Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

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. 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.

Denominator Guidance:

The denominator covers three distinct populations. Use the following process to prevent counting patients more than once.

Denominator Population 1:

Patients aged >= 21 years at the beginning of the measurement period with clinical ASCVD

-If YES, meets Denominator Population 1 risk category

-If NO, screen for next risk category

Denominator Population 2:

Patients aged >= 21 years at the beginning of the measurement period who have ever had a fasting or direct laboratory test result of LDL-C >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial or pure hypercholesterolemia

-If YES, meets Denominator Population 2 risk category

-If NO, screen for next risk category

Denominator Population 3:

Patients aged 40 to 75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes and with a LDL-C result of 70 -189 mg/dL recorded as the highest fasting or direct laboratory test result in the measurement year or during the two years prior to the beginning of the measurement period

-If YES, meets Denominator Population 3 risk category

-If NO, patient does NOT meet Denominator criteria and is NOT eligible for measure inclusion

Denominator Guidance for Encounter:

-In order for the patient to be included in the denominator, the patient must have ONE denominator-eligible visit, defined as follows:

--Outpatient encounter visit type

--Encounter, performed: 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 fasting or direct LDL-C level recorded as follows:

To meet Denominator Population 1:

There is no LDL-C result required.

To meet Denominator Population 2:

If a patient has ANY previous fasting or direct laboratory result of LDL-C >= 190 mg/dL, report the highest value >= 190 mg/dL.

To meet Denominator Population 3:

If a patient has more than one LDL-C result during the measurement period or during the two years before the start of the measurement period, report the highest level recorded during either time. The Denominator Exception, "Patients with diabetes who have the most recent fasting or direct LDL-C laboratory test result < 70 mg/dL and are not taking statin therapy" applies only to Denominator Population 3.

Intensity of statin therapy in primary and secondary prevention:

The expert panel of the 2013 ACC/AHA Guidelines (Stone et al., 2014) 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.

This eCQM is a patient-based measure.

This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.

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 were previously diagnosed with or currently have an active 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 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.

This eCQM is a patient-based measure.

This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.

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.