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  • Measure Summary
  • NQMC:008866
  • May 2013

Stable coronary artery disease: percentage of patients with diabetes with a documented HbA1c of less than 7.0% or meeting the patient's individualized HbA1c goal.

Goblirsch G, Bershow S, Cummings K, Hayes R, Kokoszka M, Lu Y, Sanders D, Zarling K. Stable coronary artery disease. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2013 May. 71 p. [98 references]

View the original measure documentation External Web Site Policy

This is the current release of the measure.

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

Primary Measure Domain

Clinical Quality Measures: Outcome

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of patients with diabetes with a documented glycated hemoglobin (HbA1c) of less than 7.0% or meeting the patient's individualized HbA1c goal.

Rationale

The priority aim addressed by this measure is to increase the percentage of patients age 18 years and older with a diagnosis of stable coronary artery disease who receive education and an intervention for modifiable risk factors.

Modifiable risk factors for coronary heart disease need to be evaluated and may include smoking, inadequate physical activity, depression, hyperlipidemia, obesity, hypertension and diabetes mellitus. Intervention involving any risk factor pertinent to the patient is encouraged and may include education, goal setting, and follow-up as necessary. For all patients, lifestyle modification, including exercise, smoking cessation, achieving and maintaining ideal body weight, and proven risk factor reduction will continue to be the focus of primary and secondary cardiovascular disease prevention.

Diabetes is associated with a marked increase in coronary artery disease. Patients with diabetes without known coronary artery disease have as high risk of a myocardial infarction as patients without diabetes with coronary artery disease. Therefore, patients with diabetes should have aggressive lipid and blood pressure management (similar to patients with coronary artery disease), and should be treated per the recommendations of the Institute for Clinical Systems Improvement (ICSI) Diagnosis and Management of Type 2 Diabetes Mellitus in Adults guideline, ICSI Lipid Management in Adults guideline and ICSI Hypertension Diagnosis and Treatment guidelines.

Every attempt should be made to achieve meticulous glucose control in patients with diabetes, because there is a clear relationship between lower hemoglobin A1c's and lower risk of myocardial infarction. In the United Kingdom Prospective Diabetes Study (UKPDS), obese patients with type 2 diabetes who were treated with metformin showed a statistically significant reduction in rates of myocardial infarction, suggesting metformin as a possible therapy of choice for these patients. A meta-analysis showed a 20% increase in cardiovascular events and mortality for every 1% increase in glycated hemoglobin (HbA1c) over 5%.

Evidence for Rationale

Boden WE, O'Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, Knudtson M, Dada M, Casperson P, Harris CL, Chaitman BR, Shaw L, Gosselin G, Nawaz S, Title LM, Gau G, Blaustein AS, Booth DC, Bates ER, Spertus JA, Berman DS, Mancini GB, Weintraub WS. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007 Apr 12;356(15):1503-16. [46 references] PubMed External Web Site Policy

Goblirsch G, Bershow S, Cummings K, Hayes R, Kokoszka M, Lu Y, Sanders D, Zarling K. Stable coronary artery disease. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2013 May. 71 p. [98 references]

Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998 Jul 23;339(4):229-34. PubMed External Web Site Policy

Rutherford JD, Braunwald E. Chronic ischemic. In: Heart disease. 4th ed. W.B. Saunders; 1992. 1292-317 p.

Selvin E, Marinopoulos S, Berkenblit G, Rami T, Brancati FL, Powe NR, Golden SH. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med. 2004 Sep 21;141(6):421-31. PubMed External Web Site Policy

Shub C. Stable angina pectoris: 1. Clinical patterns. Mayo Clin Proc. 1990 Feb;65(2):233-42. [46 references] PubMed External Web Site Policy

U.K. Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998 Sep 12;352(9131):837-53. PubMed External Web Site Policy

Primary Health Components

Stable coronary artery disease; glycated hemoglobin (HbA1c)

Denominator Description

Number of stable coronary artery disease patients with diabetes (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of stable coronary artery disease patients who had a documented glycated hemoglobin (HbA1c) of less than 7% or who met their individualized goal

State of Use

Current routine use

Current Use

Internal quality improvement

Measurement Setting

Ambulatory/Office-based Care

Professionals Involved in Delivery of Health Services

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

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Living with Illness

IOM Domain

Effectiveness

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

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Number of stable coronary artery disease patients with diabetes

Population Definition: All patients age 18 years and older with stable coronary artery disease diagnosis and diabetes.

Exclusions
Unspecified

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Number of stable coronary artery disease patients who had a documented glycated hemoglobin (HbA1c) of less than 7% or who met their individualized goal

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Paper medical record

Type of Health State

Physiologic Health State (Intermediate Outcome)

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 patients with diabetes with a documented HbA1c of < 7.0% or meeting the patient's individualized HbA1c goal.

Measure Collection Name

Stable Coronary Artery Disease

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: Greg Goblirsch, MD (Work Group Leader) (River Falls Clinic) (Family Medicine); Spencer Bershow, MD (Fairview Health Services) (Family Medicine); Yun Lu, PharmD, MS (Hennepin County Medical Center) (Pharmacy); Kathy Zarling, RN, MS, CNS (Mayo Clinic) (Nursing); Marek Kokoszka, MD (Park Nicollet Health Services) (Cardiology); Debra M. Sanders, RD (River Falls Medical Clinic) (Dietetics); Kathy Cummings, RN, BSN, MA (Institute for Clinical Systems Improvement [ICSI]) (Project Manager); Rochelle Hayes, BS (ICSI) (Systems Improvement Coordinator)

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

Spencer Bershow, MD (Work Group Member)
Family Medicine, Fairview Health Services
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Greg T. Goblirsch, MD (Work Group Leader)
Medical Director, Family Medicine, River Falls Clinic
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Marek J. Kokoszka, MD (Work Group Member)
Chair, Cardiology, Park Nicollet Health Services
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: Acute Coronary Artery Disease (ICSI)
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Yun Lu, PharmD, MS
Clinical Pharmacist, Cardiology, Hennepin County Medical Center
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Debra M. Sanders, RD (Work Group Member)
Registered Dietician, Diabetes Educator, River Falls Medical Clinic
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: Registered Dietician Consultant, Lutheran Home, Long Term Care

Kathy Zarling, RN, MS, CNS (Work Group Member)
Cardiovascular Clinical Nurse Specialist, Mayo Clinic
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 May

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.

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

Source(s)

Goblirsch G, Bershow S, Cummings K, Hayes R, Kokoszka M, Lu Y, Sanders D, Zarling K. Stable coronary artery disease. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2013 May. 71 p. [98 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 Institute on January 20, 2014.

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:009899
  • 1994 Jul (revised 2013 May)

Stable coronary artery disease.


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