (Livalo or Zypitamag or Nikita) - Statin [Pravastatin Sodium] (Pravachol) - Statin [Rosuvastatin Calcium] (Crestor) - Statin [Simvastatin] (Zocor) - Statin [Amlodipine Besylate/Atorvastatin Calcium] (Caduet) – Fixed Dose Combination [Ezetimibe / Rosuvastatin] (Roszet) – Fixed Dose Combination [Ezetimibe/Simvastatin] (Vytorin) – Fixed Dose Combination Statin-Associated Muscle Symptoms (SAMS) – The 2018 ACC/AHA/MS Guideline (Grundy et al., 2019) includes the following SAMS: myalgias, myositis, myopathy, or statin-associated autoimmune myopathy. Patients who experience significant or repeated statin-associated muscle symptoms may prefer not to take or continue statin therapy and therefore may be removed from the denominator. |
| Guidance |
Initial Population Guidance: The initial population covers three distinct populations. Use the following process to prevent counting patients more than once. Initial Population 1: All patients who have an active diagnosis of clinical ASCVD anytime during the measurement period or ever had an ASCVD procedure. -If YES, meets Initial Population 1 risk category -If NO, screen for next risk category Initial Population 2: Patients aged >= 20 years at the beginning of the measurement period who have ever had a laboratory test result of LDL-C >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia -If YES, meets Initial Population 2 risk category -If NO, screen for next risk category Initial Population 3: Patients aged 40 to 75 years at the beginning of the measurement period with an active diagnosis of Type 1 or Type 2 diabetes at any time during the measurement period -If YES, meets Initial Population 3 risk category -If NO, patient does NOT meet Initial Population criteria and is NOT eligible for measure inclusion Initial Population Guidance for Encounter: In order for the patient to be included in the Initial Population, the patient must have ONE initial population-eligible visit, defined as follows: outpatient visit, initial or established office visit, face-to-face interaction, preventive care services, or annual wellness visit LDL-C Laboratory test result options: The measure can be reported for all patients with a documented LDL-C level recorded as follows: To meet Initial Population 1: There is no LDL-C result required. To meet Initial Population 2: If a patient has ANY previous laboratory result of LDL-C >= 190 mg/dL, report the highest value >= 190 mg/dL. To meet Initial Population 3: There is no LDL-C result required. Numerator instructions and guidance: -Current statin therapy use must be documented in the patient's current medication list or ordered during the measurement period. -ONLY statin therapy meets the measure Numerator criteria (NOT other cholesterol lowering medications). -Prescription or order does NOT need to be linked to an encounter or visit; it may be called to the pharmacy. -Statin medication "samples" provided to patients can be documented as "current statin therapy" if documented in the medication list in health/medical record. -Patients who meet the denominator criteria for inclusion, but are not prescribed or using statin therapy, will NOT meet performance for this measure unless they have an allowable denominator exception. Patients with an allowable denominator exception should be removed from the denominator of the measure and reported as a valid exception. -There is only one performance rate calculated for this measure: the weighted average of the three populations. -Adherence to statin therapy is not calculated in this measure. -It may not be appropriate to prescribe statin therapy for some patients (see exceptions and exclusions for the complete list). Intensity of statin therapy in primary and secondary prevention: The expert panel of the 2018 ACC/AHA/MS Guidelines (Grundy et al., 2019) defines recommended intensity of statin therapy on the basis of the average expected LDL-C response to specific statin and dose. Although intensity of statin therapy is important in managing cholesterol, this measure assesses prescription of ANY statin therapy, irrespective of intensity. Assessment of appropriate intensity and dosage documentation added too much complexity to allow inclusion of statin therapy intensity in the measure at this time. Lifestyle modification coaching: A healthy lifestyle is important for the prevention of cardiovascular disease. However, lifestyle modification monitoring and documentation added too much complexity to allow its inclusion in the measure at this time. Millimoles per liter (mmol/L) should be converted to milligrams per deciliter (mg/dL) for reporting this measure. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
Initial Population Guidance: The initial population covers four distinct populations. Use the following process to prevent counting patients more than once. Initial Population 1: All patients who were previously diagnosed with or currently have a diagnosis of clinical ASCVD, including an ASCVD procedure before the end of the measurement period. - If YES, meets Initial Population 1 risk category - If NO, screen for next risk category Initial Population 2: Patients aged 20 to 75 years at the beginning of the measurement period who have ever had a laboratory test result of LDL-C >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia. - If YES, meets Initial Population 2 risk category - If NO, screen for next risk category Initial Population 3: Patients aged 40 to 75 years at the beginning of the measurement period with an active diagnosis of Type 1 or Type 2 diabetes at any time during the measurement period. - If YES, meets Initial Population 3 risk category - If NO, screen for next risk category Initial Population 4: Patients aged 40 to 75 at the beginning of the measurement period with a 10-year ASCVD risk score of >= 20 percent during the measurement period. - If YES, meets Initial Population 4 risk category - If NO, patient does NOT meet Initial Population criteria and is NOT eligible for measure inclusion. Initial Population Guidance for Encounter: In order for the patient to be included in the Initial Population, the patient must have ONE initial population-eligible visit, defined as follows: outpatient visit, initial or established office visit, face-to-face interaction, preventive care services, or annual wellness visit. LDL-C Laboratory test result options: The measure can be reported for all patients with a documented LDL-C level recorded as follows: To meet Initial Population 1: There is no LDL-C result required. To meet Initial Population 2: If a patient has ANY previous laboratory result of LDL-C >= 190 mg/dL, report the highest value >= 190 mg/dL. To meet Initial Population 3: There is no LDL-C result required. To meet Initial Population 4: There is no LDL-C result required. The 10-year ASCVD risk assessment options: The 10-year ASCVD risk score is calculated using the Pooled Cohort Equations: 1) the 2013 ACC/AHA ASCVD Risk Estimator (maps to LOINC Code 79423-0) OR 2) the ACC Risk Estimator Plus (maps to LOINC Code 99055-6). If your EHR does not have either of these risk calculators, we recommend that you use the on-line versions. The 10-year ASCVD risk score (quantitative result, i.e., result.value, "%") must be documented in a structure field. The 10-year ASCVD risk assessment must be performed during the measurement period.
Numerator instructions and guidance: - Current statin therapy use must be documented in the patient's current medication list or ordered during the measurement period. - ONLY statin therapy meets the measure Numerator criteria (NOT other cholesterol lowering medications). - Prescription or order does NOT need to be linked to an encounter or visit; it may be called to the pharmacy. - Statin medication "samples" provided to patients can be documented as "current statin therapy" if documented in the medication list in health/medical record. - Patients who meet the denominator criteria for inclusion, but are not prescribed or using statin therapy, will NOT meet performance for this measure unless they have an allowable denominator exception. Patients with an allowable denominator exception should be removed from the denominator of the measure and reported as a valid exception. - There is only one performance rate calculated for this measure: the weighted average of the four populations. - Adherence to statin therapy is not calculated in this measure. - It may not be appropriate to prescribe statin therapy for some patients (see exceptions and exclusions for the complete list). Intensity of statin therapy in primary and secondary prevention: The expert panel of the 2018 ACC/AHA/MS Guidelines (Grundy et al., 2019) defines recommended intensity of statin therapy on the basis of the average expected LDL-C response to specific statin and dose. Although intensity of statin therapy is important in managing cholesterol, this measure assesses prescription of ANY statin therapy, irrespective of intensity. Assessment of appropriate intensity and dosage documentation added too much complexity to allow inclusion of statin therapy intensity in the measure at this time. Lifestyle modification coaching: A healthy lifestyle is important for the prevention of cardiovascular disease. However, lifestyle modification monitoring and documentation added too much complexity to allow its inclusion in the measure at this time. Millimoles per liter (mmol/L) should be converted to milligrams per deciliter (mg/dL) for reporting this measure. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
Initial Population Guidance: The initial population covers four distinct populations. Use the following process to prevent counting patients more than once. Initial Population 1: All patients who were previously diagnosed with or currently have a diagnosis of clinical ASCVD, including an ASCVD procedure before the end of the measurement period. - If YES, meets Initial Population 1 risk category. - If NO, screen for next risk category. Initial Population 2: Patients aged 20 to 75 years at the beginning of the measurement period who have ever had a laboratory test result of LDL-C >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia. - If YES, meets Initial Population 2 risk category. - If NO, screen for next risk category. Initial Population 3: Patients aged 40 to 75 years at the beginning of the measurement period with an active diagnosis of Type 1 or Type 2 diabetes at any time during the measurement period. - If YES, meets Initial Population 3 risk category. - If NO, screen for next risk category. Initial Population 4: Patients aged 40 to 75 at the beginning of the measurement period with a 10-year ASCVD risk score of >= 20 percent during the measurement period. - If YES, meets Initial Population 4 risk category. - If NO, patient does NOT meet Initial Population criteria and is NOT eligible for measure inclusion. Initial Population Guidance for Encounter: In order for the patient to be included in the Initial Population, the patient must have ONE initial population-eligible visit, defined as follows: outpatient visit, initial or established office visit, face-to-face interaction, preventive care services, or annual wellness visit. LDL-C Laboratory test result options: The measure can be reported for all patients with a documented LDL-C level recorded as follows: To meet Initial Population 1: There is no LDL-C result required. To meet Initial Population 2: If a patient has ANY previous laboratory result of LDL-C >= 190 mg/dL, report the highest value >= 190 mg/dL. To meet Initial Population 3: There is no LDL-C result required. To meet Initial Population 4: There is no LDL-C result required. The 10-year ASCVD risk assessment options: The 10-year ASCVD risk score is calculated using the Pooled Cohort Equations: 1) the 2013 ACC/AHA ASCVD Risk Estimator (maps to LOINC Code 79423-0) OR 2) the ACC Risk Estimator Plus (maps to LOINC Code 99055-6). If your EHR does not have either of these risk calculators, we recommend that you use the on-line versions. The 10-year ASCVD risk score (quantitative result, i.e., result.value, "%") must be documented in a structured field. The 10-year ASCVD risk assessment must be performed during the measurement period.
Numerator instructions and guidance: - Current statin therapy use must be documented in the patient's current medication list or ordered during the measurement period. - ONLY statin therapy meets the measure Numerator criteria (NOT other cholesterol lowering medications). - Prescription or order does NOT need to be linked to an encounter or visit; it may be called to the pharmacy. - Statin medication "samples" provided to patients can be documented as "current statin therapy" if documented in the medication list in health/medical record. - Patients who meet the denominator criteria for inclusion, but are not prescribed or using statin therapy, will NOT meet performance for this measure unless they have an allowable denominator exception. Patients with an allowable denominator exception should be removed from the denominator of the measure and reported as a valid exception. - There is only one performance rate calculated for this measure: the weighted average of the four populations. - Adherence to statin therapy is not calculated in this measure. - It may not be appropriate to prescribe statin therapy for some patients (see exceptions and exclusions for the complete list). Intensity of statin therapy in primary and secondary prevention: The expert panel of the 2018 ACC/AHA/MS Guidelines (Grundy et al., 2019) defines recommended intensity of statin therapy on the basis of the average expected LDL-C response to specific statin and dose. Although intensity of statin therapy is important in managing cholesterol, this measure assesses prescription of ANY statin therapy, irrespective of intensity. Assessment of appropriate intensity and dosage documentation added too much complexity to allow inclusion of statin therapy intensity in the measure at this time. Lifestyle modification coaching: A healthy lifestyle is important for the prevention of cardiovascular disease. However, lifestyle modification monitoring and documentation added too much complexity to allow its inclusion in the measure at this time. Millimoles per liter (mmol/L) should be converted to milligrams per deciliter (mg/dL) for reporting this measure. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
| Initial Population |
Population 1: All patients who have an active diagnosis of clinical ASCVD or ever had an ASCVD procedure. Population 2: Patients aged >= 20 years at the beginning of the measurement period who have ever had a laboratory result of LDL-C >=190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia. Population 3: Patients aged 40 to 75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes. |
Population 1: All patients who were previously diagnosed with or currently have a diagnosis of clinical ASCVD, including an ASCVD procedure. Population 2: Patients aged 20 to 75 years at the beginning of the measurement period who have ever had a laboratory result of LDL-C >=190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia. Population 3: Patients aged 40 to 75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes. Population 4: Patients aged 40 to 75 at the beginning of the measurement period with a 10-year ASCVD risk score (i.e., 2013 ACC/AHA ASCVD Risk Estimator or the ACC Risk Estimator Plus) of >= 20 percent during the measurement period. |
Population 1: All patients who were previously diagnosed with or currently have a diagnosis of clinical ASCVD, including an ASCVD procedure. Population 2: Patients aged 20 to 75 years at the beginning of the measurement period who have ever had a laboratory result of LDL-C >=190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia. Population 3: Patients aged 40 to 75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes. Population 4: Patients aged 40 to 75 at the beginning of the measurement period with a 10-year ASCVD risk score (i.e., 2013 ACC/AHA ASCVD Risk Estimator or the ACC Risk Estimator Plus) of >= 20 percent during the measurement period. |
| Denominator |
Equals Initial Population |
Equals Initial Population |
Equals Initial Population |
| Denominator Exclusions |
Patients who are breastfeeding at any time during the measurement period. Patients who have a diagnosis of rhabdomyolysis at any time during the measurement period. |
Patients who are breastfeeding at any time during the measurement period. Patients who have a diagnosis of rhabdomyolysis at any time during the measurement period. |
Patients who are breastfeeding at any time during the measurement period. Patients who have a diagnosis of rhabdomyolysis at any time during the measurement period. |
| Numerator |
Patients who are actively using or who receive an order (prescription) for statin therapy at any time during the measurement period |
Patients who are actively using or who receive an order (prescription) for statin therapy at any time during the measurement period |
Patients who are actively using or who receive an order (prescription) for statin therapy at any time during the measurement period |
| Numerator Exclusions |
Not Applicable |
Not Applicable |
Not Applicable |
| Denominator Exceptions |
Patients with statin-associated muscle symptoms or an allergy to statin medication. Patients who are receiving palliative or hospice care. Patients with active liver disease or hepatic disease or insufficiency. Patients with end-stage renal disease (ESRD). Patients with documentation of a medical reason for not being prescribed statin therapy. |
Patients with statin-associated muscle symptoms or an allergy to statin medication. Patients who are receiving palliative or hospice care. Patients with active liver disease or hepatic disease or insufficiency. Patients with end-stage renal disease (ESRD). Patients with documentation of a medical reason for not being prescribed statin therapy. |
Patients with statin-associated muscle symptoms or an allergy to statin medication. Patients who are receiving palliative or hospice care. Patients with active liver disease or hepatic disease or insufficiency. Patients with end-stage renal disease (ESRD). Patients with documentation of a medical reason for not being prescribed statin therapy. |
| Telehealth Eligible | Yes | Yes | Yes |
| Next Version | No Version Available | ||
| Previous Version | No Version Available |
Additional Resources for CMS347v6
Header
Updated copyright.
Measure Section: Copyright
Source of Change: Annual Update
Updated references.
Measure Section: Reference
Source of Change: Measure Lead
Added Ezetimibe/Rosuvastatin (Roszet), a new fixed-dose combination statin, to the Statin Medication Therapy List to align with measure intent.
Measure Section: Definition
Source of Change: Measure Lead
Added guidance for conversion of LDL value to milligrams per deciliter (mg/dL) for consistency with numerator logic requirements.
Measure Section: Guidance
Source of Change: Measure Lead
Updated version number of the Quality Data Model (QDM) used in the measure specification to v5.6.
Measure Section: Guidance
Source of Change: Standards/Technical Update
Removed diagnosis of pregnancy as a denominator exclusions to align with the new FDA recommendations.
Measure Section: Denominator Exclusions
Source of Change: Expert Work Group Review
Added exception for documentation of a medical reason for not being prescribed statin therapy to align with guidelines.
Measure Section: Denominator Exceptions
Source of Change: Expert Work Group Review
Updated grammar, wording, and formatting to improve readability and consistency.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Updated narrative description, rate aggregation, and guidance to clarify the intent to look for only active diagnoses of atherosclerotic cardiovascular disease (ASCVD).
Measure Section: Multiple Sections
Source of Change: Expert Work Group Review
Logic
Removed 'Diagnosis': 'Pregnancy or Other Related Diagnoses' to align with the new FDA recommendations.
Measure Section: Denominator Exclusions
Source of Change: Expert Work Group Review
Replaced the 'Has Order for or Receiving Hospice Care or Palliative Care' definition with Hospice and Palliative Care shared libraries and QDM datatypes for consistency and to reduce clinician and implementer burden.
Measure Section: Denominator Exclusions
Source of Change: Measure Lead
Added 'Has Medical Reason for Not Ordering Statin Therapy' to align with guidelines and for consistency with other eCQMs.
Measure Section: Denominator Exceptions
Source of Change: Expert Work Group Review
Replaced value set Preventive Care Services Other (2.16.840.1.113883.3.464.1003.101.12.1030) with direct reference code CPT code (99429).
Measure Section: Definitions
Source of Change: Measure Lead
Replaced the 'Has Order for or Receiving Hospice Care or Palliative Care' definition with Hospice and Palliative Care libraries and QDM datatypes for consistency and to reduce clinician and implementer burden.
Measure Section: Definitions
Source of Change: Measure Lead
Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.
Measure Section: Multiple Sections
Source of Change: Standards/Technical Update
Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v7.0.000.
Measure Section: Multiple Sections
Source of Change: Standards/Technical Update
Added Hospice Library v4.0.000.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Added Palliative Care Exclusion Library v2.0.000.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Updated the version of the Quality Data Model (QDM) to 5.6 and Clinical Quality Language (CQL) to 1.5.
Measure Section: Multiple Sections
Source of Change: Standards/Technical Update
Revised measure logic to look for only active diagnoses of atherosclerotic cardiovascular disease (ASCVD), as inactive diagnoses do not represent high-risk of cardiovascular event.
Measure Section: Multiple Sections
Source of Change: Expert Work Group Review
Replaced the Global.CalendarAgeInYearsAt function with the native CQL function AgeInYearsAt to take advantage of existing CQL features and increase human readability. As a result of this change, the LOINC code 21112-8 is no longer required and has been removed from the Terminology section of the human readable specification.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Value set
The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.
Value set Diabetes (2.16.840.1.113883.3.464.1003.103.12.1001): Deleted 24 ICD-10-CM codes based on validity of code during timing of look back period.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Cerebrovascular Disease, Stroke, TIA (2.16.840.1.113762.1.4.1047.44): Deleted 1 SNOMED CT code (288723005) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Liver Disease (2.16.840.1.113762.1.4.1047.42): Deleted 1 SNOMED CT code (197279005) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Added direct reference code SNOMED CT code (428361000124107) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code SNOMED CT code (428371000124100) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Moderate Intensity Statin Therapy (2.16.840.1.113883.3.526.3.1575): Added 2 RxNorm codes (2535747, 2535750) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Added direct reference code LOINC code (71007-9) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code LOINC code (45755-6) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed direct reference code LOINC code (21112-8) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Hospice Care Ambulatory (2.16.840.1.113883.3.526.3.1584): Added 3 SNOMED CT codes (170935008, 170936009, 305911006) based on review by technical experts, SMEs, and/or public feedback. Added 2 CPT codes (99377, 99378) based on review by technical experts, SMEs, and/or public feedback. Added 1 HCPCS code (G0182) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Statin Allergen (2.16.840.1.113762.1.4.1110.42): Added 1 SNOMED CT code (96302009) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set CABG Surgeries (2.16.840.1.113883.3.666.5.694): Added 17 ICD-10-PCS codes based on review by technical experts, SMEs, and/or public feedback. Deleted 1 SNOMED CT code (309814006) based on terminology update.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Myocardial Infarction (2.16.840.1.113883.3.526.3.403): Added 23 SNOMED CT codes based on terminology update. Deleted 1 SNOMED CT code (371068009) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Removed value set Pregnancy or Other Related Diagnoses (2.16.840.1.113883.3.600.1.1623) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Palliative or Hospice Care (2.16.840.1.113883.3.600.1.1579) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Medical Reason (2.16.840.1.113883.3.526.3.1007) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Encounter Inpatient (2.16.840.1.113883.3.666.5.307) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Palliative Care Encounter (2.16.840.1.113883.3.464.1003.101.12.1090) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Hospice Encounter (2.16.840.1.113883.3.464.1003.1003) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Palliative Care Intervention (2.16.840.1.113883.3.464.1003.198.12.1135) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code SNOMED CT code (373066001) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Value set High Intensity Statin Therapy (2.16.840.1.113883.3.526.3.1572): Added 2 RxNorm codes (2535745, 2535749) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Replaced value set Preventive Care Services - Other (2.16.840.1.113883.3.464.1003.101.12.1030) with direct reference code CPT code (99429) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead