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Societies update performance measures for lipid management in secondary prevention
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The American College of Cardiology and the American Heart Association released an updated set of performance measures for lipid management in patients requiring secondary prevention.
The new document brings the recommendations in accordance with the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults and emphasizes shared decision making.
The document offers lipid management measures in five patient populations: peripheral artery disease, STEMI and non-STEMI, PCI, CAD/hypertension and atherosclerotic CVD.
Patient wishes incorporated
“These measures respect the wishes of patients regarding use of statins and do not penalize physicians who may have a patient decline to take medications for personal reasons,” Joseph P. Drozda Jr., MD, FACC, chair of the writing committee and director of outcomes research at Mercy Health, St. Louis, said in a press release. “Integrating patient values, preferences and personal context with evidence-based medicine and guidelines is novel and changes the focus from recommending and prescribing statins based on evidence to promoting choice by an informed patient.”
The measure for each involves the ratio of a numerator to a denominator. For all groups except PCI, the numerator is patients in the denominator offered a high-intensity statin or, if there is documentation of a medical reason for not prescribing a high-intensity statin, a moderate-intensity statin. “Offered” is defined as a prescription or a documented reason the patient declined the prescription.
For all groups, an exception to the denominator is documentation of a medical reason, such as allergy or intolerance, for not prescribing a statin.
Five formulas
For PAD, the denominator is patients aged 18 to 75 years seen during a 12-month period with at least one of the following: claudication, critical limb ischemia, amputation for CLI, history of vascular reconstruction, bypass surgery or percutaneous intervention in the extremities, or an abnormal noninvasive test such as ankle-brachial index.
For STEMI and non-STEMI, the denominator is all patients aged 18 to 75 years discharged after hospitalization for acute MI, excluding patients who died, who left against medical advice, who were discharged to a hospice or received a comfort-only medical order, or who transferred to another hospital for in-patient care.
For PCI, the denominator is patients aged 18 to 75 years on whom PCI was performed, excluding patients who died, who left against medical advice, who were discharged to a hospice or received a comfort-only medical order, or who transferred to another acute-care hospital. The numerator is patients offered aspirin, a statin and, for those who received a stent, a P2Y12 inhibitor at discharge.
For chronic stable CAD, the denominator is all patients aged 18 to 75 years with CAD who were seen during a 12-month period.
For atherosclerotic CVD, the denominator is all patients aged 18 to 75 years with clinical atherosclerotic CVD who were seen during a 12-month period, excluding patients in acute-care hospitals.
“The clinician and patient must collaborate, deliberate and arrive at the best answer that fits the patient’s preferences, values and context,” Drozda said in the release.
The document was endorsed by 14 other societies and associations. It was simultaneously published in Circulation and the Journal of the American College of Cardiology. – by Erik Swain
Disclosure: Drozda reports no relevant financial disclosures. See the full document for a list of the relevant financial disclosures of the other authors and reviewers.
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