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Release Notes:
Measure Information Form
Version 2010A1


**NQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE**

Measure Information Form

Measure Set: Acute Myocardial Infarction(AMI)

Set Measure ID: AMI-6

Performance Measure Name: Beta-Blocker at Arrival

Description: Acute myocardial infarction (AMI) patients without beta-blocker contraindications who received a beta-blocker within 24 hours after hospital arrival

Rationale: The early use of beta-blockers in patients with acute myocardial infarction reduces mortality and morbidity (ISIS-1, 1986; Goldstein, 1996; and MIAMI, 1985) and has demonstrated effectiveness in a wide range of AMI patients (Krumholz, 1998). National guidelines strongly recommend early beta-blockers for patients hospitalized with AMI (Antman, 2004). Despite these recommendations, beta-blockers remain under-utilized in eligible older patients hospitalized with AMI (Jencks, 2000).

Type of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: AMI patients who received a beta-blocker within 24 hours after hospital arrival
Included Populations: Not applicable

Excluded Populations: None

Data Elements:

Denominator Statement: AMI patients without beta-blocker contraindications

Included Populations:
  • Discharges with an ICD-9-CM Principal Diagnosis Code for AMI as defined in Appendix A, Table 1.1

Excluded Populations:

  • Patients less than 18 years of age
  • Patients who have a Length of Stay >120 days
  • Patients with Comfort Measures Only documented on day of or day after arrival
  • Patients enrolled in clinical trials
  • Patients received as a transfer from an acute care facility where they were an inpatient or outpatient
  • Patients received as a transfer from one distinct unit of the hospital to another distinct unit of the same hospital
  • Patients received as a transfer from the emergency department of another hospital
  • Patients discharged on day of arrival
  • Patients discharged/transferred to another hospital for inpatient care on day of or day after arrival
  • Patients who left against medical advice or discontinued care on day of or day after arrival
  • Patients who expired on day of or day after arrival
  • Patients discharged/transferred to a federal health care facility on day of or day after arrival
  • Patients with one or more of the following beta-blocker contraindications/reasons for not prescribing beta-blocker documented in the medical record:
    • Beta-blocker allergy
    • Bradycardia (heart rate less than 60 bpm) on arrival or within 24 hours after arrival while not on a beta-blocker
    • Heart failure on arrival or within 24 hours after arrival
    • Second- or third-degree heart block on ECG on arrival or within 24 hours after arrival and does not have a pacemaker
    • Shock on arrival or within 24 hours after arrival
    • Other reasons documented by a physician/advanced practice nurse/physician assistant for not giving a beta-blocker within 24 hours after hospital arrival

Data Elements:

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records.

Data Accuracy: Variation may exist in the assignment of ICD-9-CM codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: None

Sampling: Yes. For additional information see the Sampling Section.

Data Reported As: Aggregate rate generated from count data reported as a proportion.

Selected References:

  • Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, Chavey WE II, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, American College of Physicians, Society for Academic Emergency Medicine, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2007;50:e1–157.
  • Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC Jr. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). 2004.
  • First International Study of Infarct Survival Collaborative Group. Randomized trial of intravenous atenolol among 16027 cases of suspected acute myocardial infarction: ISIS-1. Lancet. 1986;2:57-66.
  • Goldstein S. Beta-blockers in hypertensive and coronary heart disease. Arch Intern Med. 1996;156:1267-76.
  • Krumholz HM, Anderson JL, Brooks NH, Fesmir FM, Lambrew CT, Landrum MB, Weaver WD, Whyte J. ACC/AHA Clinical Performance Measures for Adults With ST-Elevation and Non–ST-Elevation Myocardial Infarction: a report of the ACC/AHA Task Force on Performance Measures (ST-Elevation and Non–ST-Elevation Myocardial Infarction Performance Measures Writing Committee). J Am Coll Cardiol 2006;47:236–65. Available at http://www.acc.org and http://www.americanheart.org.
  • Jencks SJ, Cuerdon T, Burwen DR, Fleming B, Houck PM, Kussmaul AE, Nilasena DS, Ordin DL, Arday DR. Quality of medical care delivered to Medicare beneficiaries: a profile at state and national levels. JAMA. 2000;284:1670-1676.
  • Krumholz HM, Radford MJ, Wang Y, Chen J, Heiat A, Marciniak TA. National use and effectiveness of Beta-blockers for the treatment of elderly patients after acute myocardial infarction. National Cooperative Cardiovascular Project. JAMA 1998;280:623-629.
  • Metoprolol in acute myocardial infarction. Patient population. The MIAMI Trial Research Group. Am J Cardiol 1985; 56(14): 10G-14G.

Measure Algorithm:

Attach file

Related Topics

Measure Information Form AMI-6
Specifications Manual for Joint Commission National Quality Core Measures (2010A1)
Discharges 04-01-10 (2Q10) through 09-30-10 (3Q10)