Measurement Name Beta-Blocker Therapy Prior Myocardial Infarction (MI)

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1 Program Metrics The list below includes the metrics that will be calculated by the PINNACLE Registry for the outpatient office setting. These include metrics for Artery, Atrial Fibrillation, Hypertension and. The PINNACLE Registry metrics are endorsed by the National Quality Forum (), the Physician Consortium for Improvement (PCPI), the Physician Quality Reporting Initiative (PQRI), the American College of Cardiology (ACC), and the American Heart Association (AHA). *Denotes 2010 PQRI s Unique ID PINN-1 Process Artery Metric Type Accrediting Agency ACC/AHA/PCPI ment Name Beta-Blocker Therapy Prior Myocardial Infarction (MI) Description Percentage of CAD patients with prior MI who were prescribed betablocker therapy PINN-2* Artery PQRI (#7) Beta-blocker Therapy for Artery Patients with Prior Myocardial Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease and prior myocardial infarction (MI) who were prescribed beta-blocker therapy PINN-4 Artery Beta-Blocker Therapy-Prior myocardial infarction (MI) Percentage of patients with prior MI at any time who were prescribed beta-blocker therapy PINN-5 Artery Blood Pressure ment Percentage of patients who had a blood pressure measurement during the last office visit 2010 American College of Cardiology Foundation Updated 08/23/10 1

2 PINN-7 Artery Antiplatelet Therapy Percentage of patients who were prescribed antiplatelet therapy PINN-8* Artery PQRI (#6) Oral Antiplatelet Therapy Prescribed for Patients with Artery Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease who were prescribed oral antiplatelet therapy PINN-10 Artery CAD: Antiplatelet Therapy Percentage of patients with CAD who were prescribed antiplatelet therapy PINN-11 Artery Screening for Diabetes Percentage of patients who were screened for diabetes PINN-13* All Patie nts PQRI (#47) Advance Care Plan Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan in the medical record PINN-14 Artery Advance Care Plan Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan PINN-15 Artery Smoking Cessation Percentage of patients who were queried one or more times about cigarette smoking PINN-18 Artery Tobacco use prevention for infants, children, and adolescents PINN-19 Artery Smoking Cessation Percentage of patients identified as cigarette smokers who received smoking cessation intervention 2010 American College of Cardiology Foundation Updated 08/23/10 2

3 PINN-20* ALL PQRI (#115) Advising Smokers and Tobacco Users to Quit Percentage of patients aged 18 years and older and are smokers or tobacco users who received advice to quit smoking PINN-22 Artery Tobacco Cessation Intervention Percentage of patients identified as tobacco users who received cessation intervention during the two-year measurement period PINN-24 Artery Cardiac Rehabilitation Patient Referral From an Outpatient Setting All patients evaluated in an outpatient setting who within the past 12 months have experienced an acute myocardial infarction (MI), coronary artery bypass graft (CABG) surgery, a percutaneous coronary intervention (PCI), cardiac valve surgery, or cardiac transplantation, or who have chronic stable angina (CSA) and have not already participated in an early outpatient cardiac rehabilitation/secondary prevention (CR) program for the qualifying event/diagnosis are to be referred to such a program. PINN-25 Artery Symptom & Activity Assessment Percentage of patients who were evaluated for both level of activity and anginal symptoms during one or more office visits PINN-27 Artery Artery (CAD): Symptom and Activity Assessment Percentage of patients with CAD who were evaluated for both level of activity and anginal symptoms during one or more office visits PINN-29 Artery ACE Inhibitor or ARB Therapy Percentage of CAD patients who also have diabetes and/or LVSD who were prescribed ACE inhibitor or ARB therapy PINN-30* Artery PQRI (#118) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Patients with CAD and Diabetes and/or Left Ventricular Systolic Dysfunction (LVSD) Percentage of patients aged 18 years and older with a diagnosis of CAD who also have diabetes mellitus and/or LVSD (LVEF < 40%) who were prescribed ACE inhibitor or ARB therapy 2010 American College of Cardiology Foundation Updated 08/23/10 3

4 PINN-32 Artery CAD: ACE inhibitor/angiotensin receptor blocker (ARB) Therapy Percentage of patients with CAD who also have diabetes and/or LSVD who were prescribed ACE inhibitor or ARB therapy. PINN-33 Artery Lipid Profile Percentage of patients who received at least one lipid profile (or ALL component tests) PINN-35 Artery Drug Therapy for Lowering LDL- Cholesterol Percentage of patients who were prescribed lipid-lowering therapy (based on current ACC/AHA guidelines) PINN-37 Artery Drug Therapy for Lowering LDL- Cholesterol Percentage of patients with CAD who were prescribed a lipid lowering therapy (based on current ACC/AHA guidelines) PINN-38 Left Ventricular Systolic (LVS) Function Assessment Heart failure patients with documentation that LVS function has been assessed PINN-40 Left Ventricular Function (LVF) assessment Percentage of patients with HF with quantitative or qualitative results of left ventricular function (LVF) assessment recorded PINN-41 Weight ment ment of patient s weight at each outpatient visit to assess change in volume status PINN-43 H eart Failure Weight ment Percentage of patient visits for patients with HF with weight measurement recorded PINN-44 Blood Pressure ment ment of patient s blood pressure at each outpatient visit 2010 American College of Cardiology Foundation Updated 08/23/10 4

5 PINN-46 Patient Education Percentage of patients who were provided with patient education on disease management and health behavior changes during one or more visits within the period of assessment PINN-48 Percentage of patients who were provided with patient education on disease management and health behavior changes during one or more visit(s) PINN-49 ACE Inhibitor or Angiotensin Receptor Blocker (ARB) for Patients with Heart Failure Who Have Left Ventricular Systolic Dysfunction (LVSD) Prescription of ACE inhibitor or ARB for management of outpatient HF patients with LVSD PINN-50* PQRI (#5) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) Percentage of patients aged 18 years and older with a diagnosis of heart failure and left ventricular systolic dysfunction (LVSD) who were prescribed ACE inhibitor or ARB therapy PINN-52 ACEI/ ARB Therapy Percentage of patients with HF who also have left ventricular systolic dysfunction (LVSD) who were prescribed ACE inhibitor or ARB therapy. PINN-53 Warfarin Therapy for Patients with Atrial Fibrillation (AF) Use of warfarin in patients with both HF and AF 2010 American College of Cardiology Foundation Updated 08/23/10 5

6 PINN-54 Afib/Flutter Chronic Anticoagulation Therapy Prescription of warfarin for all patients with nonvalvular AF or atrial flutter at high risk for thromboembolism, according to risk stratification and 2006 guideline recommendations, as follows: Low risk No risk factors Aspirin 81 to 325 mg daily Intermediate risk One moderate-risk factor Aspirin 81 to 325 mg daily or warfarin (INR 2.0 to 3.0, target 2.5) High risk Any high-risk factor or more than 1 moderate-risk factor Warfarin (INR 2.0 to 3.0, target 2.5) PINN-57 Warfarin Therapy Patients with Atrial Fibrillation Percentage of patients with HF who also have paroxysmal or chronic atrial fibrillation who were prescribed warfarin therapy PINN-58 Assessment of Activity Level Evaluation of the impact of HF on activity level at each outpatient visit (standardized scale or assessment tool may be used) PINN-60 Assessment of Activity Level Percentage of patient visits or patients with HF with assessment of activity level. PINN-61 Assessment of Clinical Signs of Volume Overload (Excess) Completion of a physical examination pertaining to volume status assessment in patients diagnosed with HF at each outpatient visit (standardized scale or assessment tool may be used) PINN-63 Assessment of clinical symptoms of volume overload (Excess) Percentage of patient visits or patients with HF with assessment of clinical symptoms of volume overload (excess) PINN-64 Initial Laboratory Tests Initial laboratory evaluation of patients with newly diagnosed HF PINN-66 Afib/Flutter Assessment of Thromboembolic Risk Factors Patients with nonvalvular AF or atrial flutter in whom assessment of thromboembolic risk factors has been documented 2010 American College of Cardiology Foundation Updated 08/23/10 6

7 PINN-68 Assessment of Clinical Symptoms of Volume Overload (Excess) Assessment of patient s clinical symptoms of volume overload at each outpatient visit (standardized scale or assessment tool may be used) PINN-72 Hypertension Blood Pressure ment Percentage of patient visits with blood pressure measurement recorded PINN-74 Hypertension Blood Pressure ment Percentage of patient visits with blood pressure measurement recorded among all patient visits for patients aged > 18 years with diagnosed hypertension PINN-75 Hypertension Plan of Care Percentage of patient visits with either systolic blood pressure 140 mm Hg or diastolic blood pressure 90 mm Hg, with documented plan of care for hypertension PINN-77 Hypertension Plan of Care Percentage of patient visits during which either systolic blood pressure > 140 mm Hg or diastolic blood pressure > 90 mm Hg, with documented plan of care for hypertension PINN-78 Beta-Blocker Therapy Prescription of beta-blockers in patients with HF and left ventricular systolic dysfunction (LVSD) PINN-79* PQRI (#8) Beta-blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) Percentage of patients aged 18 years and older with a diagnosis of heart failure who also have LVSD (LVEF < 40%) and who were prescribed beta blocker therapy PINN-81 Beta-blocker therapy Percentage of patients with HF who also have LVSD who were prescribed beta-blocker therapy PINN-82* ALL PQRI (#114) Preventive Care and Screening: Inquiry Regarding Tobacco Use Percentage of patients aged 18 years or older who were queried about tobacco use one or more times within 24 months 2010 American College of Cardiology Foundation Updated 08/23/10 7

8 PINN-83* ALL PQRI (#124) Health Information Technology (HIT): Adoption/Use of Electronic Health Records (EHR) Documents whether provider has adopted and is using health information technology. To qualify, the provider must have adopted and be using a certified/qualified EHR PINN-84* Artery PQRI (#196) Artery (CAD): Symptom and Activity Assessment Percentage of patients aged 18 years and older with a diagnosis of CAD who were evaluated for both level of activity and anginal symptoms during one or more visits PINN-85* Artery PQRI (#197) Artery (CAD): Drug Therapy for Lowering LDL-Cholesterol Percentage of patients aged 18 years and older with a diagnosis of CAD who were prescribed a lipid-lowering therapy (based on current ACC/AHA guidelines) PINN-86* PQRI (#198) : Left Ventricular Function (LVF) Assessment Percentage of patients aged 18 years and older with a diagnosis of heart failure who have quantitative or qualitative results of LVF assessment recorded PINN-87* PQRI (#199) : Patient Education Percentage of patients aged 18 years and older with a diagnosis of heart failure who were provided with patient education on disease management and health behavior changes during one or more visit(s) within 12 months PINN-88* PQRI (#200) : Warfarin Therapy for Patients with Atrial Fibrillation Percentage of all patients aged 18 and older with a diagnosis of heart failure and paroxysmal or chronic atrial fibrillation who were prescribed warfarin therapy PINN-89 Artery Guideline Recommendation Antiplatelet Use (Excluding ASA) after Stent Placement The percentage of CAD patients that receive an antiplatelet (excluding Aspirin) after a Drug Eluting Stent or Bare Metal Stent placement within the past year American College of Cardiology Foundation Updated 08/23/10 8