Coronary Artery Disease

Coronary artery disease develops when coronary arteries (blood vessels that supply the heart) become damaged or diseased because of the build-up of cholesterol-containing deposits (plaques). When plaques build up, they narrow the coronary arteries, causing the heart to receive less blood. Eventually, diminished blood flow may cause chest pain (angina), shortness of breath or other coronary artery disease symptoms. A complete blockage of the coronary arteries can cause a heart attack.

Coronary artery disease starts with damage or injury to the coronary artery, which may be caused by factors such as high cholesterol, high blood pressure, smoking and diabetes. Once damaged, plaques accumulate at the site of injury in a process called atherosclerosis. If these plaques break or rupture, blood cells called platelets will clump at the site to try to repair the artery. This clump can block the artery and cause a heart attack. For patients with coronary artery disease, controlling cholesterol and blood pressure and other steps can reduce the risk of heart attack.

At the University of Michigan Health System, we evaluate the care patients with coronary artery disease receive during routine visits to their physicians. When reviewing our performance, it is important to consider two types of measures: adherence to best practices (or care process) and the success (or outcome) of care.

The Healthcare Effectiveness Data and Information Set (HEDIS) provides national benchmarks for some measures of performance. For measures where there is no national benchmark, we monitor our progress toward goals that we have established to ensure that we are providing the best care. The graphs show that we have opportunities to improve care for patients with coronary artery disease.

The following graphs describe the performance of the University of Michigan Health System by measuring the extent to which we follow best practices when caring for patients with coronary artery disease. These best practices are also called evidence-based processes of care. When followed, they lead to better outcomes and fewer complications.

Use of Medications to Prevent Blood Clots
Higher Value = Better Performance

Details

Why is This Measure Important?

Heart attacks can occur when blood flow to the heart is reduced or stopped by blocked blood vessels. The blockage can be caused by tiny clots or clumps of blood cells called platelets. Platelet aggregation inhibitors are medications that can help prevent these blood clots from forming and reduce the chance of a heart attack, stroke or death. This is a measure of the percentage of patients with coronary artery disease who receive a platelet aggregation inhibitor medication. A higher percentage means better performance.

How is UMHS Performing?

The University of Michigan Health System is performing well in this measure and has improved to 94%. There is no benchmark comparison. Instead, we have established a goal of 90%, which we have achieved. To continue improving, we regularly identify and contact patients who should be considered for an antiplatelet aggregation inhibitor.

UMHS Source: Hospital administrative data and chart review.
Comparison Group Source: Institutional goal set by UMHS.

Use of Cholesterol-Lowering Medications
Higher Value = Better Performance

Details

Why is This Measure Important?

Patients with a history of coronary artery disease can decrease their chance of having a heart attack or dying from a heart attack by keeping their bad cholesterol (Low Density Lipoprotein or LDLC) levels under control. Patients with a LDLC above a target level should be on a cholesterol-lowering medication. This is a measure of the percentage of patients with coronary artery disease and with LDLC above target who receive a cholesterol-lowering medication. A higher percentage means better performance.

How is UMHS Performing?

The University of Michigan Health System is performing well in this measure; our rates have been consistently above 85%. There is no benchmark comparison. Instead, we have established a goal of 90%, which we have surpassed. To continue improving, we regularly identify and contact patients who are above the LDLC goal and may need cholesterol-lowering medications.

UMHS Source: Hospital administrative data and chart review.
Comparison Group Source: Institutional goal set by UMHS.

In this section, we evaluate the success in managing patients with coronary artery disease. The graphs display the percentage of patients who had good control of cholesterol and blood pressure. They show that the University of Michigan Health System is achieving good outcomes for cholesterol control and is improving outcomes for blood pressure.

Controlling Blood Pressure
Higher Value = Better Performance

Details

Why is This Measure Important?

High blood pressure increases the risk of heart attacks, especially in patients with a history of coronary artery disease. It is important to maintain blood pressure levels less than 140/90. This is a measure of the percentage of patients with coronary artery disease with blood pressure less than 140/90. A higher percentage means better performance.

How is UMHS Performing?

At the University of Michigan Health System, the percentage of patients with blood pressure under 140/90 is 75%. There is no benchmark comparison. Instead, we have established a goal of 80%, which we have not yet achieved. To improve, we regularly identify patients who are above the blood pressure goal and may benefit from further medication therapy.

UMHS Source: Hospital administrative data and chart review.
Comparison Group Source: Institutional goal set by UMHS.