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## Complete Summary

#### TITLE

Atrial fibrillation: percentage of patients (without contraindications
to anticoagulation) with paroxysmal, persistent, or permanent atrial
fibrillation/atrial flutter (A Fib/Flutter) with risk factors for
thromboembolism who are on warfarin.

#### SOURCE(S)

Institute for Clinical Systems Improvement (ICSI). Atrial fibrillation.
Bloomington (MN): Institute for Clinical Systems Improvement (ICSI);
2007 Feb. 64 p. \[112 references\]

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Process

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure assesses the percentage of patients (without
contraindications to anticoagulation) with paroxysmal, persistent, or
permanent atrial fibrillation/atrial flutter (A Fib/Flutter) with risk
factors for thromboembolism who are on warfarin.

#### RATIONALE

The priority aim addressed by this measure is to improve the consistency
of anticoagulation in patients with paroxysmal, persistent, or permanent
atrial fibrillation/atrial flutter (A Fib/Flutter).

#### PRIMARY CLINICAL COMPONENT

Atrial fibrillation/atrial flutter (A Fib/Flutter); anticoagulation;
thromboembolism; warfarin

#### DENOMINATOR DESCRIPTION

Adults age 18 years of age or older with paroxysmal, persistent, or
permanent atrial fibrillation/atrial flutter (A Fib/Flutter) as defined
by: one or more visits with any (primary or secondary) diagnosis of A
Fib/Flutter (International Classification of Diseases, Ninth Revision
\[ICD-9\] code 427.31 or 427.32) in the last month or measurement
timeframe under review

#### NUMERATOR DESCRIPTION

Among the atrial fibrillation/atrial flutter (A Fib/Flutter) patients in
the denominator, the number of patients with risk factors for
thromboembolism without contraindications to anticoagulation who are
receiving warfarin

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

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

#### NATIONAL GUIDELINE CLEARINGHOUSE LINK

-   [Atrial
    fibrillation.](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=10723)

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Unspecified

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Internal quality improvement

### Application of Measure in its Current Use

#### CARE SETTING

Physician Group Practices/Clinics

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Physicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Group Clinical Practices

#### TARGET POPULATION AGE

Age greater than or equal to 18 years

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

The prevalence of atrial fibrillation (A Fib) 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.

#### EVIDENCE FOR INCIDENCE/PREVALENCE

Institute for Clinical Systems Improvement (ICSI). Atrial fibrillation.
Bloomington (MN): Institute for Clinical Systems Improvement (ICSI);
2007 Feb. 64 p. \[112 references\]

#### ASSOCIATION WITH VULNERABLE POPULATIONS

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

#### BURDEN OF ILLNESS

Atrial fibrillation (A Fib) 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 A Fib have a mortality rate double that of
control subjects. The attributable risk of embolic stroke from A Fib
increases from 1.5% per year for the 50 to 59-year-old age group to
nearly 30% per year for the 80 to 89-year-old age group, and increases
substantially in the presence of other cardiovascular conditions.

#### EVIDENCE FOR BURDEN OF ILLNESS

Institute for Clinical Systems Improvement (ICSI). Atrial fibrillation.
Bloomington (MN): Institute for Clinical Systems Improvement (ICSI);
2007 Feb. 64 p. \[112 references\]

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Living with Illness

#### IOM DOMAIN

Effectiveness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

Adult patients 18 years of age or older who have had an
electrocardiogram (ECG) that confirms a diagnosis of atrial
fibrillation/atrial flutter (A Fib/Flutter)

This measure may be collected electronically through claims data using
the International Classification of Diseases, Ninth Revision (ICD-9)
code: 427.31 or 427.32 to identify the patients. Charts will be reviewed
to determine if patients have risk factors for thromboembolism without
contraindications (see \"Assess risk for bleeding or thromboembolism\"
on page 11 and 12 of the guideline\*) to anticoagulation therapy are on
warfarin.

Select a random sample of the eligible population for data collection.
The suggested sample size for each medical group is at least 10 charts
each month. If the medical group identifies a total of less than 10 (A
Fib/Flutter) patients, all identified patients are to be included.

The sample would be drawn quarterly; data would be abstracted monthly.

\*See the National Guideline Clearinghouse (NGC) summary of the
Institute for Clinical Systems Improvement (ICSI) guideline [Atrial
Fibrillation](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=10723&string=5585).

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Adults age 18 years of age or older with paroxysmal, persistent, or
permanent atrial fibrillation/atrial flutter (A Fib/Flutter) as defined
by: one or more visits with any (primary or secondary) diagnosis of A
Fib/Flutter (International Classification of Diseases, Ninth Revision
\[ICD-9\] code 427.31 or 427.32) in the last month or measurement
timeframe under review

**Exclusions**\
Unspecified

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

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

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Encounter

#### DENOMINATOR TIME WINDOW

Time window is a fixed period of time

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Among the atrial fibrillation/atrial flutter (A Fib/Flutter) patients in
the denominator, the number of patients with risk factors for
thromboembolism without contraindications to anticoagulation who are
receiving warfarin

**Exclusions**\
Unspecified

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

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

#### NUMERATOR TIME WINDOW

Episode of care

#### DATA SOURCE

Administrative data\
Medical record

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Unspecified

#### STANDARD OF COMPARISON

Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

Percentage of patients (without contraindications to anticoagulation)
with paroxysmal, persistent or permanent A Fib/Flutter with risk factors
for thromboembolism who are on warfarin.

#### MEASURE COLLECTION

[Atrial Fibrillation
Measures](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=26&doc=6151)

#### DEVELOPER

Institute for Clinical Systems Improvement

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2004 Nov

#### REVISION DATE

2007 Feb

#### MEASURE STATUS

This is the current release of the measure.

This measure updates a previous version: Institute for Clinical Systems
Improvement (ICSI). Atrial Fibrillation. Bloomington (MN): Institute for
Clinical Systems Improvement (ICSI); 2004 Nov. 60 p.

#### SOURCE(S)

Institute for Clinical Systems Improvement (ICSI). Atrial fibrillation.
Bloomington (MN): Institute for Clinical Systems Improvement (ICSI);
2007 Feb. 64 p. \[112 references\]

#### MEASURE AVAILABILITY

The individual measure, \"Percentage of patients (without
contraindications to anticoagulation) with paroxysmal, persistent or
permanent A Fib/Flutter with risk factors for thromboembolism who are on
warfarin,\" is published in \"Health Care Guideline: Atrial
Fibrillation.\" This document is available from the [Institute for
Clinical Systems Improvement (ICSI) Web
site](http://www.icsi.org/guidelines_and_more/guidelines__order_sets___protocols/).

For more information, contact ICSI at, 8009 34th Avenue South, Suite
1200, Bloomington, MN 55425; phone: 952-814-7060; fax: 952-858-9675; Web
site: [www.icsi.org](http://www.icsi.org/); e-mail:
<icsi.info@icsi.org>.

#### NQMC STATUS

This NQMC summary was completed by ECRI on January 19, 2005. This NQMC
summary was updated by ECRI on May 29, 2007.

#### COPYRIGHT STATEMENT

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.

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/10/2008