The recommendation for early intervention in non-ST elevation myocardial infarction (NSTEMI), the use of therapeutic hypothermia for comatose ST-elevation myocardial infarction (STEMI), and the application of a risk score stratification strategy for predicting outcomes in patients with NSTEMI represent some of the newly revised quality and performance measures set forth by the American College of Cardiology (ACC)/American Heart Association (AHA) Task Force on Performance Measures and published in the Journal of the American College of Cardiology.
Based on recent evidence-based guidelines in the published literature, the ACC and AHA writing committee have established an updated list of quality measures (n=7) and performance measures (n=17) for the management of STEMI/NSTEMI. According to the ACC and AHA, these measure sets were developed to provide practitioners “with tools to measure the quality of care provided and identify opportunities for improvement.”
For effective clinical care in STEMI/NSTEMI, the first performance measure set forth by the writing group is the immediate administration of aspirin at the time of hospital arrival. In addition, the evaluation of left ventricular ejection fraction is advised to assess hemodynamics while assisting in risk stratification.
Furthermore, using a standardized risk stratification score in NSTEMI is a recommended quality measure to help guide and optimize treatment for these patients. An early invasive strategy (<24 hours) in high-risk patients with NSTEMI as well as therapeutic hypothermia for comatose patients with STEMI and out-of-hospital cardiac arrest represent additional quality measures for these patient populations.
The writing committee of the ACC and AHA “believes that implementation of this measure set by healthcare providers, physician practices, and hospital systems will enhance the quality of care and likely improve outcomes of patients with STEMI and NSTEMI.”
Jneid H, Addison D, Bhatt DL, et al. 2017 AHA/ACC clinical performance and quality measures for adults with ST-elevation and non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. J Am Coll Cardiol. 2017;70(16):2048-2090.