• Office of Quality and Performance (10Q). FY 2008, Q1 technical manual for the VHA performance measurement system. Washington (DC): Washington (DC); 2007 Oct 31. 315 p.

Process

This measure is used to assess the percent of patients discharged with acute myocardial infarction (AMI), coronary artery bypass graft (CABG), percutaneous transluminal coronary angioplasty (PTCA) (inpatient or outpatient), or with ischemic vascular disease who have had a full lipid panel in the past year and low-density lipoprotein cholesterol (LDL-C) less than 100 on most recent test in past year.

The Adult Treatment Panel III (ATP III) of the National Cholesterol Education Program issued an evidence-based set on cholesterol management in 2001. Since the publication of ATP III, 5 major clinical trials of statin therapy with clinical endpoints have been published. The results of these recent trials have certain implications for cholesterol management. Therapeutic lifestyle changes (TLC) remain an essential modality in clinical management. The trials confirm the benefit of cholesterol lowering therapy in high-risk patients and support the ATP III treatment goal of low-density lipoprotein cholesterol (LDL-C) less than 100 mg/dL. They support the inclusion of patients with diabetes in the high-risk category and confirm the benefits of LDL-lowering therapy in these patients. They further confirm that older persons benefit from therapeutic lowering of LDL-C. The major recommendations for modifications to footnote the ATP III treatment algorithm are the following: In high-risk persons, the recommended LDL-C goal is less than 100 mg/dL. But when risk is very high, an LDL-C goal of less than 70 mg/dL is a therapeutic option (reasonable clinical strategy) on the basis of available clinical trial evidence. This therapeutic option extends also to patients at very high risk who have baseline LDL-C less than 100 mg/dL. Moreover, when a high-risk patients has high triglycerides or low high-density lipoprotein cholesterol (HDL-C), consideration can be given to combining a fibrate or nicotinic acid with an LDL-lowering drug. For moderately high-risk persons (2+ risk factors and a 10-year risk 10% to 20%), the recommended LDL-C goal is less than 130 mg/dL, but an LDL-C goal less than 100 mg/dL is a therapeutic option on the basis of recent trial evidence. The latter option extends also to moderately high-risk persons with a baseline LDL-C of 100 to 129 mg/dL. When LDL-lowering drug therapy is employed, in high-risk or moderately high-risk persons, it is advised that the intensity of therapy be sufficient to achieve at least a 30-40% reduction in LDL-C levels. Moreover, any person at high risk or moderately high risk who has lifestyle related risk factors (e.g., obesity, physical inactivity, elevated triglycerides, low HDL-C, or metabolic syndrome) is a candidate for TLC to modify these risk factors regardless of LDL-C levels. Finally for people in lower risk categories, recent clinical trials do not modify the goals and cutpoints for therapy.

Acute myocardial infarction (AMI); coronary artery bypass graft (CABG); percutaneous transluminal coronary angioplasty (PTCA); ischemic vascular disease (IVD); full lipid panel; low-density lipoprotein cholesterol (LDL-C)

Patients from the NEXUS Clinics cohort discharged with acute myocardial infarction (AMI), coronary artery bypass graft (CABG), percutaneous transluminal coronary angioplasty (PTCA) (inpatient or outpatient), or with ischemic vascular disease (IVD) (see the related "Denominator Inclusions/Exclusions" field in the Complete Summary)

Patients discharged with acute myocardial infarction (AMI), coronary artery bypass graft (CABG), percutaneous transluminal coronary angioplasty (PTCA) (inpatient or outpatient), or with ischemic vascular disease (IVD) who have had a full lipid panel in the past year and low-density lipoprotein cholesterol (LDL-C) less than 100 on most recent test in past year (see the related "Numerator Inclusions/Exclusions" field in the Complete Summary)

Administrative data
Medical record

AMI - outpatient - LDL-C less than 100 mg/dL.

Veterans Health Administration

Measure was not adapted from another source.

2001 Nov

2007 Oct

This is the current release of the measure.

This measure updates a previous version: Office of Quality and Performance (10Q). FY 2005 VHA executive career field network director performance measurement system and JCAHO hospital core measures. Technical manual. Washington (DC): Veterans Health Administration (VHA); 2005 Mar 9. 244 p.

• Office of Quality and Performance (10Q). FY 2008, Q1 technical manual for the VHA performance measurement system. Washington (DC): Washington (DC); 2007 Oct 31. 315 p.

This NQMC summary was completed by ECRI on September 27, 2002. The information was verified by the Veterans Health Administration on October 29, 2002. This NQMC summary was updated by ECRI Institute on November 29, 2004 and again on February 7, 2008. The information was not verified by the measure developer.

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