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Performance measures for coronary artery disease, hypertension released

New performance measures are expected to help physicians care for adult patients who have two of the nation's most widespread chronic conditions -- coronary artery disease and hypertension. The measures were developed by the American College of Cardiology Foundation, the American Heart Assn. and the American Medical Association-convened Physician Consortium for Performance Improvement. They were concurrently published online June 12 in Circulation and June 13 in the Journal of the American College of Cardiology. The measures, which update metrics issued by the three organizations in 2005, examine whether cardiac risk factors are treated and controlled to target levels. Testing of these measurements is expected to start this year, said Joseph Drozda Jr., MD, co-chair of the writing committee. When testing is completed, the metrics can be used in accountability programs, including public reporting and pay-for-performance programs. Coronary artery disease and hypertension "are two prevalent conditions, and they represent a significant amount of morbidity and mortality nationally. This is also an area where there is an opportunity to improve" quality of care, said Dr. Drozda, a cardiologist and director of outcomes research at Sisters of Mercy Health System in St. Louis. "These measures are well-suited to be used in the primary care practice where a great percentage of these patients with coronary artery disease and hypertension are actually treated," Dr. Drozda said. Heart disease is the leading cause of death in the United States, according to the Centers for Disease Control and Prevention. In 2006, the condition caused about 26% of the nation's deaths. About one in three people has hypertension, which increases the risk of heart disease, the CDC said. The 2011 performance measures were developed by a committee that included cardiologists, family physicians and internists. The committee identified outcomes that are meaningful to patients with coronary artery disease and hypertension. The group also examined the processes recommended by practice guidelines that are most strongly associated with these outcomes. As a result, the committee issued 10 performance measures, which include new metrics and revisions of the 2005 measurements. The committee eliminated the 2005 measure screening for diabetes largely because of the logistical difficulty in conducting this test, which requires patients to return for laboratory testing. The new measures recommend that physicians document a plan of care to manage angina symptoms and refer individuals who had a cardiac condition, such as an acute heart attack, to an early outpatient cardiac rehabilitation program. Other measurements include a target blood pressure of less than 140/90 mm Hg for patients who are at least 18 years old and have had a diagnosis of coronary artery disease or hypertension. For those who cannot reach this goal, doctors should prescribe at least two antihypertensive medications. The metrics also recommend that physicians evaluate patients' activity level and the presence or absence of angina symptoms. The full and original article can be found at:
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