Coronary Artery Disease (CAD): Angiotensin-Converting Enzyme (ACE)

Measure Specification

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. In the absence of contraindications, ACE inhibitors or ARBs are recommended for all patients with a diagnosis of coronary artery disease and diabetes or reduced left ventricular systolic function.

ACE inhibitors remain the first choice, but ARBs can now be considered a reasonable alternative. Both pharmacologic agents have been shown to decrease the risk of death, myocardial infarction, and stroke. Additional benefits of ACE inhibitors include the reduction of diabetic symptoms and complications for patients with diabetes.

The following evidence statements are quoted verbatim from the referenced clinical guidelines. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the management of patients with chronic coronary disease (CCD): In patients with CCD who also have hypertension, diabetes, LVEF <=40%, or CKD, the use of ACE inhibitors, or ARBs if ACE inhibitor-intolerant, is recommended to reduce cardiovascular events.

(Class 1 Recommendation, Level of Evidence A) 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease (SIHD) (ACCF/AHA/ACP/AATS/PCNA/SCAI/STS, 2012) RENIN-ANGIOTENSIN-ALDOSTERONE BLOCKER THERAPY ACE inhibitors should be prescribed in all patients with SIHD who also have hypertension, diabetes mellitus, LVEF 40% or less, or CKD, unless contraindicated.

(Class I Recommendation, Level of Evidence: A) ARBs are recommended for patients with SIHD who have hypertension, diabetes mellitus, LV systolic dysfunction, or CKD and have indications for, but are intolerant of, ACE inhibitors.

This measure contains two strata defined by two submission criteria. This measure produces a single performance rate using a weighted average. There are 2 Submission Criteria for this measure: 1) Patients who are 18 years and older with a diagnosis of CAD with LVEF ≤ 40% OR 2) Patients who are 18 years and older with a diagnosis of CAD who have diabetes If the patient has CAD and LVSD (without a diagnosis of diabetes), use Denominator Submission Criteria 1.

If the patient has CAD and diabetes, use Denominator Submission Criteria 2. If the patient has both diabetes and LVSD, the eligible professional may submit quality data for Submission Criteria 2 and this will count as appropriate submission for this patient. Both submission criteria should be submitted as appropriate. For the purposes of MIPS implementation, this patient-process measure is submitted a minimum of once per patient for the performance period.

The most advantageous quality data code will be used if the measure is submitted more than once. The MIPS eligible clinician should submit data on one of the submission criteria, depending on the clinical findings.