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  • Measure Summary
  • NQMC:008936
  • Jul 2013

Heart failure in adults: percentage of heart failure patients who are current smokers or tobacco users who received smoking cessation advice or counseling in primary care.

Pinkerman C, Sander P, Breeding JE, Brink D, Curtis R, Hayes R, Ojha A, Pandita D, Raikar S, Setterlund L, Sule O, Turner A. Heart failure in adults. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2013 Jul. 94 p. [190 references]

View the original measure documentation External Web Site Policy

This is the current release of the measure.

This measure updates a previous version: Institute for Clinical Systems Improvement (ICSI). Heart failure in adults. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2011 Aug. 110 p.

The measure developer reaffirmed the currency of this measure in January 2016.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of heart failure patients age 18 years and older who are current smokers or tobacco users who received smoking cessation advice or counseling in primary care.

Rationale

The priority aim addressed by this measure is to increase the rate of heart failure patients age 18 years and older who have comprehensive patient education and follow-up care.

Heart failure is a major health problem in the United States (U.S.), and the incidence of the disease is increasing. The overall estimated 2004 prevalence of heart failure in adults age 20 and older in the U.S. was 5.2 million, with it being equally distributed among men and women.

Cigarette smoking increases the incidence of congestive heart failure. As heart failure continues to increase in prevalence in the U.S., there is a need to look at how to prevent decompensation of previously stable heart failure patients. Several precipitating factors have been suggested in the relapse of heart failure, and one of them includes cigarette smoking.

Research on the participants in the Study of Left Ventricular Dysfunction (SOLVD) showed that current cigarette smoking increased mortality and hospitalization compared to ex-smokers and those who never smoked. Quitting smoking is associated with a significant decrease in risk of all-cause mortality among patients with coronary heart disease. In fact, in patients with left ventricular dysfunction, research on the SOLVD participants showed that quitting smoking substantially decreases morbidity and mortality within two years.

Evidence for Rationale

Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA. 2003 Jul 2;290(1):86-97. [63 references] PubMed External Web Site Policy

He J, Ogden LG, Bazzano LA, Vupputuri S, Loria C, Whelton PK. Risk factors for congestive heart failure in US men and women: NHANES I epidemiologic follow-up study. Arch Intern Med. 2001 Apr 9;161(7):996-1002. PubMed External Web Site Policy

Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B, American College of Cardiology, American Heart Association Task Force on Practice Guidelines, American College of Chest Physicians, International Society for Heart and Lung Transplantation, Heart Rhythm Society. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [trunc]. Circulation. 2005 Sep 20;112(12):e154-235. PubMed External Web Site Policy

National Health and Nutrition Examination Survey 1999 to 2004 [NHANES] Data 1999-2004. [internet]. Hyattsville (MD): National Center for Health Statistics;

Pinkerman C, Sander P, Breeding JE, Brink D, Curtis R, Hayes R, Ojha A, Pandita D, Raikar S, Setterlund L, Sule O, Turner A. Heart failure in adults. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2013 Jul. 94 p. [190 references]

Roger VL, Weston SA, Redfield MM, Hellermann-Homan JP, Killian J, Yawn BP, Jacobsen SJ. Trends in heart failure incidence and survival in a community-based population. JAMA. 2004 Jul 21;292(3):344-50. PubMed External Web Site Policy

Suskin N, Sheth T, Negassa A, Yusuf S. Relationship of current and past smoking to mortality and morbidity in patients with left ventricular dysfunction. J Am Coll Cardiol. 2001 May;37(6):1677-82. PubMed External Web Site Policy

Primary Health Components

Heart failure; smoking cessation; advice or counseling

Denominator Description

Number of patients age 18 years and older with a diagnosis of heart failure and current smokers or tobacco users (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of patients 18 years and older with a diagnosis of heart failure and current smokers or tobacco users who received counseling or advice on smoking cessation at the last clinic visit

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence

Additional Information Supporting Need for the Measure

  • In age 20 to 39, the incidence of heart failure is 0.3% of the population in men and 0.2% of the population in women. In the ages 40s and 50s, the incidence is 2% in men and 1.5% in women. In the 60 to 79 age group, the incidence is 7.2% in men and 5.2% in women. However, once reaching age 80, the incidence of heart failure is higher in women, with 11.6% of men and 12.4% of women.
  • Seventy-five percent of heart failure cases have antecedent hypertension in that the lifetime risk for heart failure doubles for people with blood pressure greater than 160/90 versus those with blood pressure less than 140/90. A community-based cohort study conducted in Olmsted County, Minnesota, showed that the incidence of heart failure (International Classification of Diseases, Ninth Revision [ICD9]-428) has not declined during the past two decades, but survival after onset has increased overall, with less improvement among women and elderly persons.

Evidence for Additional Information Supporting Need for the Measure

National Health and Nutrition Examination Survey 1999 to 2004 [NHANES] Data 1999-2004. [internet]. Hyattsville (MD): National Center for Health Statistics;

Pinkerman C, Sander P, Breeding JE, Brink D, Curtis R, Hayes R, Ojha A, Pandita D, Raikar S, Setterlund L, Sule O, Turner A. Heart failure in adults. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2013 Jul. 94 p. [190 references]

Roger VL, Weston SA, Redfield MM, Hellermann-Homan JP, Killian J, Yawn BP, Jacobsen SJ. Trends in heart failure incidence and survival in a community-based population. JAMA. 2004 Jul 21;292(3):344-50. PubMed External Web Site Policy

Extent of Measure Testing

Unspecified

National Guideline Clearinghouse Link

Heart failure in adults. External Web Site Policy

State of Use

Current routine use

Current Use

Internal quality improvement

Measurement Setting

Ambulatory/Office-based Care

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Nurses

Physician Assistants

Physicians

Least Aggregated Level of Services Delivery Addressed

Clinical Practice or Public Health Sites

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Age greater than or equal to 18 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Person- and Family-centered Care
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Living with Illness

IOM Domain

Effectiveness

Patient-centeredness

Case Finding Period

The time frame pertaining to data collection is monthly.

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Encounter

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Number of patients age 18 years and older with a diagnosis of heart failure* and current smokers or tobacco users

Data Collection: Query electronic medical records (EMR) for clinic visits within the last month for patients, age 18 years and older, with heart failure diagnosis and are also current smokers or tobacco users.

*International Classification of Diseases, Ninth Revision (ICD-9) codes: 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 428.0, 428.1, 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9. (Refer to the table "Descriptions of ICD-9 Codes" in the original measure documentation for code descriptions.)

Exclusions
Unspecified

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Number of patients 18 years and older with a diagnosis of heart failure and current smokers or tobacco users who received counseling or advice on smoking cessation at the last clinic visit

Exclusions
Unspecified

Numerator Search Strategy

Encounter

Data Source

Administrative clinical data

Electronic health/medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Percentage of heart failure patients who are current smokers or tobacco users who received smoking cessation advice or counseling in primary care.

Measure Collection Name

Heart Failure in Adults

Submitter

Institute for Clinical Systems Improvement - Nonprofit Organization

Developer

Institute for Clinical Systems Improvement - Nonprofit Organization

Funding Source(s)

The Institute for Clinical Systems Improvement's (ICSI's) work is funded by the annual dues of the member medical groups and five sponsoring health plans in Minnesota and Wisconsin.

Composition of the Group that Developed the Measure

Work Group Members: Charles Pinkerman, MD (Work Group Leader) (Park Nicollet Health Services) (Cardiology); Paul Sander, MD (Work Group Leader) (North Memorial Health Care) (Cardiology); Joshua E. Breeding, PharmD, BCPS (Fairview Health Services) (Pharmacist); Shama Raikar, MD (HealthPartners Medical Group and Regions Hospital) (Internal Medicine); Oghomwen Sule, MD (Howard Young Medical Center) (Internal Medicine); Ashok Ojha, MD (Hutchinson Medical Center) (Internal Medicine); Rochelle Curtis, PA (Park Nicollet Health Services) (Cardiology); Deepti Pandita, MD (Park Nicollet Health Services) (Internal Medicine); Angela Turner, PA-C (Park Nicollet Health Services) (Cardiology); Darin Brink, MD (University of Minnesota Physicians) (Family Medicine); Rochelle Hayes, BS (Institute for Clinical Systems Improvement) (Systems Improvement Coordinator); Linda Setterlund, MA, CPHQ (Institute for Clinical Systems Improvement) (Clinical Systems Improvement Facilitator)

Financial Disclosures/Other Potential Conflicts of Interest

The Institute for Clinical Systems Improvement (ICSI) has long had a policy of transparency in declaring potential conflicting and competing interests of all individuals who participate in the development, revision and approval of ICSI guidelines and protocols.

In 2010, the ICSI Conflict of Interest Review Committee was established by the Board of Directors to review all disclosures and make recommendations to the board when steps should be taken to mitigate potential conflicts of interest, including recommendations regarding removal of work group members. This committee has adopted the Institute of Medicine Conflict of Interest standards as outlined in the report Clinical Practice Guidelines We Can Trust (2011).

Where there are work group members with identified potential conflicts, these are disclosed and discussed at the initial work group meeting. These members are expected to recuse themselves from related discussions or authorship of related recommendations, as directed by the Conflict of Interest committee or requested by the work group.

The complete ICSI policy regarding Conflicts of Interest is available at the ICSI Web site External Web Site Policy.

Disclosure of Potential Conflicts of Interest

Joshua E. Breeding, PharmD, BCPS (Work Group Member)
Pharmacy, Fairview Health Services
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Darin Brink, MD (Work Group Member)
Family Medicine, University of Minnesota Physicians
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: Colorectal Cancer Screening Guideline Work Group
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Rochelle Curtis, PA (Work Group Member)
Cardiology, Park Nicollet Health Services
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Ashok Ojha, MD (Work Group Member)
Internal Medicine, Hutchinson Medical Center
National, Regional, Local Committee Affiliations: Minneapolis Heart Institute
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Deepti Pandita, MD (Work Group Member)
Internal Medicine, Park Nicollet Health Services
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: Breast Cancer Treatment Guideline Work Group
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Charles Pinkerman, MD (Work Group Leader)
Cardiology, Park Nicollet Health Services
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Shama Raikar, MD (Work Group Member)
Internal Medicine, HealthPartners Medical Group and Regions Hospital
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: Chronic Obstructive Pulmonary Disease
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Paul Sander, MD (Work Group Leader)
Cardiology, North Memorial Health Care
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Oghomwen Sule, MD (Work Group Member)
Internal Medicine, Howard Young Medical Center
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: Diagnosis and Initial Treatment of Stroke
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Angela Turner, PA-C (Work Group Member)
Cardiology, Park Nicollet Health Services
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2013 Jul

Measure Maintenance

Scientific documents are revised every 12 to 24 months as indicated by changes in clinical practice and literature.

Date of Next Anticipated Revision

The next scheduled revision will occur within 24 months.

Measure Status

This is the current release of the measure.

This measure updates a previous version: Institute for Clinical Systems Improvement (ICSI). Heart failure in adults. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2011 Aug. 110 p.

The measure developer reaffirmed the currency of this measure in January 2016.

Source(s)

Pinkerman C, Sander P, Breeding JE, Brink D, Curtis R, Hayes R, Ojha A, Pandita D, Raikar S, Setterlund L, Sule O, Turner A. Heart failure in adults. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2013 Jul. 94 p. [190 references]

Measure Availability

Source available for purchase from the Institute for Clinical Systems Improvement (ICSI) Web site External Web Site Policy. Also available to ICSI members for free at the ICSI Web site External Web Site Policy and to Minnesota health care organizations free by request at the ICSI Web site External Web Site Policy.

For more information, contact ICSI at 8009 34th Avenue South, Suite 1200, Bloomington, MN 55425; Phone: 952-814-7060; Fax: 952-858-9675; Web site: www.icsi.org External Web Site Policy; E-mail: icsi.info@icsi.org.

NQMC Status

This NQMC summary was completed by ECRI on November 29, 2006.

This NQMC summary was updated by ECRI Institute on December 16, 2007 and on July 1, 2010.

This NQMC summary was retrofitted into the new template on July 25, 2011.

This NQMC summary was updated by ECRI Institute on October 16, 2012 and again on October 14, 2013.

The information was reaffirmed by the measure developer on January 13, 2016.

Copyright Statement

This NQMC summary (abstracted Institute for Clinical Systems Improvement [ICSI] Measure) is based on the original measure, which is subject to the measure developer's copyright restrictions.

The abstracted ICSI Measures contained in this Web site may be downloaded by any individual or organization. If the abstracted ICSI Measures are downloaded by an individual, the individual may not distribute copies to third parties.

If the abstracted ICSI Measures are downloaded by an organization, copies may be distributed to the organization's employees but may not be distributed outside of the organization without the prior written consent of the Institute for Clinical Systems Improvement, Inc.

All other copyright rights in the abstracted ICSI Measures are reserved by the Institute for Clinical Systems Improvement, Inc. The Institute for Clinical Systems Improvement, Inc. assumes no liability for any adaptations or revisions or modifications made to the abstracts of the ICSI Measures.

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NGC GUIDELINE SUMMARIES

  • NGC:009982
  • 1997 Oct (revised 2013 Jul)

Heart failure in adults.


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