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Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

General eCQM Information

CMS Measure ID CMS347v5
NQF Number Not Applicable
Measure 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 who were previously diagnosed with or currently have an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD), including 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

Initial Population Population 1: All patients who were previously diagnosed with or currently have an active diagnosis of clinical ASCVD, including an ASCVD procedurePopulation 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 hypercholesterolemiaPopulation 3: Patients aged 40 to 75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes
Denominator Statement

Equals Initial Population

Denominator Exclusions

Patients who have a diagnosis of pregnancy 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 Statement

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

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)

Measure Steward Centers for Medicare & Medicaid Services (CMS)
Domain Effective Clinical Care
Measure Scoring Proportion
Measure Type Process
Improvement Notation

Higher score indicates better quality

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 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 (https://ecqi.healthit.gov/qdm) for more information on the QDM.

Quality ID 438
Meaningful Measure Management of Chronic Conditions
Telehealth Eligible Yes
Previous Version

Release Notes

Header

  • Updated the eCQM version number.

    Measure Section: eCQM Version Number

    Source of Change: Annual Update

  • Updated Measure Developer.

    Measure Section: Measure Developer

    Source of Change: Measure Lead

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated disclaimer.

    Measure Section: Disclaimer

    Source of Change: Annual Update

  • Updated Rationale section of header to reflect most current literature.

    Measure Section: Rationale

    Source of Change: Measure Lead

  • Updated references.

    Measure Section: Reference

    Source of Change: Annual Update

  • Added clinically appropriate brand name statin drugs to the Statin Medication Therapy List in the header Definitions section to complete the list of appropriate statin therapy drugs to meet the measure numerator. Revised category of drugs to reflect that combination drugs must be of a fixed dose.

    Measure Section: Definition

    Source of Change: Expert Work Group Review

  • Removed definition for statin intolerance and added a definition for Statin-Associated Muscle Symptoms to align with the updated 2018 ACC/AHA Cholesterol Guidelines.

    Measure Section: Definition

    Source of Change: Expert Work Group Review

  • Updated Definitions header section for LDL-C result to allow either fasting or nonfasting and either direct or calculated LDL-C results to calculate the measure.

    Measure Section: Definition

    Source of Change: Expert Work Group Review

  • Updated Guidance language to reflect that the denominator equals one of three new Initial Populations. Updated Guidance language to remove the denominator exception for Population 3 for patients who have an LDL-C

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Updated numerator guidance to provide clarity for implementers about when an exception would be appropriate.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Updated Denominator header statement to set Denominator equal to Initial Population to reduce the number of patients counted in Population 1 due to the removal of the age restriction.

    Measure Section: Denominator

    Source of Change: Expert Work Group Review

  • Added language to Denominator Exclusions header section to clarify that exclusions must be active during the measurement period.

    Measure Section: Denominator Exclusions

    Source of Change: Expert Work Group Review

  • Revised language in Numerator header statement about timing to align with the rest of the measure.

    Measure Section: Numerator

    Source of Change: Expert Work Group Review

  • Removed 'statin intolerance' and replaced with 'statin-associated muscle symptoms' in the first Denominator Exception and removed exception for patients with diabetes who have an LDL-C result

    Measure Section: Denominator Exceptions

    Source of Change: Expert Work Group Review

  • Updated measure Description, Rationale, and Clinical Recommendations header statements to align with updated 2018 ACC/AHA Cholesterol Guidelines.

    Measure Section: Multiple Sections

    Source of Change: Expert Work Group Review

  • Updated age thresholds in Populations 1 and 2, removed 'pure hypercholesterolemia' from Population 2, and removed LDL-C requirement from Population 3 in Rate Aggregation and Initial Population header sections to align with updated 2018 ACC/AHA Cholesterol Guidelines.

    Measure Section: Multiple Sections

    Source of Change: Expert Work Group Review

  • Added the phrase 'including an ASCVD procedure' to Population 1 throughout the measure header to align the header with the existing measure logic that patients who have an ASCVD procedure are included in Population 1.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Removed the phrase 'fasting or direct' throughout the measure to clarify that any LDL-C results can be used to calculate the measure.

    Measure Section: Multiple Sections

    Source of Change: Expert Work Group Review

Logic

  • Updated Initial Population to revise age thresholds in Populations 1 and 2, removed 'pure hypercholesterolemia' from Initial Population 2 logic, and removed LDL-C requirement from Initial Population 3 logic to align with updated 2018 ACC/AHA Cholesterol Guidelines.

    Measure Section: Initial Population

    Source of Change: Expert Work Group Review

  • Updated Denominator logic statements to set Denominator equal to Initial Population to reduce the number of patients counted in Population 1 due to the removal of the age restriction.

    Measure Section: Denominator

    Source of Change: Expert Work Group Review

  • Removed exception for allergy or intolerance to statin and added exception for statin-associated muscle symptoms to align with the updated 2018 ACC/AHA Cholesterol Guidelines.

    Measure Section: Denominator Exceptions

    Source of Change: Expert Work Group Review

  • Removed exception for patients with diabetes who have an LDL-C

    Measure Section: Denominator Exceptions

    Source of Change: Expert Work Group Review

  • Updated definition for Denominator Exceptions, removed definition for Allergy or Intolerance to Statin, and added definitions for Has Allergy to Statin and Has Statin Associated Muscle Symptoms to align with the updated 2018 ACC/AHA Cholesterol Guidelines.

    Measure Section: Definitions

    Source of Change: Expert Work Group Review

  • Updated definitions for Denominator 1, 2, and 3 to set them equal to Initial Population to reduce the number of patients counted in Population 1 due to the removal of the age restriction. Removed definition for Denominator Exceptions 3 because Denominator Exceptions 3 equals Denominator Exceptions for Populations 1 and 2 when the last exception for LDL-C result is removed. Removed definition for Highest LDL Result because the LDL-C requirement was removed from Population 3. Removed Initial Population definition because the measure was revised to use three Initial Populations. Added definitions for Initial Population 1, 2, and 3 to allow for greater specificity after the age threshold was removed from Population 1. Removed definition for Most Recent LDL Result Within 3 Years because the LDL-C requirement was removed from Population 3. Added definition for Patients Age 20 or Older to align with new age range for Population 2. Added definition for Patients Age 20 Years and Older with LDL Cholesterol Result >= 190 to align with new age range for Population 2 and to clarify that patients can also have hypercholesterolemia and cannot have ASCVD. Added definition for Patients Age 40 50 75 with Diabetes to revise the logic because the LDL-C result requirement was removed from Population 3 and to clarify that patients in this population cannot have hypercholesterolemia or LDL-C > 190 or ASCVD.

    Measure Section: Definitions

    Source of Change: Expert Work Group Review

  • Updated the names of Clinical Quality Language (CQL) definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-6.2.000). Updated the 'Inpatient Encounter' definition to include a 'day of' timing clarification. Added the following timing functions: Normalize Interval, Has Start, Has End, Latest, Latest Of, Earliest, and Earliest Of. Please see individual measure details for application of specific timing functions.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Added new NormalizeInterval function to timing attributes to decrease implementation burden due to variable use of timing attributes for select QDM data types. The NormalizeInterval function was applied, where applicable, for the following data elements: Assessment, Performed; Device, Applied; Diagnostic Study, Performed; Intervention, Performed; Laboratory Test, Performed; Medication, Administered; Medication, Dispensed; Physical Exam, Performed; Procedure, Performed; Substance, Administered.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

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 Liver Disease (2.16.840.1.113762.1.4.1047.42): Added 3 ICD-10-CM codes (K74.00, K74.01, K74.02) based on terminology update. Deleted 1 ICD-10-CM code (K74.0) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set (2.16.840.1.113762.1.4.1047.100): Renamed to Familial Hypercholesterolemia. Deleted 2 SNOMED CT codes (267432004, 414416008) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations. Deleted 1 ICD-10-CM code (E78.00) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations.

    Measure Section: Terminology

    Source of Change: ONC Project Tracking System (Jira): CQM-3483

  • Value set Breastfeeding (2.16.840.1.113762.1.4.1047.73): Added 1 SNOMED CT code (866041003) based on terminology update. Deleted 1 SNOMED CT code (169750002) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Pregnancy or Other Related Diagnoses (2.16.840.1.113883.3.600.1.1623): Added 5 ICD-10-CM codes (O99.891, O99.892, O99.893, O34.218, O34.22) based on terminology update. Deleted 2 ICD-10-CM codes (A34, O99.89) based on terminology update. Added 1 SNOMED CT code (169488004) based on terminology update. Deleted 1 SNOMED CT code (102873005) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Atherosclerosis and Peripheral Arterial Disease (2.16.840.1.113762.1.4.1047.21): Added 3 SNOMED CT codes (792843009, 792844003, 792845002) based on terminology update. Deleted 4 SNOMED CT codes (145891000119104, 149841000119109, 5111000119102, 5561000119107) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Ischemic Heart Disease or Other Related Diagnoses (2.16.840.1.113762.1.4.1047.46): Added 1 SNOMED CT code (413444003) based on review by technical experts, SMEs, and/or public feedback. Deleted 3 SNOMED CT codes (210078001, 473393007, 52674009) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: ONC Project Tracking System (Jira): CQM-3482

  • Value set Diabetes (2.16.840.1.113883.3.464.1003.103.12.1001): Added 37 SNOMED CT codes based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations. Deleted 12 SNOMED CT codes (421920002, 4783006, 75682002, 76751001, 769219006, 190388001, 190390000, 395204000, 421750000, 422014003, 703138006, 781000119106) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set High Intensity Statin Therapy (2.16.840.1.113883.3.526.3.1572): Deleted 1 RxNorm code (757705) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set LDL Cholesterol (2.16.840.1.113883.3.526.3.1573): Added 2 LOINC codes (96259-7, 96597-0) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Low Intensity Statin Therapy (2.16.840.1.113883.3.526.3.1574): Deleted 1 RxNorm code (757702) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Moderate Intensity Statin Therapy (2.16.840.1.113883.3.526.3.1575): Deleted 2 RxNorm codes (757703, 757704) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Added value set Statin Associated Muscle Symptoms (2.16.840.1.113762.1.4.1108.85) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Jul 08, 2021