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#	mnemonic	QUESTION TEXT	RESPONSE	DEFINITIONS/DECISION RULES

1	dcfromi	Enter the discharge date from the most recent hospitalization for acute myocardial infarction.	mm/dd/yyyy	Enter a date that is as exact as possible. If the day is not known, enter month, and year. If only year is known, use 01/01/yyyy.
2	lipid3	Within the past year, was a lipid profile, to include total cholesterol, triglycerides, HDL-C, and LDL-C obtained for this patient?	1,2 If 1, go to lipidt, else go to lip2yr	A cholesterol level alone is not a lipid profile. Total cholesterol, triglycerides, HDL-C, and LDL-C have to be reported to respond “1.” All questions refer to values for the most recent profile. If the triglycerides are too high to report a valid LDL-C, answer “1” because the attempt was made to measure all lipid profile components. The answer to ldlcalc will be “3.”
3	lip2yr	Was a lipid profile, to include all components, done within the past two years?	1,2* *If 2, go to onasa, else go to lipidt	A cholesterol level alone is not a lipid profile. Total cholesterol, triglycerides, HDL-C, and LDL-C have to be reported to respond “1.” All questions refer to values for the most recent profile. If the triglycerides are too high to report a valid LDL-C, answer “1” because the attempt was made to measure all lipid profile components. The answer to ldlcalc will be “3.”
4	lipidt	Enter the date of the most recent lipid profile obtained for this patient.	mm/dd/yyyy	Day may be entered as 01, if exact date is unknown. At a minimum, the month and year must be entered accurately.
5	ldlcalc	How was the LDL value measured? 1. direct 2. calculated 3. triglycerides elevated and LDL-C not valid	1,2,3* *If 3, go to totalc, else go to ldlclvl2	LDL cholesterol is most commonly estimated from quantitative measurements of total and HDL-cholesterol and plasma triglycerides (TG) using the empirical relationship of Friedewald et al. This method of measurement generally requires a 12-hour fast. If lab report does not indicate direct or calculated, ask the Liaison to find out from the laboratory how LDL cholesterol measurement is obtained in this particular facility. If fasting triglycerides are over 400, and LDL-C value is noted to be invalid, answer “3.”
6	ldlclvl2	Enter the value of the LDL-C measured on this date.	_____	Normal range is usually 60 – 130 mg/dl or less than 3.36 mmol/L (although this varies depending on the way the LDL is calculated, if it is not a direct measurement.)

#	mnemonic	QUESTION TEXT	RESPONSE	DEFINITIONS/DECISION RULES

7	ldl2unit	Enter the LDL-C unit of measurement: 1= mg/dL 2 = mMol/L	1,2	This data must be taken from the lab report in order to ensure the correct unit of measurement is linked to the LDL-C value.
8	totalc	Enter the total cholesterol value obtained as part of the lipid profile.	_____	Value is generally reported as mg/dl or mmol/L and the normal range is usually less than 200mg/dl or 5.18 mmol/L.
9	totalunt	Enter the total cholesterol unit of measurement: 1= mg/dL 2 = mMol/L	1,2	This data must be taken from the lab report in order to ensure the correct unit of measurement is linked to the total cholesterol value.
10	hdlval	Enter HDL cholesterol value obtained as part of the lipid profile.	_____	Value is generally reported as mg/dl or mmol/L and the normal findings are usually greater than 45 mg/dl (1.17 mmol/L) in males or 55 mg/dl (1.42 mmol/L) in females.
11	hdlunit	Enter the HDL cholesterol unit of measurement: 1= mg/dL 2 = mMol/L	1,2	This data must be taken from the lab report in order to ensure the correct unit of measurement is linked to the HDL-C value.
12	trivalue	Enter the triglycerides value obtained as part of the lipid profile.	_____	Normal findings are usually <180 mg/dL (2.01 mmol/L) in females and <190 mg/dL (2.12 mmol/L ) in males.
13	triunit	Enter the triglyceride unit of measurement: 1= mg/dL 2 = mMol/L	1,2	This data must be taken from the lab report in order to ensure the correct unit of measurement is linked to the triglyceride value.
14	onasa	At the most recent outpatient visit, was aspirin included in the patient’s current medications?	1,2 If 1, go to betablkr, else go to notasa	“Included in the patient’s current medications” = ASA was listed as one of the medications the patient is taking routinely or aspirin was prescribed at this visit. If it is noted in the paper or electronic record at least once within the past six months that the patient is taking aspirin, this is acceptable documentation of “aspirin at the most recent outpatient visit.” “Within the past six months” = from the last day of the study interval to the first day of the month six months previously. (Example: end of study interval is1/31/03. Within the past six months is from 8/1/02 – 1/31/03.). If patient was on clopidogrel (Plavix) or ticlopidine hydrochloride (Ticlid), answer “2” to this question and follow “Definitions/Decision Rules” for question “notasa.”

#	mnemonic	QUESTION TEXT	RESPONSE	DEFINITIONS/DECISION RULES

15	notasa	Does the record document one or more of the following contraindications to aspirin or other anti-platelet therapy? 1. aspirin allergy 2. active bleeding at the time of the outpatient visit 3. taking warfarin/Coumadin 4. other reason documented by MD, NP, or PA 6. no documented contraindication	1,2,3,4,5,6	When there is documentation of an aspirin “allergy” or “sensitivity,” regard this as documentation of aspirin allergy regardless of what type of reaction might be noted. History of allergy, sensitivity, reaction, or intolerance to aspirin also includes medications that contain aspirin. If warfarin (Coumadin) is listed in patient medications, the contraindication is met. If patient is on on clopidogrel (Plavix) or ticlopidine hydrochloride (Ticlid), enter response #4 if one of these drugs is listed among the patient’s medications. Other reason(s) documented by MD, NP, or PA must be explicitly documented or clearly implied (Examples: “Chronic hepatitis – no ASA.” “May start ASA after GI bleed resolves.” If reasons are no mentioned in the context of aspirin, do not make inferences, e.g., Do not assume that aspirin is not prescribed because of physician notation of history of PUD.
16	betablkr	At the most recent outpatient visit, was a beta-blocker included in the patient’s current medications?	1,2 If 1, go to wichbeta, else go to nobetab	“Included in the patient’s current medications” = a beta-blocker was listed as one of the medications the patient is taking routinely or a beta-blocker was prescribed at this visit If the most recent outpatient visit was for a specialized examination or purpose, e.g., audiology, ophthalmology, podiatry, etc., in which current medications may not be referenced, look at one or more previous outpatient visits to determine the patient’s medication regime.

mnemonic

QUESTION TEXT

RESPONSE

DEFINITIONS/DECISION RULES

nobetab

Does the record document one or more of the following contraindications/reasons for not prescribing a beta blocker?

1. Beta blocker allergy

2. Bradycardia (heart rate less than 60 bpm) while not on a beta blocker

3. Second or third degree heart block on ECG and does not have a pacemaker

4. Systolic blood pressure less than 90 mm HG while not on a beta blocker

5. Other reasons documented by an MD, NP, or PA for not prescribing a beta blocker

6. No documented contraindication

1,2,3,4,5,6

Go to lipdlowr

Contraindication = a factor or condition that renders the administration of a drug or agent or the performance of a procedure or other practice inadvisable, improper, and/or undesirable.

Option Rules:

Beta blocker allergy = must be specific reference in the record to allergy or intolerance to beta-blockers

Bradycardia = must be documented by a clinician as the reason for non-use of a beta blocker

Second or third degree heart block = Do not attempt to use the EKG tracing to answer this question. The EKG interpretation of second or third degree heart block must be documented in the record by a clinician or by electronic interpretation. Documentation of the EKG interpretation does not have to be linked specifically to contraindication to beta-blocker.

Systolic blood pressure = must be documented by a clinician as the reason for non-use of a beta blocker

Other reasons = MD, NP, or PA documentation must explicitly link the noted reason with non-prescription of a beta-blocker

COPD listed as a diagnosis is not a specific contraindication to beta-blocker therapy. There must be clinician documentation that beta-blockers have not been prescribed for this patient due to his/her COPD or asthma.

mnemonic

QUESTION TEXT

RESPONSE

DEFINITIONS/DECISION RULES

wichbeta

Designate the beta blocker the patient was taking at the time of the most recent outpatient visit:

1. metoprolol succinate (Toprol-XL)

2. metoprolol tartrate

3. bisoprolol (Zebeta or Ziac)

4. carvedilol (Coreg)

5. atenolol (Tenoretic or Tenormin)

6. acebutolol (Sectral)

7. sotalol (Betapace)

8. betaxolol (Kerlone)

9. carteolol (Cartrol)

10. nadolol (Corgard)

11. nadolol/bendroflumethiazide (Corzide)

12. propranolol (Inderal)

13. propranolol hydrochloride (Inderide)

14. labetalol (Normodyne or Trandate)

15. penbutolol sulfate (Levatol)

16. metoprolol/hydrocholorthiazide (Lopressor HCT )

17. penbutolol sulfate (Levatol)

18. pindolol (Visken)

19. timolol (Timolide or Blocadren)

20. timolol/hydrocholorthiazide

1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,
18,19,20

Beta blocker generic names are not capitalized. Brand names are capitalized.

Enter the number corresponding to the generic name documented in the medical record.

Question is applicable to the beta blocker being taken or prescribed at the time of the most recent visit. If the patient’s beta blocker medication was changed at the most recent visit, use the newly prescribed medication.

mnemonic

QUESTION TEXT

RESPONSE

DEFINITIONS/DECISION RULES

bbdose

Was the prescribed beta blocker dosage within the recommended dosage range?

1. yes

2. greater than the recommended dosage

3. less than the recommended dosage

1,2,3

1. metoprolol succinate 100-400 mg/day

2. metoprolol tartrate 50-75 mg bid

3. bisoprolol 2.5-20 mg/day

4. carvedilol 6.25-50 mg/day

5. atenolol 50-100 mg/day

6. acebutolol 200-1200mg/day

7. sotalol 160-320 mg/day

8. betaxolol 10-20 mg/day

9. carteolol 2.5-10 mg/day

10. nadolol 40-320 mg/day

11. nadolol/bendroflumethiazide 40-320 mg/day

12. propranolol 80-320 mg/day

13. propranolol hydrochloride 180-320 m/d

14. labetalol 200-400 mg/day

15. penbutolol sulfate 20-40 mg/day

16. metoprolol/hydrocholorthiazide 100-400 mg/day

17. penbutolol sulfate 20-40 mg/day

18. pindolol 5-60 mg/day

19. timolol 12.5-50 mg/day

20. timolol/hydrocholorthiazide 12.5-50 mg/day

lipdlowr

Within the past two years, was the patient on lipid-lowering medication?

1,2*

*If 2, go to cardvise, else go to medname

“Taking or prescribed” = lipid-lowing medication was listed among the patient’s medications within the past two years or was prescribed at a clinic visit or inpatient admission

Question does not reference a new prescription. The patient can have been on lipid-lowering medication for many years.

Classifications of lipid-lowering medication=HMG Co-A reductase inhibitors (statins), niacin, bile acid resins, and fibrates.

mnemonic

QUESTION TEXT

RESPONSE

DEFINITIONS/DECISION RULES

medname

Designate all lipid-lowering medications the patient was taking at the most recent clinic visit:

Statins:

1. fluvastatin sodium (Lescol)

2. atorvastatin calcium (Lipitor)

3. lovastatin (Mevacor)

4. pravastatin sodium (Pravachol)

5. simvastatin (Zocor)

Niacin:

6. niacin extended release tablets (Niaspan)

Bile Acid Resin:

7. colestipol hydrochloride (Colestid)

8. colesevelam hydrochloride (Welchol)

Fibrates:

9. clofibrate (Atromid-S)

10. gemfibrozil (Lopid)

11. fenofibrate (Tricor)

12. patient not taking any of these meds at most recent visit

13. Chloride salt of basic anion exchange resin
cholestryamine (Prevalite)

1,2,3,4,5,6,7,8,
9,10,11,12,13

Note that although the previous question asks about lipid-lowering medication in the past two years, this question references the most recent visit prior to the pull list date.

More than one lipid-lowering drug may be designated by the abstractor if the patient is on multiple medications for dyslipidemia.

QUESTION TEXT

QUESTION TEXT

If patient was on clopidogrel (Plavix) or ticlopidine hydrochloride (Ticlid), answer “2” to this question and follow “Definitions/Decision Rules” for question “notasa.”

1*,2