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Heart Attack (AMI)

How Do We Compare?

What is a heart attack (acute myocardial infarction)?

Heart Attack (AMI) - Quality Measures
MEASURE: MEMORIAL RESULTS
Jul to Sep 2011
(Actual/Total)
COLORADOAVERAGE‡
Jan 2010 to Dec 2010
NATIONAL
AVERAGE‡
  Jan 2010 to Dec 2010
TOP 10% NATIONAL LOWEST SCORE†
  Jan 2010 to Dec 2010
Met all measures 97.8%
(89/91)
No data available No data available No data available
ACE inhibitor on discharge Achieved the best possible results
100.0%
(8/8)
98% 96% 100%
Aspirin on arrival At or near national average performance
98.9%
(87/88)
99% 99% 100%
Aspirin on discharge Achieved the best possible results
100.0%
(86/86)
99% 99% 100%
Beta blocker on discharge Achieved the best possible results
100.0%
(81/81)
99% 98% 100%
Smoking cessation Achieved the best possible results
100.0%
(29/29)
99% 100% 100%

KEY:
(‡) This is the most current data available for average Colorado hospital quality performance according to the Centers for Medicare and Medicaid Services (CMS).
(‡‡) This is the most current data available for average national hospital quality performance according to the Centers for Medicare and Medicaid Services (CMS.
(†) This is the most current data available for lowest scores of national top 10% hospital quality performance according to the Joint Commission.

NOTE: Memorial results are highlighted in the blue column of data and annotated with one of the following quality indicators:

Achieved the best possible results = Achieved the best possible results
Above national average performance = Above national average performance
At or near national average performance = At or near national average performance
Below national average performance = Below national average performance

 

 

What is a heart attack?

A heart attack, or acute myocardial infarction (AMI), occurs when one or more regions of the heart muscle experience a severe or prolonged lack of oxygen caused by blocked blood flow to the heart muscle.

The blockage is often a result of atherosclerosis – a buildup of plaque, known as cholesterol, and other fatty substances. Plaque inhibits and obstructs the flow of blood and oxygen to the heart, thus reducing the flow to the rest of the body. The cause of a heart attack is a blood clot that forms within the plaque-obstructed area.

If the blood and oxygen supply is cut off severely or for a long period of time, muscle cells of the heart suffer damage and die. The result is dysfunction of the muscle of the heart in the area affected by the lack of oxygen.

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What does “met all measures” mean?

This quality measure indicates the percentage of patients that successfully received all the heart attack (acute myocardial infarction) quality measures they were qualified to receive.

This is a measure not typically reported or required by Joint Commission or CMS. Our hospital chooses to disclose this information voluntarily.

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What is an ACE inhibitor and what does it do for the heart?

The left ventricle is the part of the heart that holds and pumps blood to other vital organs. A measure called the left ventricular ejection fraction (LVEF) is used to check for damage due to heart attacks and other conditions. The LVEF value for a person with no heart damage is usually around 60 percent or greater. Systolic dysfunction (condition that causes reduced pumping ability of the heart's left lower ventricle) represents reduced pumping ability of the heart.

Angiotensin converting enzyme (ACE) inhibitors are a group of medications that relax blood vessels and make it easier for the heart muscle to pump blood to vital organs. Angiotensin receptor blockers (ARB) are a similar group of medications, and both are recommended by the Joint Commission as important tools for reducing mortality in heart attack survivors who have left ventricular systolic dysfunction (LVSD).

A Scientific Statement from the American Heart Association Council on Clinical Cardiology Research indicates those heart attack survivors who have LVEF systolic dysfunction should be placed on an ACE inhibitor or an ARB. This medication reduces the chance of death and reduces disease symptoms after a heart attack. (Circulation, May 24, 2005: 111 (20); 2699-2710)

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What does aspirin do for the heart upon arrival at the hospital?

To work properly, the heart muscle requires constant oxygen and nutrients, which travel through blood vessels. A narrowed blood vessel of the heart (coronary artery) diminishes the oxygen and nutrient delivery to the heart. If a blood clot forms in a coronary artery it can cut off the oxygen supply completely and cause a heart attack or myocardial infarction. Aspirin helps to prevent blood clot formation.

Multiple research studies over the past ten years provide strong evidence that aspirin and certain platelet inhibitors (drugs that keep blood platelets from sticking together) decrease the risk of re-closing a narrowed artery (restenosis) and of death after a heart attack.

According to the Joint Commission, persons with a suspected heart attack should receive aspirin within 24 hours before or after hospital arrival.

A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines found Class I evidence (highest level of scientific support) for giving aspirin as soon as possible for a confirmed or strongly suspected heart attack (Circulation, September, 2000: 102 (10); 1193-1209). Individuals who are at increased risk for bleeding, however, may not be candidates for aspirin therapy because aspirin thins the blood, further increasing the risk of bleeding.

Unless otherwise contraindicated, the protocol at Memorial Hospital includes the administration of aspirin to heart attack patients upon arrival to the hospital.

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What does aspirin do for the heart upon discharge from the hospital?

According to the US Preventive Services Task Force, aspirin is recommended to decrease the incidence (frequency of new cases) of heart disease in adults who have risk factors for heart disease. Individuals who are at increased risk for bleeding, however, may not be candidates for aspirin therapy because aspirin thins the blood, further increasing the risk of bleeding.
The American College of Cardiology/American Heart Association Task Force on Practice Guidelines found Class I evidence (highest level of scientific support) for taking aspirin indefinitely after a heart attack. (Circulation, September, 2000: 102 (10); 1193-1209).

Evidence for this guideline has existed since the mid- to late-1990s and has been further supported by subsequent research. "Long-term aspirin therapy confers conclusive net benefits on risk of subsequent MI [myocardial infarction], stroke, and vascular death among patients with a wide range of prior manifestations of cardiovascular disease" (Circulation, October 21, 1997: 96(8); 2751-2753).

Unless otherwise contraindicated, the protocol at Memorial Hospital includes prescribing daily aspirin for heart attack survivors after Hospital discharge.

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What does a beta blocker do for the heart upon discharge from the hospital?

For most heart attack survivors, starting beta blockers (group of medications that block the stress hormone adrenaline) at or before discharge from the hospital has been shown to reduce death and disability. (American Heart Journal, December, 2004: 148 (6); 944-50).

Unless otherwise contraindicated, the protocol at Memorial Hospital includes the administration of beta blockers to patients with heart attacks upon arrival to the hospital and discharge from the hospital.

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Why should heart attack survivors stop smoking?

Smoking is a modifiable risk factor for heart disease. National guidelines strongly recommend smoking counseling to help heart attack survivors quit smoking (National Cancer Institute (NCI) Prevention and Cessation of Cigarette Smoking: Control of Tobacco Use). Tobacco Cessation Guidelines from the United States Department of Health and Human Services (DHS) provide helpful tips on smoking cessation for patients.

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RELATED INFORMATION:

Agency for Healthcare Research and Quality (AHRQ)
www.ahrq.gov

American Board of Medical Specialties
www.abms.org

American College of Cardiology (ACC)
www.acc.org

American Heart Association (AHA)
www.americanheart.org

Centers for Medicare and Medicaid Services (CMS)
www.cms.hhs.gov

Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample
www.hcup.ahrq.gov/HcupNet.asp

The Joint Commission
www.jointcommission.org

National Cancer Institute
www.cancer.gov

National Cholesterol Education Program
www.nhlbi.nih.gove/about/ncep/index.htm

National Committee for Quality Assurance (NCQA)
www.ncqa.org

National Heart Lung and Blood Institute (NHLBI)
www.nhlbi.nih.gov

Society of Chest Pain Centers (SCPC)
www.scpcp.org

U.S. Department of Health and Human Resources (DHS)
www.hhs.gov

U.S. Preventative Services Task Force
http://odphp.osophs.dhhs.gov/pubs/guidecps/uspstf.htm

 

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