Measure Information Form
Clinical Area: Acute Myocardial Infarction (AMI)
Measure ID#: HQID-10
Performance Measure Name: LDL-Cholesterol Assessment
Description: Acute myocardial infarction (AMI) patients with documentation of low-density lipoprotein cholesterol (LDL-c) level in the hospital record or documentation that LDL-c testing was done during the hospital stay or is planned for after discharge.
Rationale: The reduction of LDL-c reduces mortality and morbidity in patients with coronary artery disease (CAD). Placebo-controlled trials demonstrate a 30 to 40% relative risk reduction in cardiovascular endpoints with lipid-lowering therapy in a broad range of patients with established CAD (Collins, 2003 and Shepherd, 2002). The National Cholesterol Education Panel and the ACC/AHA recommend lipid screening and lipid lowering, particularly LDL-c reduction, in patients with CAD and hyperlipidemia (NCEP ATP III, 2001; Antman, 2004; and Smith, 2001). The ACC/AHA ST-Elevation Myocardial Infarction guidelines also recommend that lipid measurements should be performed or obtained from prior medical records for all patients (Antman, 2004). Despite the increasing evidence to support lipid testing to direct therapy, many eligible older patients hospitalized with AMI do not have measurements of their lipid levels performed (Foody, 2005).
Type of Measure: Process; CMS Test
Improvement Noted As: An increase in the rate
Numerator Statement: AMI patients with documentation of LDL-c level in the hospital record or documentation that LDL-c testing was done either during the hospital stay or is planned for after discharge
Included Populations: Not Applicable
Excluded Populations: None
; In-Hospital LDL-Cholesterol Test
; Plan for LDL-Cholesterol Test
; Pre-Arrival LDL-Cholesterol Qualitative Description
; Pre-Arrival LDL-Cholesterol Test
; Pre-Arrival LDL-Cholesterol Value
Source: Specifications Manual for National Hospital Inpatient Quality Measures HQID-10-1 Discharges 04-01-09 (2Q09) through 09-30-09 (3Q09)
Denominator Statement: AMI patients
Discharges with an ICD-9-CM Principal Diagnosis Code for AMI as defined in HQID
Appendix A, Table 1.1
; Patients less than 18 years of age
; Patients who have a Length of Stay >120 days
; Patients with Comfort Measures Only documented
; Patients enrolled in clinical trials
; Patients discharged/transferred to another hospital for inpatient care
; Patients who left against medical advice or discontinued care
; Patients who expired
; Patients discharged/transferred to a federal health care facility
; Patients discharged/transferred to hospice
; Lipid-lowering medication as pre-arrival medication
; Patients with reason documented by a physician/advanced practice nurse/physician
assistant for no LDL-c testing
; Admission Date
; Clinical Trial
; Comfort Measures Only
; Discharge Date
; Discharge Status
; ICD-9-CM Principal Diagnosis Code
; Pre-Arrival Lipid-Lowering Agent
; Reason for No LDL-Cholesterol Testing
Risk Adjustment: No
Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records.
Data Accuracy: Variation may exist in the assignment of ICD-9-CM codes; therefore, coding practices may require evaluation to ensure consistency.
Measure Analysis Suggestions: None
Sampling: Yes, for additional information see the Population and Sampling Specifications section NHQM version 2.6b.
Data Reported As: Aggregate rate generated from count data reported as a proportion
Source: Specifications Manual for National Hospital Inpatient Quality Measures HQID-10-2 Discharges 04-01-09 (2Q09) through 09-30-09 (3Q09)
; Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, Chavey WE II,
Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK,
Wright RS. ACC/AHA 2007 guidelines for the management of patients with unstable
angina/non–ST-elevation myocardial infarction: a report of the American College of
Cardiology/American Heart Association Task Force on Practice Guidelines (Writing
Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable
Angina/Non–ST-Elevation Myocardial Infarction): developed in collaboration with the
American College of Emergency Physicians, American College of Physicians, Society for
Academic Emergency Medicine, Society for Cardiovascular Angiography and Interventions,
and Society of Thoracic Surgeons. J Am Coll Cardiol 2007;50:e1–157.
; Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS,
Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA,
Smith SC Jr. ACC/AHA guidelines for the management of patients with ST-elevation
myocardial infarction: a report of the American College of Cardiology/American Heart
Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for
the Management of Patients With Acute Myocardial Infarction). 2004. ; Collins R, Armitage J, Parish S, Sleigh P, Peto R. MRC/BHF Heart Protection Study of
cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomized placebo-
controlled trial. Lancet. 2003;361:2005-2016.
; Executive Summary of the Third Report of the National Cholesterol Education Program
(NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in
Adults (Adult Treatment Panel III). JAMA 2001;285:2486-2497.
; Foody JM, Roe MT, Chen AY, Smith SC Jr, Brindis RG, Peterson ED, Gibler WB, Ohman
EM; CRUSADE Investigators. Lipid management in patients with unstable angina pectoris
and non-ST-segment elevation acute myocardial infarction (from CRUSADE). Am J Cardiol.
2005 Feb 15;95(4):483-5.
; Grundy SM, Cleeman JI, Merz CNB et al. Implications of Recent Clinical Trials for the
National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation.
; Krumholz HM, Anderson JL, Brooks NH, Fesmir FM, Lambrew CT, Landrum MB, Weaver
WD, Whyte J. ACC/AHA Clinical Performance Measures for Adults With ST-Elevation and
Non–ST-Elevation Myocardial Infarction: a report of the ACC/AHA Task Force on
Performance Measures (ST-Elevation and Non–ST-Elevation Myocardial Infarction
Performance Measures Writing Committee). J Am Coll Cardiol 2006;47:236–65. Available
at http://www.acc.org and http://www.americanheart.org.
; Smith SC, Blair SN, Bonow RO, Brass LM, Cerqueira MD, Dracup K, Fuster V, Gotto A,
Grundy SM, Houston Miller N, Jacobs A, Jones D, Krauss RM, Mosca L, Ockene I,
Pasternak RC, Pearson T, Pfeffer MA, Starke RD, Taubert KA. AHA/ACC guidelines for
preventing heart attack and death in patients with atherosclerotic cardiovascular disease:
2001 update. Circulation 2001;104:1577-1579.
; Shepherd J, Blauw GJ, Murphy MB et al. Pravastatin in elderly individuals at risk of vascular
disease (PROSPER): a randomized controlled trial. Lancet. 2002;360:1623-1630. Source: Specifications Manual for National Hospital Inpatient Quality Measures HQID-10-3 Discharges 04-01-09 (2Q09) through 09-30-09 (3Q09)
HQID-10: LDL-Cholesterol Assessment (CMS Test)
Numerator:AMI patients with documentation of LDL-c level in the hospital record or
documentation that LDL-c testing was done either during the hospital stay or is
planned for after discharge.
Run cases that are included in the AMI Initial Patient Population and pass the edits defined in the Data Processing Flow through this measure.
HQID-10HQID-10Comfort Missing = 1, 2, 3XBMeasures Only
HQID-10HQID-10MissingClinical Trial = YXB
Source: Specifications Manual for National Hospital Inpatient Quality Measures HQID-10-4 Discharges 04-01-09 (2Q09) through 09-30-09 (3Q09)
HQID-10= 02, 07, 20,BDischarge Status 43, 50, 51, 66
= 01, 03, 04, 05, 06, 61, 62, 63, 64, 65, 70
HQID-10HQID-10Pre-Arrival XMissing = YBLipid-Lowering Agent
HQID-10In-Hospital LDL- = YMissingXCholesterol Test
HQID-10HQID-10Pre-Arrival LDL-I = NMissingXCholesterol Test
Pre-Arrival LDL-HQID-10XMissingNon-UTDCholesterol Value
HQID-10Pre-Arrival LDL-HQID-10XMissingCholesterol Qualitative = 1 or 2EDescription
Source: Specifications Manual for National Hospital Inpatient Quality Measures HQID-10-5 Discharges 04-01-09 (2Q09) through 09-30-09 (3Q09)
Plan for HQID-10In Numerator MissingLDL-Cholesterol = YZPopulationTestEHQID-10XHQID-10= NB
Reason for NoCase WillNot In Measure MissingLDL-Cholesterol = YBe RejectedPopulationTestingXB
In Measure PopulationD
Source: Specifications Manual for National Hospital Inpatient Quality Measures HQID-10-6 Discharges 04-01-09 (2Q09) through 09-30-09 (3Q09)