Table 21-1.

Acute Coronary Syndrome Quality-of-Care Measures, 2011

Quality-of-Care Measure	VHA*	National Data From HIQR Program†	ACTION-GWTG STEMI‡	ACTION-GWTG NSTEMI‡
Aspirin within 24 h of admission	99	99	98.4	97.1
Aspirin at discharge	99	98.8	98.9	97.9
β-Blockers within 24 h of admission, among AMI and angina patients	96	R	NM	NM
β-Blockers at discharge	99	98.6	97.7	96.1
Lipid-lowering medication at discharge§	98	96.8	99	98.1
Lipid therapy at discharge if LDL cholesterol >130 mg/dL	97	NM	NM	NM
ARB/ACEI at discharge for patients with LVEF <40%	95	96.8	90.4	85.7
ACEI at discharge for AMI patients	NM	NM	72.9	60.8
ARB at discharge for AMI patients	NM	NM	8.1	12.4
Adult smoking cessation advice/counseling	100	99.7	98.7	98.1
Cardiac rehabilitation referral for AMI patients	NM	NM	83.2	72

Values are percentages.

VHA indicates Veterans Health Administration; HIQR, Hospital Inpatient Quality Reporting; ACTION-GWTG, Acute Coronary Treatment and Intervention Outcomes Registry–Get With The Guidelines; STEMI, ST-elevation myocardial infarction; NSTEMI, non–ST-elevation myocardial infarction; AMI, acute myocardial infarction; R, retired in 2009; NM, not measured; LDL, low-density lipoprotein; ARB, angiotensin receptor blocker; ACEI, angiotensin-converting enzyme inhibitor; and LVEF, left ventricular ejection fraction.

^*VHA: AMI patients.

^†HIQR Program includes data from all payers, including Medicare and Medicaid.

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

^§Denotes statin use at discharge. Use of nonstatin lipid-lowering agent was 9.7% for STEMI patients and 12.6% for NSTEMI patients in the ACTION registry.