New Performance, Quality Measures for STEMI, NSTEMI Published

 Updated clinical performance and quality measures to benchmark and improve the quality of care for adult patients hospitalized with ST-elevation and non–ST-elevation myocardial infarction (STEMI and NSTEMI, respectively) from the ACC and the American Heart Association were published Sept. 21 in the Journal of the American College of Cardiology.

This new measure set, which updates the 2008 measure set to reflect the 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes and the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, includes 24 total measures, of which 17 are performance measures and seven are quality measures.

The new measure set is based on a thorough review of recent clinical practice guidelines and other clinical guidance documents. The writing committee also examined available information on disparities in care to determine which new measures might be appropriate as performance versus quality measures for this update.

Resulting from these efforts, one performance measure addressing adult smoking cessation advice/counseling was retired due to the consistently high levels of performance achieved, while eight quality measures were also retired, primarily because they covered only “one aspect of medication use (e.g., overdosing) and miss[ed] other aspects such as under-dosing and inappropriate use.” Additionally, most were not direct stand-alone Class I or III recommendation in the guidelines. Four measures addressing statins for acute MI, evaluation of left ventricular ejection fraction, cardiac rehabilitation referral and P2Y12 receptor inhibitor prescribed at discharge were revised, mostly to reflect new evidence and guideline recommendations, strengthen the measure construct or to expand the measure to include new pharmacotherapies.

Eleven new measures – four performance measures and seven quality measures – are also included in the new document. Of the quality measures, four are structured with the goal of achieving a 100 percent score, while three (inappropriate in-hospital use of NSAIDs; inappropriate prescription of prasugrel at discharge in patients with a history of prior stroke or transischemic attack; and inappropriate prescription of high-dose aspirin with ticagrelor at discharge) are safety measures with a goal of achieving zero percent.

Other highlights, include four dedicated measures addressing timeliness of reperfusion therapy for STEMI and treatment for all acute MI patients with dual antiplatelet therapies, if no contraindications are present.

Moving forward, writing committee members stress “the impact of these and other measures on hospital quality should be the focus of future research.” They also “emphasize the importance of assessing the impact of compliance (or lack thereof) to some or all performance measures on short- and long-term clinical outcomes.”

“Implementation of this measure set by health care providers, physician practices and hospital systems will enhance the quality of care and likely improve outcomes of patients hospitalized with a heart attack,” said Hani Jneid, MD, FACC, chair of the writing committee for the measures. “The writing committee acknowledges that the new measures created in this set will need to be tested and validated over time. By publishing this performance and quality measure set, we hope to encourage their widespread and expeditious adoption, as well as facilitate the collection and analysis of data needed to continuously assess their relevance over time.”

Clinical Topics: Acute Coronary Syndromes, Dyslipidemia, Nonstatins, Novel Agents, Statins

Keywords: Aspirin, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Anti-Inflammatory Agents, Non-Steroidal, Myocardial Infarction, Cardiac Rehabilitation, Benchmarking, Committee Membership, Inappropriate Prescribing, Acute Coronary Syndrome, Stroke Volume, Goals, Smoking Cessation, Myocardial Infarction, Adenosine, Research, Stroke, Counseling, Referral and Consultation, Health Personnel

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