• Institute for Clinical Systems Improvement (ICSI). Atrial fibrillation. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2008 Oct. 62 p. [91 references]

Does not apply to this measure

This measure is used to assess the percentage of patients with non-valvular atrial fibrillation/flutter with risk factors for thromboembolism having a CHADS2 score of 2 or greater (without contraindications to anticoagulation therapy) who are receiving warfarin.

The priority aim addressed by this measure is to improve the consistency of anticoagulation therapy in adult patients (age 18 years and older) with non-valvular paroxysmal, persistent or permanent atrial fibrillation/flutter.

Atrial fibrillation/atrial flutter; anticoagulation; thromboembolism; CHADS2 score; warfarin

Adult patients (18 years of age and older) with non-valvular atrial fibrillation/flutter as defined by one or more visits with any (primary or secondary) diagnosis of atrial fibrillation/flutter (International Classification of Diseases, Ninth Revision [ICD-9] code 427.31 or 427.32) in the last month or measurement time frame under review

Among atrial fibrillation/flutter patients in the denominator, the number of patients with non-valvular atrial fibrillation/flutter with risk factors for thromboembolism having a CHADS2 score of 2 or greater (without contraindications to anticoagulation therapy) who are receiving warfarin

• A clinical practice guideline or other peer-reviewed synthesis of the clinical evidence

Unspecified

Current routine use

Internal quality improvement

Physician Group Practices/Clinics

Physicians

Group Clinical Practices

Age greater than or equal to 18 years

Either male or female

Unspecified

The prevalence of atrial fibrillation increases from 0.5% for the 50 to 59-year-old age group to 8.8% in the 80 to 89-year-old age group.

• Institute for Clinical Systems Improvement (ICSI). Atrial fibrillation. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2008 Oct. 62 p. [91 references]

See the "Incidence/Prevalence" and "Burden of Illness" fields.

Atrial fibrillation is a common arrhythmia and an important independent risk factor for stroke.

Symptoms vary from none to severe disabling palpitations, dyspnea, and syncope. Patients with atrial fibrillation have a mortality rate double that of control subjects. Atrial fibrillation is one of a number of factors that increase the risk of systemic thromboembolic events including cerebrovascular events and peripheral arterial emboli.

• Institute for Clinical Systems Improvement (ICSI). Atrial fibrillation. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2008 Oct. 62 p. [91 references]

Unspecified

Unspecified

Living with Illness

Effectiveness

Users of care only

Patients associated with provider

Inclusions
Adult patients (18 years of age and older) with non-valvular atrial fibrillation/flutter as defined by one or more visits with any (primary or secondary) diagnosis of atrial fibrillation/flutter (International Classification of Diseases, Ninth Revision [ICD-9] code 427.31 or 427.32) in the last month or measurement time frame under review

Exclusions
Unspecified

All cases in the denominator are equally eligible to appear in the numerator

Clinical Condition
Encounter

Time window is a fixed period of time

Inclusions
Among atrial fibrillation/flutter patients in the denominator, the number of patients with non-valvular atrial fibrillation/flutter with risk factors for thromboembolism having a CHADS2 score of 2 or greater (without contraindications to anticoagulation therapy) who are receiving warfarin

Exclusions
Unspecified

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

Encounter or point in time

Administrative data
Medical record

Individual Case

Unspecified

Rate

Better quality is associated with a higher score

Unspecified

Internal time comparison

Unspecified

Improve the consistency of anticoagulation therapy in adult patients (age 18 years and older) with non-valvular atrial fibrillation/flutter.

Institute for Clinical Systems Improvement

The following Minnesota health plans provide direct financial support: Blue Cross and Blue Shield of Minnesota, HealthPartners, Medica, Metropolitan Health Plan, PreferredOne and UCare Minnesota. In-kind support is provided by the Institute for Clinical Systems Improvement's (ICSI) members.

Work Group Members: Thomas Munger, MD (Work Group Leader) (Mayo Clinic) (Cardiology/Electrophysiology); David Dunbar, MD (St. Paul Heart Clinic) (Cardiology/Electrophysiology); Humberto Vidaillet, MD (Marshfield Clinic) (Cardiology/Electrophysiology); Mark Morrow, MD (Aspen Medical Group) (Internal Medicine); Tonja Larson, PharmD, BCPS (Marshfield Clinic) (Pharmacy); Krissa Skoglund, PharmD, BCPS (HealthPartners Medical Group) (Pharmacy); Penny Fredrickson (Institute for Clinical Systems Improvement) (Measurement/Implementation Advisor); Joann Foreman, RN (Institute for Clinical Systems Improvement) (Facilitator)

Measure was not adapted from another source.

2008 Oct

This is the current release of the measure.

• Institute for Clinical Systems Improvement (ICSI). Atrial fibrillation. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2008 Oct. 62 p. [91 references]

This NQMC summary was completed by ECRI Institute on February 19, 2009.

This NQMC summary (abstracted Institute for Clinical Systems Improvement [ICSI] Measure) is based on the original measure, which is subject to the measure developer's copyright restrictions.

The abstracted ICSI Measures contained in this Web site may be downloaded by any individual or organization. If the abstracted ICSI Measures are downloaded by an individual, the individual may not distribute copies to third parties.

If the abstracted ICSI Measures are downloaded by an organization, copies may be distributed to the organization's employees but may not be distributed outside of the organization without the prior written consent of the Institute for Clinical Systems Improvement, Inc.

All other copyright rights in the abstracted ICSI Measures are reserved by the Institute for Clinical Systems Improvement, Inc. The Institute for Clinical Systems Improvement, Inc. assumes no liability for any adaptations or revisions or modifications made to the abstracts of the ICSI Measures.