A new set of clinical performance measures, jointly developed by the American College of Cardiology (ACC) and the American Heart Association (AHA), will help doctors and hospitals give the best possible care to MI patients by providing up-to-date tools for gauging how closely they're sticking to guideline recommendations and where they need to improve.
The performance measures will appear in the Dec. 9 issue of the Journal of the American College of Cardiology and the Dec. 9 issue of Circulation.
The measures identify some of the most important steps in helping patients return to a healthy life after surviving a heart attack—steps that are oftentimes missed by doctors, according to the associations.
“Performance measures are extraordinarily important in helping us learn how well we are doing and in providing targets for improving quality,” said Harlan M. Krumholz, MD, chair of the writing committee that developed the heart attack performance measures and a professor of medicine at Yale University, New Haven, Conn.
Performance measures are derived from clinical guidelines but serve a different purpose. They are distilled from the guidelines’ key therapies that so clearly improve patient outcomes they literally define high-quality care, according to the associations.
Hospitals and doctors can begin using the new performance measures to benchmark the quality of heart attack care in several areas, including:
- Prescribe statins before patients are discharged from the hospital. The previous performance measures were more general, calling for “lipid lowering therapy.”
- The timeliness of PCI when the patient must be transferred from a hospital without a cardiac cath laboratory to a PCI-capable hospital. Previous performance measures did not track transferred heart attack patients. The new performance measures call for collecting data not only on how much time elapses from arrival at the first hospital to departure to the second hospital, but also from arrival at the first hospital to PCI at the second hospital.
- Referral to a cardiac rehabilitation program. Studies have shown that cardiac rehab markedly improves survival after an MI, but only about one in three patients participate in such programs. The new performance measures call for hospitals to track referral to such programs.
- Elimination of a performance measure on treatment with beta blockers within 24 hours of hospitalization for an MI. New evidence has made the clinical decision to give or withhold beta blockers more complex, making measurement difficult.
- Evaluation of the heart's pumping function, or left ventricular systolic function, during hospitalization. This measurement is essential for subsequent decisions about care, according to the authors.
- Several “test” performance measures that are intended for internal use by hospitals and doctors, including evaluation of blood levels of low-density-lipoprotein cholesterol, dosage of several types of blood-thinning medications, and prescription at hospital discharge of the anti-clotting medication clopidogrel.
The new performance measures have been endorsed by the American Academy of Family Physicians, American College of Emergency Physicians, American Association of Cardiovascular and Pulmonary Rehabilitation, Society of Hospital Medicine, and Society for Cardiovascular Angiography and Interventions. They update a previous version published in 2006.