Percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months prior to the measurement period, or who had an active diagnosis of ischemic vascular disease (IVD) during the measurement period, and who had documentation of use of aspirin or another antithrombotic during the measurement period.

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Coronary heart disease (CHD) is a major cause of death in the United States – in 2004, it was an underlying or contributing cause of death for 451,300 people (1 of every 5 deaths). Acute myocardial infarction (AMI) was an underlying or contributing cause of death for 156,000 people (American Heart Association 2008). In addition, nearly 16 million people (or 7.3 percent of the American population) had CHD in 2005 (American Heart Association 2008). The cost of cardiovascular diseases and stroke in the United States for 2008 was estimated at $448.5 billion (American Heart Association 2008). This figure includes health expenditures (direct costs such as the cost of physicians and healthcare practitioners, hospital and nursing home services, medications, home health care and other medical durables) and lost productivity resulting from morbidity and mortality (indirect costs). AMI accounts for 18 percent of hospital discharges and 28 percent of deaths due to heart disease (National Heart, Lung, and Blood Institute 2000). Research has shown that costs associated with cardiovascular disease for hospitals are easily $156 billion (American Heart Association 2008).

Aspirin treatments reduce MI in men (127 events per 100,000 person-years) and women (17 events per 100,000 person-years) (Grieving et al. 2008). While studies have shown warfarin to be more effective, aspirin is a safer, more convenient, and less expensive form of therapy (Patrono et al. 2004). Aspirin therapy has been shown to directly reduce the odds of cardiovascular events among men by 14 percent and among women by 12 percent (Berger et al. 2006). Aspirin use has been shown to reduce the number of strokes by 20 percent, MI by 30 percent, and other vascular events by 30 percent (Weisman and Graham 2002).

U.S. Preventive Services Task Force (2009): 
The U.S. Preventive Services Task Force (USPSTF) strongly recommends that clinicians discuss aspirin chemoprevention with adults who are at increased risk (5-year risk of greater than or equal to 3 percent) for coronary heart disease (CHD). Discussions with patients should address both the potential benefits and harms of aspirin therapy. 

The USPSTF found good evidence that aspirin decreases the incidence of coronary heart disease in adults who are at increased risk for heart disease. They also found good evidence that aspirin increases the incidence of gastrointestinal bleeding and fair evidence that aspirin increases the incidence of hemorrhagic strokes. The USPSTF concluded that the balance of benefits and harms is most favorable in patients at high risk of CHD (5-year risk of greater than or equal to 3 percent) but is also influenced by patient preferences. 

USPSTF encourages men age 45 to 79 years to use aspirin when the potential benefit of a reduction in myocardial infarctions outweighs the potential harm of an increase in gastrointestinal hemorrhage. They encourage women age 55 to 79 years to use aspirin when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage. 

American Diabetes Association (2008): 
Use aspirin therapy (75-162 mg/day) as a primary prevention strategy in those with type 1 or 2 diabetes at increased cardiovascular risk, including those who are 40 years of age or who have additional risk factors (family history of CVD, hypertension, smoking, dyslipidemia, or albuminuria). 

American Heart Association/American Stroke Association (2008): 
AHA/ASA: The use of aspirin is recommended for cardiovascular (including but not specific to stroke) prophylaxis among persons whose risk is sufficiently high for the benefits to outweigh the risks associated with treatment (a 10-year risk of cardiovascular events of 6% to 10%). 

American College of Clinical Pharmacy (2004): 
For long-term treatment after PCI, the guideline developers recommend aspirin, 75 to 162 mg/day. For long-term treatment after PCI in patients who receive antithrombotic agents such as clopidogrel or warfarin, the guideline developers recommend lower-dose aspirin, 75 to 100 mg/day. For patients with ischemic stroke who are not receiving thrombolysis, the guideline developers recommend early aspirin therapy, 160 to 325 mg/day.

Higher score indicates better quality

American Diabetes Association. 2008. “Standards of Medical Care in Diabetes - 2008.” Diabetes Care 31:S12-S54.

U.S. Preventive Services Task Force. 2009. “Aspirin for the Prevention of Cardiovascular Disease.” (December) .  http://www.ahrq.gov/clinic/uspstf/uspsasmi.htm

National Institutes of Health, National Heart, Lung, and Blood Institute. 2000. Morbidity and Mortality: 2000 Chart Book on Cardiovascular, Lung, and Blood Diseases. http://www.nhlbi.nih.gov/resources/docs/cht-book.htm

Grieving, J.P., E. Buskens, H. Koffijberg, A. Algra. 2008. “Cost-effectiveness of aspirin treatment in the primary prevention of cardiovascular disease events in subgroups based on age, gender, and varying cardiovascular risk.” Circulation 117:2875-2883.

Patrono, C., B. Coller, G.A. FitzGerald, J. Hirsh, G. Roth. 2004. “Platelet-Active Drugs: The relationships among dose, effectiveness, and side effects: the seventh ACCP Conference on antithrombotic and thrombolytic therapy.” Chest 126:234-264.

Berger, J.S., M.C. Roncaglioni, F. Avanzini, I. Pangrazzi, G. Tognoni, D.L. Brown. 2006. “Aspirin for the primary prevention of cardiovascular events in women and men: a sex-specific meta-analysis of randomized controlled trials.” JAMA 296(4):306-314.

Weisman, S.M., and D.Y. Graham. 2002. “Evaluation of the benefits and risks of low-dose aspirin in the secondary prevention of cardiovascular and cerebrovascular events.” Arch Intern Med 162(19):2197-2202.

American Heart Association. 2008. “Heart Disease and Stroke Statistics — 2008 Update.” http://www.americanheart.org/downloadable/heart/1200082005246HS_Stats%202008.final.pdf

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Only patients who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) should be included in the measure.

TBD

Patients 18 years of age and older with a visit during the measurement period, and an active diagnosis of ischemic vascular disease (IVD) or who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months prior to the measurement period

Equals Initial Patient Population

Not Applicable

Patients who have documentation of use of aspirin or another antithrombotic during the measurement period

Not Applicable

None

Not Applicable

Not Applicable

For every patient evaluated by this measure also identify payer, race, ethnicity and sex