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Release Notes:
Measure Information Form
Version 2010B


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

Measure Information Form

Measure Set: Acute Myocardial Infarction(AMI)

Set Measure ID: AMI-5

Performance Measure Name: Beta-Blocker Prescribed at Discharge

Description: Acute myocardial infarction (AMI) patients without beta-blocker contraindications who are prescribed a beta-blocker at hospital discharge

Rationale: The use of beta-blockers for patients who have suffered an acute myocardial infarction can reduce mortality and morbidity. Studies have demonstrated that the use of beta-blockers is associated with about a 20% reduction in this risk (Yusuf, 1985 and Yusuf, 1988), and there is evidence of effectiveness in broad populations of patients with AMI (Krumholz, 1998). National guidelines strongly recommend long-term beta-blocker therapy for the secondary prevention of subsequent cardiovascular events in patients discharged after AMI (Antman, 2004). Despite these recommendations, beta-blockers remain under-utilized in eligible older patients discharged after AMI (Jencks, 2000).

Type of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: AMI patients who are prescribed a beta-blocker at hospital discharge
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
  • Patients enrolled in clinical trials
  • Patients discharged/transferred to another hospital for inpatient care
  • Patients who left against medical advice or discontinued care
  • Patients who expired
  • Patients discharged/transferred to a federal health care facility
  • Patients discharged/transferred to hospice
  • Patients with one or more of the following beta-blocker contraindications/reasons for not prescribing a beta-blocker documented in the medical record:
    • Beta-blocker allergy
    • Bradycardia (heart rate less than 60 bpm) on day of discharge or day prior to discharge while not on a beta-blocker
    • Second- or third-degree heart block on ECG on arrival or during hospital stay and does not have a pacemaker
    • Other reasons documented by a physician/advanced practice nurse/physician assistant for not prescribing a beta-blocker at discharge

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.
  • 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, 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.
  • Krumholz HM, Radford MJ, Wang Y, Chen J, Heiat A, Marciniak TA. National use and effectiveness of -blockers for the treatment of elderly patients after acute myocardial infarction: National Cooperative Cardiovascular Project. JAMA. 1998;280:623-629.
  • Smith SC Jr, Blair SN, Bonow RO, Brass LM, Cerqueira MD, Dracup K, Fuster V, Gotto A, Grundy SM, Miller NH, Jacobs A, Jones D, Krauss RM, Mosca L, Ockene I, Pasternak RC, Pearson T, Pfeffer MA, Starke RD, Taubert KA. AHA/ACC guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 Update. A statement for healthcare professionals from the American Heart Association and the American College of Cardiology. Circulation. 2001;104:1577-79. Available at http://www.acc.org and http://www.americanheart.org.
  • Yusuf S, Peto R, Lewis J, Collins R, Sleight P. Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis. 1985;27:335-71.
  • Yusuf S, Wittes J, Friedman L. Overview of results of randomized clinical trials in heart disease. I. Treatments following myocardial infarction. JAMA 1988; 260(14):2088:2093

Measure Algorithm:

Attach file

Related Topics

Measure Information Form AMI-5
Specifications Manual for Joint Commission National Quality Core Measures (2010B)
Discharges 10-01-10 (4Q10) through 03-31-11 (1Q11)
Questions? Ask Question to Joint Commission staff Copyright © 2010 by The Joint Commission.