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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) 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 5.6 4.5 6.5 2.2   5.5   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 6.0 5.6 4.8 2.4   5.3   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 97
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           . 26 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             68 59
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           . 59 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           . 6 7

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