eMeasure Title Coronary Artery Disease (CAD): Beta-Blocker Therapy—Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%)
eMeasure Identifier
(Measure Authoring Tool)
145 eMeasure Version number 3
NQF Number 0070 GUID 80744ae2-de81-4b16-a71d-69522eb865c5
Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)
Measure Developer American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)
Endorsed By National Quality Forum
Description
Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12 month period who also have a prior MI or a current or prior LVEF <40% who were prescribed beta-blocker therapy
Copyright
Copyright 2013 American College of Cardiology, American Heart Association and American Medical Association. All Rights Reserved.
Disclaimer
Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (PCPI[R]), American College of Cardiology (ACC) and American Heart Association (AHA). These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, eg, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA, (on behalf of the PCPI), ACC or AHA. Neither the AMA, ACC, AHA, PCPI nor its members shall be responsible for any use of the Measures. 

THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND. 

Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, ACC, AHA, the PCPI and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. 

CPT(R) contained in the Measure specifications is copyright 2004-2013 American Medical Association. LOINC(R) copyright 2004-2013 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2013 International Health Terminology Standards Development Organisation. ICD-10 copyright 2013 World Health Organization. All Rights Reserved.

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Measure Scoring Proportion
Measure Type Process
Stratification
None
Risk Adjustment
None
Rate Aggregation
Denominator 1: Patients with left ventricular systolic dysfunction (LVEF <40%)
Denominator 2: Patients with a prior (resolved) myocardial infarction
Rationale
Nonadherence to cardioprotective medications is prevalent among outpatients with coronary artery disease and can be associated with a broad range of adverse outcomes, including all-cause and cardiovascular mortality, cardiovascular hospitalizations, and the need for revascularization procedures.

A patient with a diagnosis of coronary artery disease seen within a 12 month period and LVEF <40% should be taking either bisoprolol, carvedilol, or sustained release metoprolol succinate. While all beta-blockers appear to be of equal efficacy in patients with chronic stable coronary artery disease, these three medications have specifically shown to reduce mortality in patients with reduced LVEF.
Clinical Recommendation Statement
It is beneficial to start and continue beta-blocker therapy indefinitely in all patients who have had MI, acute coronary syndrome, or left ventricular dysfunction with or without heart failure symptoms, unless contraindicated. (Class I Recommendation, Level A Evidence) (ACC/AHA, 2007) 
Beta-blockers (using 1 of the 3 proven to reduce mortality, i.e., bisoprolol, carvedilol, and sustained release metoprolol succinate) are recommended for all stable patients with current or prior symptoms of heart failure and reduced LVEF, unless contraindicated. (Class I, Level of Evidence: A) (ACC/AHA, 2009)
Improvement Notation
Higher score indicates better quality
Reference
Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, Ferguson TB Jr., Fihn SD, Fraker TD Jr., Gardin JM, O’Rourke RA, Pasternak RC, Williams SV. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for the Management of Patients with Chronic Stable Angina). 2002. Available at: www.acc.org/clinical/guidelines/stable/stable.pdf
Reference
Fraker JD, Fihn SD, writing on behalf of the 2002 Chronic Stable Angina Writing Committee. 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the Management of Patients with Chronic Stable Angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to Develop the Focused Update of the 2002 Guidelines for the Management of Patients with Chronic Stable Angina. J Am Coll Cardiol. 2007;50:2264-2274
Reference
Hunt SA, Abraham WT, Chin MH, et al. 2009 Focused update incorporated
into the ACC/AHA 2005 guidelines for the diagnosis and management
of heart failure in adults: a report of the American College of
Cardiology Foundation/American Heart Association Task Force on
Practice Guidelines [published correction appears in Circulation. 2010;
121:e258]. Circulation. 2009;119:e391– 479
Definition
Prescribed may include prescription given to the patient for beta-blocker therapy at one or more visits in the measurement period OR patient already taking beta-blocker therapy as documented in current medication list
Guidance
Beta-blocker therapy:
- For patients with prior MI, beta-blocker therapy includes any agent within the beta-blocker drug class. As of 2011, during the development process, no recommendations or evidence cited in current chronic stable angina guidelines for preferential use of specific agents
- For patients with prior LVEF <40%, beta-blocker therapy includes the following: bisoprolol, carvedilol, or sustained release metoprolol succinate

The requirement of “Count >=2 of Encounter, Performed“ is to establish that the eligible professional has an existing relationship with the patient.
Transmission Format
TBD
Initial Patient Population
All patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12 month period
Denominator
Equals Initial Patient Population who also have prior MI or a current or prior LVEF <40%
Denominator Exclusions
None
Numerator
Patients who were prescribed beta-blocker therapy
Numerator Exclusions
Not Applicable
Denominator Exceptions
Documentation of medical reason(s) for not prescribing beta-blocker therapy (eg, allergy, intolerance, other medical reasons)
Documentation of patient reason(s) for not prescribing beta-blocker therapy (eg, patient declined, other patient reasons)
Documentation of system reason(s) for not prescribing beta-blocker therapy (eg, other reasons attributable to the health care system)
Measure Population
Not Applicable
Measure Observations
Not Applicable
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex.

Table of Contents


Population criteria

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Data criteria (QDM Data Elements)

Reporting Stratification

Supplemental Data Elements




Measure Set
None