Title
Acute myocardial infarction (AMI): percentage of patients with an AMI requiring thrombolysis who receive thrombolytic therapy within 30 minutes of presentation to the ED, as their primary treatment, during the 6 month time period.
Source(s)
| Australian Council on Healthcare Standards (ACHS). ACHS clinical indicator users' manual 2012. ULTIMO NSW: Australian Council on Healthcare Standards (ACHS); 2012 Jan. |
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Primary Measure Domain
Clinical Quality Measures: Process
Secondary Measure Domain
Does not apply to this measure
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Description
This measure is used to assess the percentage of patients with an acute myocardial infarction (AMI) requiring thrombolysis who receive thrombolytic therapy within 30 minutes of presentation to the emergency department (ED), as their primary treatment, during the 6 month time period.
Rationale
ST-segment elevation myocardial infarction occurs secondary to a sudden interruption of coronary blood supply to a part of the myocardium as a result of a complete thrombotic occlusion of an atheromatous coronary artery. The immediate goal is to establish reperfusion promptly to salvage the myocardium and preserve the left ventricular ejection fraction. Multi-centre studies have shown that the mortality rate of acute myocardial infarction (AMI) is directly proportional to the time delay before the commencement of definitive therapy. Health care organisations with cardiac catheterisation facilities achieve coronary blood flow restoration by emergency angioplasty and stenting of the affected artery. Alternatively, restoration of coronary blood flow can be attempted by intravenous administration of thrombolytic therapy in the emergency department as soon as the diagnosis is established and any contraindications (high risk of bleeding) are excluded. Thrombolytic therapy administered within the first 90 minutes of symptoms has been shown to reduce mortality and infarction size in patients with AMI.
Evidence for Rationale
Acute Coronary Syndrome Guidelines Working Group. Guidelines for the management of acute coronary syndromes 2006. Med J Aust 2006 Apr 17;184(8 Suppl):S1-32. [105 references] PubMed  |
| Aroney CN, Aylward P, Chew DP, Huang N, Kelly AM, White H, Wilson M, National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand. 2007 addendum to the National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand Guidelines for the management of acute coronary syndromes 2006. Med J Aust 2008 Mar 3;188(5):302-3. [10 references] PubMed |
| Australian Council on Healthcare Standards (ACHS). ACHS clinical indicator users' manual 2012. ULTIMO NSW: Australian Council on Healthcare Standards (ACHS); 2012 Jan. |
| Diercks DB, Kontos MC, Weber JE, Amsterdam EA. Management of ST-segment elevation myocardial infarction in EDs. Am J Emerg Med 2008 Jan;26(1):91-100. [50 references] PubMed |
| Kashani A, Giugliano RP. Management of ST-elevation myocardial infarction: an update on pharmacoinvasive recanalization. Am J Cardiovasc Drugs 2008;8(3):187-97. [54 references] PubMed |
| Lamas GA, Escolar E, Faxon DP. Examining treatment of ST-elevation myocardial infarction: the importance of early intervention. J Cardiovasc Pharmacol Ther 2010 Mar;15(1):6-16. [70 references] PubMed |
| Morse MA, Todd JW, Stouffer GA. Optimizing the use of thrombolytics in ST-segment elevation myocardial infarction. Drugs 2009 Oct 1;69(14):1945-66. [77 references] PubMed |
| Pollack CV Jr, Antman EM, Hollander JE, American College of Cardiology, American Heart Association. 2007 focused update to the ACC/AHA guidelines for the management of patients with ST-segment elevation myocardial infarction: implications for emergency department practice. Ann Emerg Med 2008 Oct;52(4):344-355.e1. PubMed |
| Rakel R. Textbook of family medicine. 7th ed. Philadelphia (PA): Saunders Elsevier; 2007. |
| Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, Filippatos G, Fox K, Huber K, Kastrati A, Rosengren A, Steg PG, Tubaro M, Verheugt F, Weidinger F, Weis M, ESC Committee for Practice Guidelines (CPG), Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J 2008 Dec;29(23):2909-45. [257 references] PubMed |
Primary Health Components
Emergency department (ED); acute myocardial infarction (AMI); thrombolytic therapy
Denominator Description
Total number of patients with an acute myocardial infarction (AMI) requiring thrombolysis who receive thrombolytic therapy after presentation to the emergency department (ED), during the 6 month time period (see the related "Denominator Inclusions/Exclusions" field)
Numerator Description
Total number of patients with an acute myocardial infarction (AMI) requiring thrombolysis who receive thrombolytic therapy within 30 minutes of presentation to the emergency department (ED), as their primary treatment, during the 6 month time period (see the related "Numerator Inclusions/Exclusions" field)
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Evidence Supporting the Measure
Type of Evidence Supporting the Criterion of Quality for the Measure
- A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
- A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
- One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal
Additional Information Supporting Need for the Measure
Extent of Measure Testing
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State of Use of the Measure
State of Use
Current routine use
Current Use
Accreditation
Internal quality improvement
National reporting
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Application of the Measure in its Current Use
Measurement Setting
Emergency Medical Services
Professionals Involved in Delivery of Health Services
Advanced Practice Nurses
Physician Assistants
Physicians
Least Aggregated Level of Services Delivery Addressed
Single Health Care Delivery or Public Health Organizations
Statement of Acceptable Minimum Sample Size
Unspecified
Target Population Gender
Either male or female
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National Strategy for Quality Improvement in Health Care
National Quality Strategy Aim
Better Care
National Quality Strategy Priority
Prevention and Treatment of Leading Causes of Mortality
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Institute of Medicine (IOM) National Health Care Quality Report Categories
IOM Care Need
Getting Better
IOM Domain
Effectiveness
Timeliness
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Data Collection for the Measure
Case Finding Period
January to June and July to December
Denominator Sampling Frame
Patients associated with provider
Denominator (Index) Event or Characteristic
Clinical Condition
Encounter
Therapeutic Intervention
Denominator Time Window
Does not apply to this measure
Denominator Inclusions/Exclusions
Inclusions
Total number of patients with an acute myocardial infarction (AMI)* requiring thrombolysis who receive thrombolytic therapy after presentation to the emergency department (ED), during the 6 month time period
Note: Refer to the original measure documentation for International Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) codes.
*AMI is defined as chest pain greater than 30 minutes plus new ST segment elevation or left bundle branch block (LBBB).
Exclusions
Unspecified
Exclusions/Exceptions
Unspecified
Numerator Inclusions/Exclusions
Inclusions
Total number of patients with an acute myocardial infarction (AMI) requiring thrombolysis who receive thrombolytic therapy* within 30 minutes of presentation** to the emergency department (ED) as their primary treatment, during the 6 month time period
Note: Only patients receiving thrombolytic therapy as their primary treatment and who receive this treatment on-site are included.
*Thrombolytic therapy is defined as intravenous therapy for the purpose of enhancing clot lysis, such as streptokinase, recombinant human tissue plasminogen activator (rT-PA), tenecteplase, and activase.
**Time of presentation is defined as arrival time — the time of first contact between the patient and hospital staff (the earliest recorded be it medical, triage, or clerical).
Exclusions
- Patients who are transferred for treatment
- Patients who receive rescue angioplasty
- Patients not triaged and assessed through the emergency department
Numerator Search Strategy
Encounter
Data Source
Administrative clinical data
Paper medical record
Type of Health State
Does not apply to this measure
Instruments Used and/or Associated with the Measure
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Computation of the Measure
Measure Specifies Disaggregation
Does not apply to this measure
Interpretation of Score
Desired value is a higher score
Allowance for Patient or Population Factors
Unspecified
Standard of Comparison
External comparison at a point in, or interval of, time
External comparison of time trends
Internal time comparison
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Original Title
Indicator area 2: acute myocardial infarction management CI 2.1.
Submitter
Australian Council on Healthcare Standards - Health Care Accreditation Organization
Developer
Australian Council on Healthcare Standards - Health Care Accreditation Organization
Funding Source(s)
Funding is direct Australian Council on Healthcare Standards (ACHS) funding sourced through our membership. ACHS does not receive external funding from the government or other sources.
Composition of the Group that Developed the Measure
Working Party Membership
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Australasian College of Emergency Medicine
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Dr. Chris May
(Chair)
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Director, Emergency Services
Redland Hospital, Queensland
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Dr. Stephen Priestley
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Director, Emergency Medicine
Sunshine Coast-Wide Bay Health Service, Queensland
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Dr. Carmel Crock
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Director, Emergency Department
Royal Victorian Eye & Ear Hospital, Victoria
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Dr. Geoffrey Williamson
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Director, Clinical Services
Rockingham General Hospital, Western Australia
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Dr. Kim Hansen
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Emergency Physician
Box Hill Hospital, Victoria
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College of Emergency Nursing Australasia
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Ms. Julie Finucane
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Associate Executive Director, Queensland
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Australian Private Hospitals Association
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Dr. David Rosengren
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Head, Emergency
Greenslopes Private Hospital, Queensland
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Consumer Representative
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Ms. Janney Wale
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Consumers Health Forum of Australia
Australian Capital Territory
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National Casemix and Classification Centre
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Ms. Bronwyn Graham
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Centre for Health Service Development
University of Wollongong, New South Wales
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The Australian Council on Healthcare Standards
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Dr. Chris Maxwell
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Clinical Director
Performance and Outcomes Service, New South Wales
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Mr. Stephen Hancock
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Statistician
Health Services Research Group
University of Newcastle, New South Wales
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Dr. Jen Bichel-Findlay
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Coordinator
Performance and Outcomes Service, New South Wales
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Financial Disclosures/Other Potential Conflicts of Interest
Adaptation
This measure was not adapted from another source.
Date of Most Current Version in NQMC
2012 Jan
Date of Next Anticipated Revision
Measure Status
This is the current release of the measure.
This measure updates a previous version: Australian Council on Healthcare Standards (ACHS). ACHS clinical indicator users' manual 2011. ULTIMO NSW: Australian Council on Healthcare Standards (ACHS); 2011 Jan.
Source(s)
| Australian Council on Healthcare Standards (ACHS). ACHS clinical indicator users' manual 2012. ULTIMO NSW: Australian Council on Healthcare Standards (ACHS); 2012 Jan. |
Measure Availability
The individual measure, "Indicator Area 2: Acute Myocardial Infarction Management CI 2.1," is published in "ACHS Clinical Indicator Users' Manual 2012."
For more information, contact the Australian Council on Healthcare Standards (ACHS), 5 Macarthur Street, ULTIMO NSW 2007; Phone: (02) 9281 9955; Fax: (02) 9211 9633; E-mail: pos@achs.org.au; Web site: www.achs.org.au .
NQMC Status
This NQMC summary was completed by ECRI on August 31, 2007. The information was verified by the measure developer on November 1, 2007. This NQMC summary was updated by ECRI Institute on May 11, 2009 and again on September 27, 2010. This NQMC summary was retrofitted into the new template on June 6, 2011. This NQMC summary was updated by ECRI Institute on November 10, 2011 and again on December 10, 2012.
Copyright Statement
This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions. This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without written permission from The Australian Council on Healthcare Standards (ACHS).
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