Clinical performance measures raise bar in heart attack care

This practical tool aims to ensure that every eligible patient receives proven therapies

Heart attack strikes some 865,000 Americans each year. Treating patients with scientifically proven therapies both in the hospital and at home can markedly increase the chances of survival and a return to an active life. To aid physicians in achieving this therapeutic goal, the American College of Cardiology (ACC) and the American Heart Association (AHA) have today released Clinical Performance Measures focusing on the most critical steps in the treatment of patients with heart attack.

"These Clinical Performance Measures define key healthcare processes for which the supporting evidence is so strong, every patient ought to have the opportunity to receive the treatment," said Harlan M. Krumholz, M.D., F.A.C.C., chair of the writing committee, and the Harold H. Hines Jr. Professor of Medicine at Yale School of Medicine, New Haven, CT. "They move us from an arena of recommendations to one of accountability."

Practical and to-the-point, the Clinical Performance Measures are distilled from comprehensive ACC/AHA guidelines on the treatment of patients with two forms of heart attack, ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI), terms that reflect differences in electrocardiographic tracings that define each type of heart attack, or myocardial infarction.

The Clinical Performance Measures bridge the gap between knowing what should be done in treating heart attack and putting that knowledge into action, patient after patient, day after day. "Performance Measures are a wake-up call. They allow physicians and hospitals to benchmark themselves and see whether they're adhering to evidence-based recommendations, and if not, to develop systems to improve the quality of healthcare," said Robert O. Bonow, M.D., F.A.C.C., chair of the ACC/AHA Task Force on Performance Measures and the Goldberg Professor of Medicine at Northwestern University, Chicago.

The new ACC/AHA document was developed in collaboration with representatives from the American College of Physicians, the American Academy of Family Physicians, and the American College of Emergency Physicians.

Key criteria outlined in the Clinical Performance Measures include:

  • The prescription of aspirin upon arrival in the emergency room and at discharge from the hospital,
  • The prescription of beta blockers upon arrival and discharge,
  • The prescription of angiotensin-converting-enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) upon discharge for patients whose heart has been damaged and no longer pumps as forcefully as it should, and
  • Counseling on smoking cessation, as needed.

These criteria conform to measures currently used by the federal government and other organizations to measure healthcare quality and, indeed, represent an endorsement of those measures. The ACC/AHA Clinical Performance Measures go a step further, however, calling for:

  • Assessment of blood levels of low-density-lipoprotein (LDL) cholesterol--so-called bad cholesterol,
  • Initiation of cholesterol-lowering therapy as needed,
  • Improvements in the measurement of time to treatment for patients who either receive clot-busting medications or undergo catheter-based intervention to open the blocked artery responsible for the heart attack, and
  • Documentation of the proportion of patients who receive therapy to open a blocked artery, from among those who are eligible for such therapy.

By putting the full set of ACC/AHA Clinical Performance Measures into action, physicians and hospitals can improve healthcare quality today and prepare for the future, Dr. Krumholz said. "These performance measures document where we are now in measuring quality, but it's not a static effort," he said. "As science progresses, there will be a continuing need to assess, evaluate, and refine our measures--and to coordinate with other organizations so that we do not create competing sets of performance measures. We are working together to translate the best science into practice and use these tools to assess our progress."

The full text of the Clinical Performance Measures are available online at and


About the American College of Cardiology:
The American College of Cardiology, a 33,000-member nonprofit professional medical society and teaching institution, is dedicated to fostering optimal cardiovascular care and disease prevention through professional education, promotion of research, leadership in the development of standards and guidelines, and the formulation of health care policy.

About the American Heart Association:
Since 1924 the American Heart Association has helped protect people of all ages and ethnicities from the ravages of heart disease and stroke. These diseases, the nation's No. 1 and No. 3 killers together with other vascular diseases, claim about 930,000 American lives a year. The association invested more than $473 million in fiscal year 200405 for research, professional and public education, advocacy and community service programs so people across America can live stronger, longer lives.

Last reviewed: By John M. Grohol, Psy.D. on 30 Apr 2016
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