Acute Myocardial Infarctions Indicators - Quality Measurement
Heart attacks, or Acute Myocardial Infarctions, are caused by a blockage in one or more arteries carrying oxygen to the heart. Although the management of a heart attack is complicated, there are key treatments and interventions that have been proven to improve survival, reduce complications, and preserve heart muscle.
The heart is a muscle that pumps blood and oxygen to the body. A heart attack can temporarily or permanently damage the heart muscle so that it can no longer function, which weakens the heart overall. Anything that can reduce the work of the heart or improve blood supply is potentially advantageous.
Heart Attack Care
Certain medications have been shown to be beneficial. Aspirin, apart from its well known pain relieving properties, may minimize or reduce the amount of artery blockage. Unless contraindicated, meaning there are specific reasons to avoid it, aspirin should be given both on arrival at the hospital with a heart attack, and prescribed at discharge to continue once the patient leaves.
Beta blockers are other drugs that are effective for selected heart attack patients because they reduce the workload on the heart, so it does not have to pump so hard.
When the left ventricle, the main pumping chamber of the heart, has been shown to be already weakened, other drugs can reduce the workload as well and improve blood supply. These are Angiotensin Converting Enzyme (ACE) Inhibitors or Angiotensin Receptor Blockers (ARB). We measure how often patients with heart attacks are given all these medications appropriately.
Percutaneous Coronary Intervention (PCI)
Certain patients with severe heart attacks are best managed by trying to open up the blocked artery that has caused the heart attack. This is done in a cardiac catheterization laboratory and is called a Percutaneous Coronary Intervention, or PCI.
Under an XRAY machine, small tubes (catheters) and wires with attached devices are threaded into the blocked artery to first show the blockage and then to open the blockage, generally either with a balloon or with a small tube (stent) that is left in place to hold the artery open. The faster this is accomplished, the more quickly blood flow is restored. Restoring blood flow quickly can improve survival and reduce the amount of long term damage to the heart muscle. We call this “Time is muscle”.
Research has shown that this procedure is most effective when accomplished within 90 minutes of arrival, which requires rapid diagnosis, very effective coordination of staff, and the availability to perform this procedure on very short notice at any time of the day or night. We measure how often the procedure, PCI, is accomplished within 90 minutes for appropriate heart attack patients.
AMI Performance Report of Danbury Hospital
Overall, effective heart attack care will improve survival, both in the hospital and long term. We also measure and report the mortality rate of patients with heart attacks during their hospitalization.
Medicare, or Centers for Medicare and Medicaid Services (CMS), requires all hospitals to track and report on a number of measures related to Heart Attack Care. We have selected some of these measures to report here which we believe are most critical or most challenging. Medicare sends auditors to each hospital to ensure that the reporting is accurate. We have always been found to be reporting accurately.
You may review our performance on these and all the other Medicare mandated measures by going to the Hospital Compare web site from the U.S. Department of Health and Human Services.