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:

• Adults aged ≥ 21 years who were previously diagnosed with or currently have an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD); OR

• Adults aged ≥ 21 years who have ever had a fasting or direct low-density lipoprotein cholesterol (LDL-C) level ≥ 190 mg/dL or were previously diagnosed with or currently have an active         diagnosis of familial or pure hypercholesterolemia; OR

• Adults aged 40-75 years with a diagnosis of diabetes with a fasting or direct LDL-C level of 70-189 mg/dL

IMPROVEMENT NOTATION:

Higher score indicates better quality

INITIAL POPULATION:

All patients aged 21 years and older at the beginning of the measurement period with a patient encounter during the measurement period.

DENOMINATOR:

All patients who meet one or more of the following criteria (considered at "high risk" for cardiovascular events, under ACC/AHA guidelines):

1) Patients aged ≥ 21 years at the beginning of the measurement period with clinical ASCVD diagnosis  2) Patients aged ≥ 21 years at the beginning of the measurement period who have ever had a fasting or direct laboratory result of LDL-C ≥ 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial or pure hypercholesterolemia

3) Patients aged 40 to 75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes and with an 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

DENOMINATOR EXCLUSIONS:

Patients who have a diagnosis of pregnancy

Patients who are breastfeeding

Patients who have a diagnosis of rhabdomyolysis 

DENOMINATOR EXCEPTIONS:

Patients with adverse effect, allergy, or intolerance to statin medication

Patients with active liver disease or hepatic disease or insufficiency

Patients with end-stage renal disease (ESRD)

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

NUMERATOR:

Patients who are actively using or who receive an order (prescription) for statin therapy at any point during the measurement period


NUMERATOR NOTE: In order to meet the measure, 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. Adherence to statin therapy is not calculated in this measure. 

NUMERATOR EXCLUSIONS:

Not Applicable



DEFINITIONS:

Clinical atherosclerotic cardiovascular disease (ASCVD) includes: 

Acute coronary syndromes

History of myocardial infarction

Stable or unstable angina

Coronary or other arterial revascularization

Stroke or transient ischemic attack (TIA)

Peripheral arterial disease of atherosclerotic origin

 

Lipoprotein Density Cholesterol (LDL-C) result - A fasting or direct LDL-C laboratory test performed and test result documented in the medical record.

Statin therapy - Administration of one or more of a group of medications that are used to lower plasma lipoprotein levels in the treatment of hyperlipoproteinemia.

Statin Medication Therapy List (NOTE: List does NOT include dosage) is included in the clinical recommendations.

Some patients may not be appropriate to prescribe or use statin therapy (see exceptions and exclusions for a complete list).

"Statin intolerance is the inability to tolerate a dose of statin required to reduce a person's CV risk sufficiently from their baseline risk and could result from different statin related side effects including: muscle symptoms, headache, sleep disorders, dyspepsia, nausea, rash, alopecia, erectile dysfunction, gynecomastia, and/or arthritis" (Banach, et al., 2015).

Patients that experience symptoms such as these may prefer not to take or continue statin therapy and therefore may be exempt from the denominator.

 

GUIDANCE: 

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, patient 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, patient meets Denominator Population 2 risk category If NO, screen for next risk category

Denominator Population 3: Patients aged 40 through 75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes and with an 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, patient 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. 2013) 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.