This measure is used to assess the percent of acute myocardial infarction (AMI) patients, 18 years of age and older, who are prescribed aspirin at hospital discharge.

Aspirin therapy in patients who have suffered an acute myocardial infarction (AMI) reduces the risk of adverse events and mortality. Studies have demonstrated that aspirin can reduce this risk by 20% (Antiplatelet Trialists' Collaboration, 1994). National guidelines strongly recommend long-term aspirin for the secondary prevention of subsequent cardiovascular events in eligible older patients discharged after AMI (Antman, 2004; Antman, 2008; Anderson, 2007; and Smith, 2006).

Acute myocardial infarction (AMI); aspirin

Acute myocardial infarction (AMI) patients, 18 years of age and older (see the related "Denominator Inclusions/Exclusions" field)

Acute myocardial infarction (AMI) patients who are prescribed aspirin at hospital discharge

Each year, an estimated 785,000 Americans will have a new coronary event, and approximately 470,000 will have a recurrent event. An estimated additional 195,000 silent first myocardial infarctions occur each year. Approximately every 25 seconds, an American will have a coronary event, and approximately every minute, one will die. In 2004, acute myocardial infarction (AMI) resulted in 695,000 hospital stays and $31 billion in health expenditures. The risk of further cardiovascular complications, including recurrent MI, sudden cardiac death, heart failure, stroke, and angina pectoris, among AMI survivors is substantial.

The core measure pilot project was a collaboration among The Joint Commission, five state hospital associations, five measurement systems, and 83 hospitals from across nine states. Participating hospitals collected and reported data for acute myocardial infarction (AMI) measures from December 2000 to December 2001.

Core measure reliability visits were completed in the summer of 2001 at a random sample of 16 participating hospitals across 6 states.

Preliminary data gathered during The Joint Commission's pilot project shows a mean measure rate of 95% for this measure.

This measure is reviewed bi-annually and revised as needed to ensure reliable specifications. An independent abstracting contractor is utilized by the Hospital Inpatient Quality Reporting Program to monitor validity of the measure specifications. Feedback from this contractor is incorporated into the proposed changes for each manual update.

Age greater than or equal to 18 years

Discharges January 1 through June 30 and July 1 through December 31

Inclusions
Discharges, 18 years of age and older, with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Principal Diagnosis Code for acute myocardial infarction (AMI) (as defined in the appendices of the original measure documentation)

Exclusions

• Patients less than 18 years of age
• Patients who have a Length of Stay (LOS) greater than 120 days
• Patients with Comfort Measures Only (as defined in the Data Dictionary) documented
• Patients enrolled in clinical trials
• Patients discharged to another hospital
• Patients who left against medical advice
• Patients who expired
• Patients discharged to home for hospice care
• Patients discharged to a health care facility for hospice care
• Patients with a documented Reason for No Aspirin at Discharge (as defined in the Data Dictionary)

Inclusions
Acute myocardial infarction (AMI) patients who are prescribed aspirin at hospital discharge

Exclusions
None

Unspecified

AMI-2: aspirin prescribed at discharge.

All external funding for measure development has been received and used in full compliance with The Joint Commission's Corporate Sponsorship policies, which are available upon written request to The Joint Commission.

Centers for Medicare & Medicaid Services (CMS) funding is from the United States Government.

In February 1992, the Centers for Medicare & Medicaid Services (CMS) (formerly HCFA) and the American Medical Association convened a steering committee for the Cooperative Cardiovascular Project (CCP). The committee drafted measures heavily based on clinical practice guidelines developed by the American College of Cardiology (ACC) and the American Heart Association (AHA). More than 30 different physicians, health service researchers, and representatives of physician specialty societies or health care organizations participated in review and refinement of the measures. Acute myocardial infarction (AMI) study groups at Quality Improvement Organizations (formerly Peer Review Organizations) from the states of Alabama, Connecticut, Iowa, and Wisconsin also contributed. A subgroup of this committee, including members of the ACC who had participated in the development of guidelines on treatment of AMI, assisted in developing 26 potential quality-of-care indicators. These indicators were reviewed by other representatives of the ACC, the American College of Physicians, the American Academy of Family Physicians, and a panel of practicing physicians participating in the Internal Medicine Center to Advance Research and Education Practice Guidelines Review Network, and eleven measures were finalized and implemented, including this measure. The Joint Commission was also a co-developer of this measure as well. The original versions of this measure have undergone revisions over the years, and have evolved into the current version being operationalized in the Hospital Inpatient Quality Reporting Program today.

Expert panel members have made full disclosure of relevant financial and conflict of interest information in accordance with the Conflict of Interest policies, copies of which are available upon written request to The Joint Commission and the Centers for Medicare & Medicaid Services (CMS).

2012 Jan 18

This measure was not adapted from another source.

This measure is reviewed and updated by the developing organizations every 6 months.

Unspecified

This is the current release of the measure.

This measure updates a previous version: Specifications manual for national hospital quality measures, version 3.1a. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; 2010 Apr 1. various p.

The individual measure, "AMI-2: Aspirin Prescribed at Discharge," is published in "Specifications Manual for National Hospital Inpatient Quality Measures." This document is available from The Joint Commission Web site . Information is also available from the QualityNet Web site . Check The Joint Commission Web site and QualityNet Web site regularly for the most recent version of the specifications manual and for the applicable dates of discharge.

The following are available:

• A software application designed for the collection and analysis of quality improvement data, the CMS Abstraction and Reporting Tool (CART), is available from the CMS CART Web site . Supporting documentation is also available. For more information, e-mail CMS PROINQUIRIES at proinquiries@cms.hhs.gov.
• The Joint Commission. A comprehensive review of development and testing for national implementation of hospital core measures. Oakbrook Terrace (IL): The Joint Commission; 40 p. This document is available in Portable Document Format (PDF) from The Joint Commission Web site .
• The Joint Commission. Attributes of core performance measures and associated evaluation criteria. Oakbrook Terrace (IL): The Joint Commission; 5 p. This document is available in PDF from The Joint Commission Web site .
• Hospital compare: a quality tool provided by Medicare. [internet]. Washington (DC): U.S. Department of Health and Human Services; [accessed 2012 Jan 16]. This is available from the Medicare Web site.  See the related QualityTools  summary.

This NQMC summary was originally completed by ECRI on February 7, 2003. This NQMC summary was updated by ECRI Institute on October 6, 2005, April 16, 2007, and October 26, 2007. The Joint Commission informed NQMC that this measure was updated on August 13, 2008 and provided an updated version of the NQMC summary. This NQMC summary was updated accordingly by ECRI Institute on November 11, 2008. The information was verified by the Centers for Medicare & Medicaid Services (CMS) on January 22, 2009. The Joint Commission informed NQMC that this measure was updated again on October 1, 2009 and provided an updated version of the NQMC summary. This NQMC summary was updated accordingly by ECRI Institute on November 25, 2009. The information was verified by CMS on February 18, 2010. This NQMC summary was updated again by ECRI Institute on October 8, 2010. The information was verified by The Joint Commission on December 3, 2010. The information was verified by CMS on January 6, 2011. This NQMC summary was retrofitted into the new template on May 13, 2011. The Joint Commission informed NQMC that this measure was updated again on March 28, 2012 and provided an updated version of the NQMC summary. This NQMC summary was updated accordingly by ECRI Institute on July 10, 2012. The information was verified by CMS on August 1, 2012.

The Specifications Manual for National Hospital Inpatient Quality Measures [Version 4.1, July, 2012] is the collaborative work of the Centers for Medicare & Medicaid Services and The Joint Commission. The Specifications Manual is periodically updated by the Centers for Medicare & Medicaid Services and The Joint Commission. Users of the Specifications Manual for National Hospital Inpatient Quality Measures should periodically verify that the most up-to-date version is being utilized.