Table 20-1.

Acute Coronary Syndrome Quality-of-Care Measures, 2009

Quality-of-Care Measure	VHA*	National Medicare and Medicaid†	AHA GWTG- CAD‡	ACTION/GWTG- STEMI§	ACTION/GWTG- NSTEMI§
Aspirin within 24 h of admission	99	98	91‖	99	97
Aspirin at discharge	99	98	96‖	99	97
β-blockers within 24 h of admission among AMI and angina patients	97	95	NM	NM	NM
β-blockers at discharge	99	98	95‖	97	95
Lipid-lowering medication at discharge	92	NM	87	98	97
Lipid therapy at discharge if LDL >100 mg/dL	97¶	NM	93‖	NM	NM
ARB/ACEI at discharge for patients with LVEF <40%	96	95	92‖	88	84
ACEI at discharge for AMI patients	75	NM	66‖	NM	NM
Adult smoking cessation advice/counseling	99	99	98‖	98	97
Cardiac rehabilitation referral for AMI patients	NM	NM	49	84	74

VHA indicates Veterans Health Administration; AHA GWTG-CAD, American Heart Association’s Get With The Guidelines–Coronary Artery Disease; ACTION/GWTG-STEMI, Acute Coronary Treatment and Intervention Outcomes Network/Get With The Guidelines–ST-Elevation Myocardial Infarction; ACTION/GWTG-NSTEMI, Acute Coronary Treatment and Intervention Outcomes Network/Get With The Guidelines–Non–ST-Elevation Myocardial Infarction; AMI, acute myocardial infarction; NM, not measured; LDL, low-density lipoprotein; ARB, angiotensin receptor blocker; ACEI, angiotensin-converting enzyme inhibitor; LVEF, left ventricular ejection fraction.

Values are percentages.

^*VHA: AMI patients.

^†National Medicare and Medicaid: AMI patients.

^‡AHA GWTG-CAD: Patients admitted with a cardiovascular event. In the GWTG-CAD registry, the in-hospital mortality rate was 4.5% (excludes transfer-out patients; if discharge status was missing, it was assumed to be “no.”). The mean length of hospital stay was 5.0 days (median 3.0 days).

^§ACTION Registry: STEMI and NSTEMI patients were reported separately. Patients must have been admitted with acute ischemic symptoms within the previous 24 hours, typically reflected by a primary diagnosis of STEMI or NSTEMI. Patients who were admitted for any other clinical condition were not eligible.

^‖Indicates the 7 key achievement measures targeted in GWTG-CAD. The composite quality-of-care measure for 2009 was 94.4%. The composite quality-of-care measure indicates performance on the provision of several elements of care. It is computed by summing the numerators for each key performance measure across the population of interest to create a composite numerator (all the care that was given), summing the denominators for each measure to form a composite denominator (all the care that should have been given), and reporting the ratio (the percentage of all the needed care that was given).

^¶Lipid-lowering therapy among patients with LDL >130 mg/dL.