Table 1.

Acute myocardial infarction quality of care criteria

Criterion	Candidates	Timeliness Standard	Selected Indications, Contraindications or Exceptions
Oral ASA	all AMI	within 24 hours of admission	allergy to ASA, bleeding on admission
Beta blocker	all AMI	within 24 hours of admission	pulse<60, CHF, pulmonary edema, shock, heart block, COPD
Angiotensin converting enzyme inhibitor (ACE-I)	all AMI	within 24 hours of admission	allergy, history of angioedema
Timely reperfusion: thrombolytic therapy OR revascularization (PCI or CABC)	chest pain <12 hours AND ST elevation in 2 contiguous leads	within 24 hours of admission	bleeding diathesis, age>80, previous stroke, surgery in past 2 months, bilirubin>2.0, warfarin therapy, trauma in past month
ASA at discharge	all discharges	at discharge	allergy to ASA, bleeding or platelets<100,000, creatinine>3.0, Hgb<10.0gm/dL
Beta blocker at discharge	all discharges	at discharge	pulse<50 (not previously on beta blocker), heart block, COPD, LVEF<30% SBP< 90mm Hg
ACE-I at discharge	if LVEF <40%	at discharge	creatinine>2.0 mg/dL allergy, aortic stenosis, lastSBP<100 (off ACE-I)
Smoking cessation counseling	all smokers	at discharge	no reported tobacco abuse
Dyslipidemia screening	all discharges	during hospital stay	none
Dietary counseling	cases with dyslipidemia	at discharge	none
Medication treatment for hyperlipidemia	cases with dyslipidemia	at discharge	if LDL-C<100mg/dL and triglycerides <150mg/dL
Cardiac rehab	all discharges	at discharge	none

Note: ASA, aspirin; CHF, congestive heart failure; LVEF, left ventricular ejection fraction; LDL-C, low density lipoprotein, cholesterol; COPD, chronic obstructive pulmonary disease; PCI, percutaneous coronary intervention; CABG, coronary artery bypass graft surgery; Hgb, hemoglobin.