2017 AHA/ACC Clinical Performance and Quality Measures …

1 JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY VOL. -, NO. -, 2017. 2017 AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION AND ISSN 0735-1097/$ AMERICAN HEART ASSOCIATION, INC. Performance measure . 2017 AHA/ACC Clinical Performance and Quality Measures for adults With ST-Elevation and Non ST-Elevation Myocardial Infarction A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures Developed in Collaboration With the Society for Cardiovascular Angiography and Interventions Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation Writing Hani Jneid, MD, FACC, FAHA, Chair P. Michael Ho, MD, PhD, FACC, FAHA. Committee Corrine Y. Jurgens, PhD, RN, ANP-BC, FAHA. Members Daniel Addison, MD Marjorie L. King, MD, FACC. Deepak L. Bhatt, MD, MPH, FACC, FAHA Dharam J. Kumbhani, MD, SM, FACC, FAHA. Gregg C. Fonarow, MD, FACC, FAHA Samir Pancholy, MD, FACCy Sana Gokak, MPH.

2 Kathleen L. Grady, PhD, FAHA. *ACC/AHA Task Force on Performance Measures Liaison. ySociety for Lee A. Green, MD, MPH. Cardiovascular Angiography and Interventions Representative. Paul A. Heidenreich, MD, MS, FACC, FAHA*. ACC/AHA Gregg C. Fonarow, MD, FACC, FAHA, Chair Paul S. Chan, MD, MSc, FACCx Task Force on Paul A. Heidenreich, MD, MS, FACC, FAHA, Lesley H. Curtis, PhDx Performance Immediate Past Chair Lauren Gilstrap, MDx Measures Michelle Gurvitz, MD, FACCz Nancy M. Albert, PhD, CCNS, CCRN, FAHAz P. Michael Ho, MD, PhD, FACC, FAHAx Geoffrey D. Barnes, MD, MSc, FACCx Corrine Y. Jurgens, PhD, RN, ANP-BC, FAHAx This document underwent peer review between December 7, 2016, and December 31, 2016, and a 30-day public comment period between December 7, 2016, and January 6, 2017. This document was approved by the American College of Cardiology Clinical Policy Approval Committee on May 22, 2017, the American Heart As- sociation Science Advisory and Coordinating Committee on June 7, 2017, the American Heart Association Executive Committee on August 11, 2017, and the Society for Cardiovascular Angiography and Interventions on July 17, 2017.

3 The American College of Cardiology requests that this document be cited as follows: Jneid H, Addison D, Bhatt DL, Fonarow GC, Gokak S, Grady KL, Green LA, Heidenreich PA, Ho PM, Jurgens CY, King ML, Kumbhani DJ, Pancholy S. 2017 AHA/ACC Clinical Performance and Quality Measures for adults with ST-elevation and non ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures . J Am Coll Cardiol. 2017;xx:xxx xxx. This article has been copublished in Circulation: Cardiovascular Quality and Outcomes. Copies: This document is available on the World Wide Web sites of the American College of Cardiology ( ) and the American Heart Association ( ). For copies of this document, please contact Elsevier Reprint Department via fax (212-633-3820) or email ). Permissions: Multiple copies, modi cation, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American College of Cardiology.

4 Please contact Elsevier's permission department at 2 Jneid et al. JACC VOL. -, NO. -, 2017. 2017 AHA/ACC STEMI/NSTEMI measure Set -, 2017:- - Sean O'Brien, PhDz Robert Yeh, MD, FACCz Jeffrey Olin, DO, FACC, FAHAx Samad Zaheeruddin, MDz Tiffany Randolph, MDz Andrea M. Russo, MD, FACCx zAmerican College of Cardiology Representative. xAmerican Heart Randal J. Thomas, MD, FACC, FAHAz Association Representative. Paul D. Varosy, MD, FACCz TABLE OF CONTENTS. PREAMBLE .. - Short Title: PM-11: Time to Primary PCI Among Transferred Patients .. - Short Title: PM-12: Cardiac Rehabilitation 1. INTRODUCTION .. - Referral .. - Scope of the Problem .. - Short Title: PM-13: P2Y12 Inhibitor at Discharge .. - Disclosure of Relationships With Industry and Short Title: PM-14: Immediate Angiography Other Entities .. - After Cardiac Arrest .. - Short Title: PM-15: Stress Test in Conservatively 2. METHODOLOGY .. - Treated Patients.

5 - Short Title: PM-16: Early Troponin Measurement Literature Review .. - After NSTEMI .. - De nition and Selection of Measures .. - Short Title: PM-17: AMI Registry Participation .. - 3. AHA/ACC STEMI AND NSTEMI measure SET Quality Improvement Measures for Inpatient Performance Measures .. - STEMI and NSTEMI Patients .. - Inpatient Measures .. - Discussion of Changes to 2008 STEMI and NSTEMI Short Title: QM-1: Risk Score Strati cation for measure Set .. - NSTEMI .. - Retired Measures .. - Short Title: QM-2: Early Invasive Strategy for Revised Measures .. - High-Risk NSTEMI .. - Short Title: QM-3: Therapeutic Hypothermia for New Measures .. - STEMI Patients .. - Short Title: QM-4: Aldosterone Antagonist at 4. AREAS FOR FURTHER RESEARCH .. - Discharge .. - Short Title: QM-5: Inappropriate In-Hospital Use APPENDIX A of NSAIDs .. - Short Title: QM-6: Inappropriate Prasugrel at STEMI and NSTEMI Performance Measures .

6 - Discharge in TIA/Stroke Patients .. - Performance Measures for Use in Patients With Short Title: QM-7: Inappropriate High-Dose Inpatient STEMI and NSTEMI .. - Aspirin With Ticagrelor at Discharge .. - Inpatient Measures .. - Short Title: PM-1: Aspirin at Arrival .. - APPENDIX B. Short Title: PM-2: Aspirin at Discharge .. - Short Title: PM-3: Beta Blocker at Author Listing of Relationships With Industry and Discharge .. - Other Entities (Relevant) 2017 AHA/ACC Clinical Performance and Quality Measures for adults With Short Title: PM-4: High-Intensity Statin at ST-Elevation and Non ST-Elevation Myocardial Discharge .. - Infarction .. - Short Title: PM-5: Evaluation of LVEF .. - Short Title: PM-6: ACEI or ARB for LVSD .. - Short Title: PM-7: Door-to-Needle Time .. - APPENDIX C. Short Title: PM-8: First Medical Peer Reviewer Relationships With Industry and Other Contact-Device Time .. - Entities 2017 AHA/ACC Clinical Performance and Short Title: PM-9: Reperfusion Therapy.

7 - Quality Measures for adults With ST-Elevation and Short Title: PM-10: Door-in-Door-Out Time .. - Non ST-Elevation Myocardial Infarction .. - JACC VOL. -, NO. -, 2017 Jneid et al. 3. -, 2017:- - 2017 AHA/ACC STEMI/NSTEMI measure Set PREAMBLE was charged with the task of developing new Measures to benchmark and improve the Quality of care for patients The American College of Cardiology (ACC)/American with STEMI and NSTEMI. Heart Association (AHA) Performance measure sets serve All the Measures included in the measure set are brie y as vehicles to accelerate translation of scienti c evidence summarized in Table 1, which provides information on the into Clinical practice. measure sets developed by the measure number, title, care setting, attribution, and ACC/AHA are intended to provide practitioners and in- domain. The detailed measure speci cations (available in stitutions that deliver cardiovascular services with tools Appendix A) provide not only the information included in to measure the Quality of care provided and identify Table 1, but also more detailed information including the opportunities for improvement.

8 measure description, numerator, denominator (including Writing committees are instructed to consider the denominator exclusions and exceptions), rationale for the methodology of Performance measure development (1) measure , guideline recommendations that support the and to ensure that the Measures developed are aligned measure , measurement period, and sources of data. with ACC/AHA Clinical practice guidelines. The writing The writing committee has developed a comprehensive committees also are charged with constructing Measures STEMI/NSTEMI measure set that includes 24 total mea- that maximally capture important aspects of care Quality , sures of which 17 are Performance Measures and 7 are including timeliness, safety, effectiveness, ef ciency, Quality Measures (as re ected in Table 1 and Appendix A). equity, and patient-centeredness, while minimizing, The writing committee believes that implementation of when possible, the reporting burden imposed on hospi- this measure set by healthcare providers, physician tals, practices, and/or practitioners.

9 Practices, and hospital systems will enhance the Quality Potential challenges from measure implementation of care and likely improve outcomes of patients with may lead to unintended consequences. The manner in STEMI and NSTEMI. which challenges are addressed is dependent on several factors, including the measure design, data collection Scope of the Problem method, Performance attribution, baseline Performance Acute myocardial infarction (AMI) is a frequent cause of rates, reporting methods, and incentives linked to these hospital admission in the United States and is associated reports. with signi cant short- and long-term mortality and The ACC/AHA Task Force on Performance Measures morbidity. Every 42 seconds, approximately 1 American (Task Force) distinguishes Quality Measures from perfor- will suffer an AMI, and the estimated annual incidences of mance Measures . Quality Measures are those metrics that new and recurrent MI events are 550,000 and 200,000.

10 May be useful for local Quality improvement but are not events, respectively (3). yet appropriate for public reporting or pay for perfor- Fortunately, the rates of hospitalization and 30-day mance programs (uses of Performance Measures ). New mortality for AMI have been on the decline (4,5). This Measures are initially evaluated for potential inclusion as reduction in mortality is likely related to the shift in the Performance Measures . In some cases, a measure is pattern of Clinical presentation of AMI as well as to insuf ciently supported by the guidelines. In other in- improved acute treatments and long-term care. Yeh and stances, when the guidelines support a measure , the colleagues examined age- and sex-adjusted incidence writing committee may feel it is necessary to have rates for STEMI and NSTEMI from a community-based the measure tested to identify the consequences of mea- population (Northern California) between 1999 and sure implementation.