Perspective:

The following are 10 points to remember about these performance measures for adults with coronary artery disease (CAD) and hypertension:

1. CAD and hypertension are major and growing public health problems in the United States. To guide the selection of measures for inclusion in the measure set, the writing committee sought to identify outcomes that are meaningful to patients with CAD or hypertension.

2. The blood pressure control measure includes percentage of patients ages ≥18 years with a diagnosis of CAD seen within a 12-month period who have a blood pressure <140/90 mm Hg, OR who have a blood pressure ≥140/90 mm Hg and were prescribed ≥2 antihypertensive medications during the most recent office visit.

3. Lipid control measure includes percentage of patients ages ≥18 years with a diagnosis of CAD seen within a 12-month period who have a low-density protein (LDL) cholesterol result <100 mg/dl, OR who have an LDL cholesterol result ≥100 mg/dl and have a documented plan of care to achieve LDL cholesterol <100 mg/dl, including, at a minimum, the prescription of a statin.

4. Symptom and activity assessment measure includes percentage of patients ages ≥18 years with a diagnosis of CAD seen within a 12-month period for whom there are documented results of an evaluation of level of activity AND an evaluation of presence or absence of anginal symptoms in the medical record.

5. Tobacco use cessation measure includes percentage of patients ages ≥18 years with a diagnosis of CAD seen within a 12-month period who were screened for tobacco use AND received tobacco-cessation counseling if identified as tobacco users.

6. Antiplatelet therapy measure includes percentage of patients ages ≥18 years with a diagnosis of CAD seen within a 12-month period who were prescribed aspirin or clopidogrel.

7. Beta-blocker use measure includes percentage of patients ages ≥18 years with a diagnosis of CAD seen within a 12-month period who also have prior myocardial infarction or a current or prior left ventricular ejection fraction (LVEF) <40% who were prescribed beta-blocker therapy.

8. Angiotensin-converting enzyme (ACE) inhibitor use measure includes percentage of patients ages ≥18 years with a diagnosis of CAD seen within a 12-month period who also have diabetes or a current or prior LVEF <40% and who were prescribed ACE inhibitor or angiotensin-receptor blocker therapy.

9. Cardiac rehabilitation (CR) measure includes all patients evaluated in an outpatient setting who within the previous 12 months have experienced an acute myocardial infarction, coronary artery bypass graft surgery, percutaneous coronary intervention, cardiac valve surgery, or cardiac transplantation, or who have chronic stable angina and have not already participated in an early outpatient CR or secondary prevention program for the qualifying event/diagnosis and are referred to such a program.

10. The process measures recommended in this set should be systematically studied with respect to their effects on clinical, financial, and patient satisfaction outcomes.