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Heart Attack


Heart attack, also called acute myocardial infarction (AMI or MI), is a life-threatening event caused by insufficient oxygen reaching the heart. When a heart attack occurs, quick use of aspirin and other treatments can reduce damage to the heart and reduce the chance of death. The indicators in this section examine the initial care of heart attack patients and whether patients leave the hospital with medications known to be helpful after a heart attack. Norton Healthcare performance represents the performance of all the hospitals combined.

Heart attack (AMI) treatment - percent of AMI inpatients
This indicator monitors the composite score on all 6 Heart Attack accountability measures. Accountability measures are quality measures that meet four criteria designed to identify measures that produce the greatest positive impact on patient outcomes when hospitals demonstrate improvement: Research (strong scientific evidence exists demonstrating that compliance with a given process of care improves health outcomes), Proximity (the process being measured is closely connected to the outcome it impacts; there are relatively few clinical processes that occur after the one that is measured and before the improved outcome occurs), Accuracy (the measure accurately assesses whether the evidence-based process has actually been provided), and Adverse Effects (the measure construct is designed to minimize or eliminate unintended adverse effects). Elements include ami1, ami2, ami3, ami5, ami7a, ami8a. Accountability measures have been integrated into the information reported on Quality Check. Ho wever, the categorization of the measures into accountability and non-accountability measures will not affect individual measure information reported on Quality Check.(JC) AMI accountability measures' composite high 99 96 99 100Quality Ribbon   99 90 99
Number of heart attack patients per 100, who received an aspirin within 24 hours before or after arrival at the hospital. The early use of aspirin improves survival for heart attack patients. Includes inpatients discharged with a principal diagnosis of AMI. Excludes patients with contraindication to aspirin, patients transferred from another hospital, and patients who were discharged, left AMA, or died the day of arrival.(NQF HC 1 / JC / CMS AMI 1) given aspirin at arrival high 100Quality Ribbon 100Quality Ribbon 100Quality Ribbon 100Quality Ribbon   100Quality Ribbon 99 99
Number of heart attack patients per 100, who received fibrinolytic therapy (clot-dissolving drugs) within 30 minutes of hospital arrival. The early use of thrombolytic agents increases survival rates of heart attack patients. Includes inpatients discharged with a principal diagnosis of AMI and ST segment elevation, a segment in EKG most affected in ischemic conditions, or left bundle branch block, a delay in left ventricular firing. Excludes patients transferred from another hospital.(NQF HC 8 / JC/CMS AMI 7a) given fibrinolytics w/in 30 min high # # # #   #   58
Number of heart attack patients receiving percutaneous coronary intervention (PCI), a procedure to relieve coronary narrowing, per 100, who received the PCI within 90 minutes of hospital arrival. Early use of PCI in eligible patients increases the survival rate of heart attack patients. This indicator applies only to patients who had a heart attack before arriving at the hospital. Includes inpatients discharged with a principal diagnosis of AMI and either ST segment elevation (segment most affected in ischemic conditions) or left bundle branch block (a delay in left ventricular firing) on EKG performed closest to hospital arrival, who had PCI performed. Excludes patients transferred from another hospital, patients administered thrombolytic agents (clot-dissolving drugs), and patients that have non-clinical reasons for delay documented.(NQF HC 7 / JC / CMS AMI 8a) with PCI procedure treated w/in 90 minutes high 100Quality Ribbon   #     100Quality Ribbon 96 96
Number of heart attack patients with left ventricular systolic dysfunction (LVSD), a particular form of heart failure, per 100, who were prescribed an angiotensin converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB), a class of drugs used in the treatment of heart failure, upon discharge from the hospital. ACEI therapy improves survival for heart attack patients. Recent medical recommendations also include angiotensin II receptor blocker (ARB) therapy. Includes inpatients discharged with a principal diagnosis of AMI and with moderate or severe systolic dysfunction (decreased filling pressure congestion). Excludes patients with contraindication to both ACEI and ARB, patients transferred to another hospital, patients who died, and patients discharged to hospice.(NQF HC 6 / JC / CMS AMI 3) with LVSD given ACEI or ARB high 100Quality Ribbon # 100Quality Ribbon #   98 95 97
Number of heart attack patients per 100, who had aspirin prescribed upon discharge from the hospital. Aspirin therapy improves survival for heart attack patients. Includes inpatients discharged with a principal diagnosis of AMI. Excludes patients with contraindication to aspirin, patients transferred to another hospital, and patients who died.(NQF HC 2 / JC / CMS AMI 2) given aspirin at discharge high 100Quality Ribbon 94 100Quality Ribbon #   100 99 99
Number of heart attack patients per 100, who had beta blocker, a class of drugs that relieves stress on the heart, prescribed upon discharge from the hospital. Use of beta blockers lowers the risk of heart attacks. Includes inpatients discharged with a principal diagnosis of AMI. Excludes patients with contraindication to beta blocker, patients transferred to another hospital, patients who died, left AMA, or were discharged to hospice.(NQF HC 4 / JC / CMS AMI 5) given beta blocker at discharge high 99 96 98 #   98 98 99
Number of heart attack patients per 100, who had a statin medication (also know as HMG Co-A reductase inhibitors) prescribed upon discharge from the hospital. Benefits of statin drugs include reducing the risk of death and recurrent cardiovascular events. Includes inpatients discharged with a principal diagnosis of AMI. Excludes patients transferred to another hospital, patients who died, left AMA, discharged to hospice, patients with LDL value less than 100 mg/dL within the first 24 hours of hospital arrival and not discharged on a statin or had a reason for not being prescribed a statin medication at discharge.(NQF/JC/CMS AMI 10) given statin at discharge high 99 94 96 #   98 97 99
Heart attack (AMI) mortality - percent of AMI patients
Number of heart attack patients per 100, who died in the hospital. Risk-adjusted using patient age and severity of illness (APR-DRG version 20). Includes inpatients 18 years and older discharged with a principal diagnosis of AMI. Excludes patients with missing discharge dispositions or patients transferred to a short-term hospital.(AHRQ IQI 15) who die (AHRQ risk-adjusted) low 5.0 5.9 3.3 2.5   4.4   6.1
Number of non-transferred acute myocardial infarction (AMI) patients per 100, who died in the hospital. Risk-adjusted using patient age, severity of illness, and risk of mortality (APR-DRG version 20). Includes inpatients 18 years and older discharged with a principal diagnosis of AMI. Excludes patients with missing discharge dispositions, patients transferred to or from an acute care hospital, and patients with missing admission source.(AHRQ IQI 32) who are not transferred who die (AHRQ risk-adj) low 5.0 6.2 2.2 2.7   4.3   6.5
Number of heart attack patients per 100, who died of any cause within 30 days of admission. Includes Medicare patients who are 65 years of age and older and discharged with a principal diagnosis of AMI. Excludes patients discharged alive with length of stay less than 1 day/AMA, and patients not enrolled in Medicare for the past 12 months. who die of any cause w/in 30 days (adj) low 15.9 15.9 15.9 15.9   15.9   15.2
Heart attack (AMI) readmission - percent of AMI patients
Number of heart attack patients per 100, who were readmitted to any hospital for any cause within 30 days of discharge. Includes Medicare patients who are 65 years of age and older who were discharged with a principal diagnosis of AMI. Excludes patients who died, and patients not enrolled in Medicare for the past 12 months. who are readmitted for any cause w/in 30 days (adj) low 18.7 18.7 18.7 18.7   18.7   18.3
Emergency Department care - AMI/chest pain transfers
Emergency Department acute myocardial infarction (AMI) patients or chest pain patients (with Probable Cardiac Chest Pain) who received aspirin within 24 hours before ED arrival or prior to transfer. The early use of aspirin in patients with AMI results in a significant reduction in adverse events and subsequent mortality. Includes patients with E/M code for emergency department, discharge/transferred to a short-term general hospital or a federal healthcare facility, principal diagnosis of acute myocardial infarction (AMI), principal or secondary diagnosis of Agina, Acute Coronary Syndrome or Chest Pain. Excludes patient less than 18 years of age and patients with a documented reason for no aspirin on arrival.(CMS OP 4) % patients receiving aspirin at arrival high # #   #   # 97 96
Median time from emergency department arrival to administration of fibrinolytic therapy in ED patients with ST-segment elevation or left bundle branch block (LBBB) on the electrocardiogram (ECG) performed closest to ED arrival and prior to transfer. Time to fibrinolytic therapy is a strong predictor of outcome in patients with an acute myocardial infarction. National guidelines recommend that fibrinolytic therapy be given within 30 minutes of hospital arrival in patients with ST-segment elevation myocardial infarction. Includes patients with E/M code for emergency department, discharged/transferred to a short-term general hospital or a federal healthcare facility, principal diagnosis of acute myocardial infarction (AMI), ST-segment elevation or LBBB on the ECG performed closest to ED arrival and fibrinolytic therapy administered. Excludes patient less than 18 years of age and/or patients who did not receive fibrinolytic administration within 30 minutes and had a reason for delay in fi brinolytic therapy.(CMS OP 1) median time to fibrinolysis (minutes) low # #       . 27 28
Emergency Department acute myocardial infarction (AMI) patients receiving fibrinolytic therapy during the ED stay and having a time from ED arrival to fibrinolysis of 30 minutes or less. Time to fibrinolytic therapy is a strong predictor of outcome in patients with an acute myocardial infarction. National guidelines recommend that fibrinolytic therapy be given within 30 minutes of hospital arrival in patients with ST-segment elevation myocardial infarction. Includes patients with E/M code for emergency department, discharged/transferred to a short-term general hospital or a federal healthcare facility, principal diagnosis of acute myocardial infarction (AMI), ST-segment elevation or LBBB on the ECG performed closest to ED arrival and fibrinolytic therapy administered. Excludes patient less than 18 years of age and/or patients who did not receive fibrinolytic administration within 30 minutes and had a reason for delay in fibrinolytic therapy.(CMS OP 2) % fibrinolytic therapy received w/in 30 min arrival high # #       # 61 57
Median time from emergency department arrival to time of transfer to another facility for acute coronary intervention. The early use of primary angioplasty in patients with acute myocardial infarction (AMI) who present with ST-segment elevation or LBBB results in a significant reduction in mortality and morbidity. The earlier primary coronary intervention is provided, the more effective it is. Includes patients with E/M code for emergency department, discharged/transferred to a short-term general hospital or a federal healthcare facility, principal diagnosis of acute myocardial infarction (AMI), ST-segment elevation or LBBB on the ECG performed closest to ED arrival, and patients with transfer for acute coronary intervention. Excludes patient less than 18 years of age and/or patients receiving fibrinolytic administration.(CMS OP 3) median time transfer to another facility (minutes) low # #   #   49 64 59
Median time from emergency department arrival to ECG (performed in the ED prior to transfer) for acute myocardial infarction (AMI) or Chest Pain patients (with Probable Cardiac Chest Pain). Includes patients with E/M code for emergency department, discharged/transferred to a short-term general hospital or a federal healthcare facility, principal diagnosis of acute myocardial infarction (AMI), principal or secondary diagnosis of Agina, Acute Coronary Syndrome or Chest Pain and patients receiving an ECG. Excludes patient less than 18 years of age.(CMS OP 5) median time to ECG (minutes) low # #   #   5 6 7

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