Table 3

Cardiac Rehabilitation/Secondary Prevention Performance Measurement Set B-3c

Performance Measure B-3c—Individualized Assessment of Optimal Lipid Control
For each eligible patient enrolled in the cardiac rehabilitation/secondary prevention (CR) program, there is documentation that the following criteria have been met:
1. An assessment of blood lipid control and use of lipid-lowering medications, with target goals defined by the AHA/ACC secondary prevention guidelines.
2. For patients with a diagnosis of hyperlipidemia, an intervention plan has been recommended to the patient. This should include education about target lipid goals, importance of medication compliance, lifestyle modification for optimal dietary and regular physical activity habits, and weight control.
3. Prior to completion of the CR program, lipid control and the lipid management plan, including lifestyle modification, are reassessed and communicated to the patient as well as to the primary care provider and/or cardiologist.
NumeratorNumber of patients in the health care system's CR program(s) who meet the performance measure for lipid control
DenominatorNumber of patients in the health care system's CR program(s)
Period of AssessmentPer reporting year
Method of ReportingInclusive data collection tracking sheet
Sources of DataElectronic- or paper-based prospective flow sheet (preferred) or retrospective medical record review
Rationale
Multiple clinical trials have shown the benefit of lipid-lowering agents and lifestyle modification for patients with documented cardiovascular disease (39). A more aggressive low-density lipoprotein (LDL) target goal of <70 mg/dL should be considered for persons with multiple cardiovascular risk factors, particularly when they are under suboptimal control (e.g., a patient with coronary artery disease who continues to smoke).
Corresponding Guidelines and Clinical Recommendations
AHA/ACC Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2006 Update (39)
Class I
Goal: Low-density lipoprotein-cholesterol (LDL-C) <100 mg/dL; If triglycerides are >200 mg/dL, non–high-density lipoprotein cholesterol (HDL-C) should be <130 mg/dL. (Level of Evidence: B, for lifestyle modification; A, for pharmacological treatment)
AHA/AACVPR Scientific Statement: Core Components of Cardiac Rehabilitation/Secondary Prevention Programs: 2007 Update (57)
(No class of recommendation or level of evidence given)
Goals:
Short-term: Continued assessment and modification of intervention until LDL <100 mg/dL (further reduction to a goal <70 mg/dL is considered reasonable).
Long-term: LDL <100 mg/dL (further reduction to a goal <70 mg/dL is considered reasonable). Secondary goal: non–HDL-C <130 mg/dL (further reduction to a goal of <100 mg/dL is considered reasonable).
AHA Scientific Statement: Diet and Lifestyle Recommendations Revision 2006 (58)
(No class of recommendation or level of evidence given)
Goal: Aim for recommended levels of LDL-C, HDL-C, and triglycerides.
Related Performance Measurement Sets
Clinical Performance Measures. Chronic Stable Coronary Artery Disease. Tools Developed by Physicians for Physicians. Physician Consortium for Performance Improvement (59)
Percentage of patients receiving at least one lipid profile during the reporting year. Percentage of patients who are receiving a statin (based on current ACC/AHA guidelines).

Reprinted, with permission, from Thomas et al. (15). All references within this table are from Thomas et al. (15).