Ischemic Vascular Disease (IVD) All or None Outcome Measure (Optimal Control)

Measure Specification

There has been important evidence from clinical trials that further supports and broadens the merits of risk-reduction therapies for patients with established coronary and other atherosclerotic vascular disease, including peripheral arterial disease, atherosclerotic aortic disease, and carotid artery disease.

The American College of Cardiology (ACC) and the American Heart Association (AHA) recommend that high-intensity statin therapy should be initiated or continued as first-line therapy in women and men less than or equal to 75 years of age who have clinical atherosclerotic cardiovascular disease, unless contraindicated. In November 2013, the ACC and AHA Task Force on Practice Guidelines released updated guidance for the treatment of blood cholesterol.

The new recommendations remove treatment targets for LDL-C for the primary or secondary prevention of atherosclerotic cardiovascular disease (ASCVD) and recommend high or moderate intensity statin therapy based on patient risk factors. Four major statin benefit groups were identified for whom ASCVD risk clearly outweighs the risk of adverse events.

Individuals with ASCVD are one of the identified groups. Based on trials involving other secondary prevention therapies, the ACC and AHA recommend aspirin in all patients, unless contraindicated, with established coronary and other atherosclerotic vascular disease, including peripheral arterial disease, atherosclerotic aortic disease, and carotid artery disease.

The ACC and AHA also recommend the use of other antiplatelet agents based on disease type and clinical conditions. Patients with blood pressure greater than or equal to 130/80 mm Hg should be treated, as tolerated, with blood pressure medication, treating initially with beta blockers and/or ACE inhibitors, with addition of other drugs as needed to achieve goal blood pressure.

The ACC and AHA recommends secondary prevention for patients with Coronary and other Vascular Disease that includes strongly encouraging patient and family to stop smoking and to avoid secondhand smoke through the provision of counseling, pharmacological therapy and formal smoking cessation programs as appropriate. The goal is for complete smoking cessation.

This measure contains two strata defined by two submission criteria. This measure produces two performance rates. There are 2 Submission Criteria for this measure: 1) Patients with coronary artery disease (CAD) or a CAD Risk-Equivalent Condition 18-75 years of age and alive as of the last day of the measurement period and a minimum of two CAD or CAD Risk-Equivalent Condition coded office visits with a Primary Care Provider (PCP) / Cardiologist in 24 months and one office visit in 12 months OR 2) Patients with one Acute Coronary Event (Acute Myocardial Infarction [AMI], Percutaneous Coronary Intervention [PCI], or Coronary Artery Bypass Graft [CABG]) 18-75 years of age and alive as of the last day of the measurement period from a hospital visit (excluding Emergency and Lab Only visits) and have been seen by a primary care provider (PCP) / Cardiologist for two office visits in 24 months and one office visit in 12 months Please note that a patient will only be included once in the measurement if they meet the denominator criteria for both Submission Criteria 1 and Submission Criteria 2.

The measure will be calculated with 2 performance rates: 1) Patients with coronary artery disease (CAD) or a CAD Risk-Equivalent Condition 18-75 years of age and alive as of the last day of the measurement period and a minimum of two CAD or CAD Risk-Equivalent Condition coded office visits with a Primary Care Provider (PCP) / Cardiologist in 24 months and one office visit in 12 months 2) Patients with one Acute Coronary Event (Acute Myocardial Infarction [AMI], Percutaneous Coronary Intervention [PCI], or Coronary Artery Bypass Graft [CABG]) 18-75 years of age and alive as of the last day of the measurement period from a hospital visit (excluding Emergency and Lab Only visits) and have been seen by a primary care provider (PCP) / Cardiologist for two office visits in 24 months and one office visit in 12 months The most recent quality data code submitted will be used for performance calculation.

For the purposes of MIPS implementation, this patient-intermediate measure is submitted a minimum of once per patient for the performance period. The most recent quality data code (QDC) will be used if the measure is submitted more than once.