Have a Heart to Heart – Monitor the effectiveness of care of cardiac patients
The 2010 HEDIS measure for acute myocardial infarction (AMI) assesses the percentage of members age 18 and older with a diagnosis of AMI who were hospitalized and discharged during the period of July 1, 2009, to June 30, 2010, and who were taking a beta blocker for at least 180 days after discharge.
Use of beta blockers after AMI has been shown to reduce the risk of rehospitalization and death from subsequent attacks within the first two years. But despite these potentially lifesaving benefits, compliance is a problem. In a study of Medicaid patients, only 32 percent of AMI patients continually filled their beta-blocker prescriptions for six months after discharge. Within 30 days of hospital discharge, just over half of patients had filled their initial ambulatory prescription.
Steps You Can Take
Impart a strong message to your AMI patients about the value of long-term, persistent use of beta blockers. Do this at every appointment. Ask about side effects. If possible, coordinate with pharmacies to remind patients to fill or refill prescriptions.
Keep an Eye on LDL Levels
The higher the level of low-density lipoprotein cholesterol (LDL-C), the greater the risk of plaque buildup on artery walls, where hemorrhaging or clot formation can block arteries and cause heart attack and stroke. For patients with cardiovascular disease, an LDL level of less than 100 mg/dL is a desirable target. 2010 HEDIS cholesterol management measures assess the percentage of patients age 18 to 75 years old with cardiovascular conditions who had an LDL-C screening performed during the year and the percentage of those patients with an LDL level less than 100 mg/dL.
People at risk of a major coronary event are most likely to benefit from statin therapy to lower LDL levels, as are those with elevated LDL levels and any cardiac risk factors (smoking, high blood pressure, obesity or family history of heart disease). But supplement it with lifestyle counseling. Changes in diet and exercise can have dramatic effects in a relatively short time and may be the most important recourse for CVD patients unable to tolerate the side effects, like muscle pain or liver damage, produced by statins.
Where there’s heart trouble, depression also may occur. Depression, in turn, can increase cardiac risks, so screen promptly and periodically.