Updated performance measures for lipid management in secondary prevention were released Dec. 14 by the ACC and American Heart Association (AHA), and were published in the Journal of the American College of Cardiology. The updated measures place a greater emphasis on shared decision-making, and are based on the secondary prevention recommendations of the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults.

The document includes five measures, four of which are revisions of lipid management measures appearing in four existing measure sets: peripheral artery disease, ST-elevation and non-ST-elevation myocardial infarction, percutaneous coronary intervention, and coronary artery disease and hypertension. The fifth new measure applies to the population of patients with clinical atherosclerotic cardiovascular disease as defined by the cholesterol guidelines.

The new measures introduce the concept of shared decision-making into the performance measures. The writing committee explains that evidence-based medicine and guidelines alone are not sufficient to make a recommendation or decision. They note that the path forward includes engaging patients in making decisions about their care and developing tools to promote, facilitate and measure shared decision-making. Further, the evidence must be considered from the viewpoint of what matters to the individual patient.

“These measures respect the wishes of patients regarding the use of statins and do not penalize physicians who may have a patient decline to take medications for personal reasons,” says Joseph P. Drozda Jr., MD, FACC, chair of the writing committee. “Integrating patient values, preferences and personal context with evidence-based medicine and guidelines is novel and changes the focus from recommending and prescribing statins based on evidence to promoting choice by an informed patient.”

“The clinician and patient must collaborate, deliberate and arrive at the best answer that fits the patient’s preferences, values and context,” Drozda adds.

Keywords: Atherosclerosis, Cardiovascular Diseases, Cholesterol, Coronary Artery Disease, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hypertension, Lipids, Myocardial Infarction, Patient Preference, Percutaneous Coronary Intervention, Peripheral Arterial Disease, Risk Factors, Secondary Prevention

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