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2003 National Healthcare Quality Report

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Percent of AMI patients with left ventricular systolic dysfunction prescribed ACE inhibitor at discharge.

Measure Source

Centers for Medicare and Medicaid Services, Health Care Quality Improvement Program (HCQIP) Quality Indicator.

Tables

1.38a Percent of AMI patients with left ventricular systolic dysfunction prescribed ACE inhibitor at discharge, United States, 2000 - 2001.

1.38b Percent of AMI patients with left ventricular systolic dysfunction prescribed ACE inhibitor at discharge, by state, 2000 – 2001.

Data Source

Centers for Medicare and Medicaid Services, Medicare Quality Improvement Organization Program. Data are from a systematic random sample of up to 800 inpatient records per state.

Denominator

Medicare discharges with a principal diagnosis of acute myocardial infarction (AMI, ICD-9 codes 410.00, 410.01, 410.10, 410.11, 410.20, 410.21, 410.30, 410.31, 410.40, 410.41, 410.50 410.51, 410.60, 410.61, 410.70, 410.71, 410.80, 410.81, 410.90, 410.91) and chart documentation of a left ventricular ejection fraction (LVEF) less than 40% or a narrative description of left ventricular function (LVF) consistent with moderate or severe systolic dysfunction.

Numerator

Subset of denominator population prescribed an angiotensin converting enzyme inhibitor (ACEI) at hospital discharge.

Comments

Excludes patients transferred to another acute care hospital, patients who expired, and patients with unknown discharge disposition.

Excludes patients with one or more of the following ACEI contraindications documented in the medical record: ACEI allergy or reaction to angiotensin converting enzyme inhibitors during hospitalization; aortic stenosis; admission or highest serum creatinine greater than 2 mg/dL; last systolic blood pressure lower than 100 mm Hg and not discharged on an ACE inhibitor.

Left ventricular systolic dysfunction (LVSD) is defined in this measure as chart documentation of a LVEF less than 40% or a narrative description of LVF consistent with moderate or severe systolic dysfunction. This measure is also a Joint Commission on Accreditation of Healthcare Organizations core measure.

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