• Specifications manual for national hospital inpatient quality measures, version 2.5b. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; 2008 Oct. various p.

Does not apply to this measure

This measure is used to assess the percent of acute myocardial infarction (AMI) patients with left ventricular systolic dysfunction (LVSD) and without both angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) contraindications who are prescribed an ACEI or ARB at hospital discharge. For purposes of this measure, LVSD is defined as chart documentation of a left ventricular ejection fraction (LVEF) less than 40% or a narrative description of left ventricular systolic (LVS) function consistent with moderate or severe systolic dysfunction.

Angiotensin converting enzyme inhibitor (ACEI) therapy reduces mortality and morbidity in patients with left ventricular systolic dysfunction (LVSD) after acute myocardial infarction (AMI). Recent clinical trials have also established angiotensin receptor blocker (ARB) therapy as an acceptable alternative to ACEI, especially in patients with heart failure and/or LVSD who are ACEI intolerant. National guidelines strongly recommend ACEI for patients hospitalized with AMI who have either clinical heart failure or LVSD. Guideline committees have also supported inclusion of ARBs in performance measures for AMI. Despite these recommendations, ACEIs remain underutilized in eligible older patients hospitalized with AMI.

Acute myocardial infarction (AMI); left ventricular systolic dysfunction (LVSD); angiotensin converting enzyme inhibitor (ACEI); angiotensin receptor blocker (ARB)

Acute myocardial infarction (AMI) patients with left ventricular systolic dysfunction (LVSD) and without both angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) contraindications (see the related "Denominator Inclusions/Exclusions" field in the Complete Summary)

Acute myocardial infarction (AMI) patients who are prescribed an angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) at hospital discharge

Administrative data
Medical record

AMI-3: ACEI or ARB for LVSD.

Centers for Medicare & Medicaid Services
Joint Commission, The

Centers for Medicare & Medicaid Services/The Joint Commission

All external funding for measure development has been received and used in full compliance with The Joint Commission's Corporate Sponsorship policies, which are available upon written request to The Joint Commission.

Expert panel members have made full disclosure of relevant financial and conflict of interest information in accordance with the Joint Commission's Conflict of Interest policies, copies of which are available upon written request to The Joint Commission.

National Quality Forum

Hospital Compare
Hospital Quality Alliance

Measure was not adapted from another source.

2000 Aug

2008 Oct

This is the current release of the measure.

This measure updates a previous version: Specifications manual for national hospital quality measures, version 2.3b. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; 2007 Oct. various p.

• Specifications manual for national hospital inpatient quality measures, version 2.5b. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; 2008 Oct. various p.

This NQMC summary was completed by ECRI on February 7, 2003. The information was verified by the measure developer on February 12, 2003. This NQMC summary was updated by ECRI on October 6, 2005 and on April 16, 2007. The information was verified by the measure developer on July 24, 2007. This NQMC summary was updated again by ECRI Institute on October 26, 2007. The Joint Commission informed NQMC that this measure was updated on August 13, 2008 and provided an updated version of the NQMC summary. This NQMC summary was updated accordingly by ECRI Institute on November 11, 2008. The information was verified by the Centers for Medicare & Medicaid Services on Janaury 22, 2009.

The Specifications Manual for National Hospital Inpatient Quality Measures [Version 2.5b, October, 2008] is the collaborative work of the Centers for Medicare & Medicaid Services and The Joint Commission. The Specifications Manual is periodically updated by the Centers for Medicare & Medicaid Services and The Joint Commission. Users of the Specifications Manual for National Hospital Inpatient Quality Measures should periodically verify that the most up-to-date version is being utilized.