ACEI or ARB for LVSD

What It Means
The percentage of patients with Acute Myocardial Infarction with left ventricular systolic dysfunction (LVSD) who were prescribed with either an ACE (angiotensin converting enzyme inhibitor) or an ARB (Angiotensin receptor blocker) at hospital discharge.

Why It Is Important
Clinical evidence shows that the use of an ACE or an ARB after a heart attack on the front side of the heart improves long-term survival and provides greater benefit to the patient. ACE inhibitors and ARBs work by limiting the effects of a hormone that narrows blood vessels, and may thus lower blood pressure and reduce the work the heart has to perform. Since the ways in which these two kinds of drugs work are different, your doctor will decide which drug is most appropriate for you.

Numerator Definition
Patients with AMI who are prescribed either an ACE or an ARB at hospital discharge

Denominator Definition
Patients with AMI who have left ventricular systolic dysfunction (LVSD) and do not have a contraindication for taking either ACEs or ARBs.

Denominator Excluded Populations

  • Patients less than 18 years of age
  • Patients who have a Length of Stay >120 days
  • Patients less than 18 years of age
  • Patients who have a Length of Stay >120 days
  • Patients with Comfort Measures Only documented
  • Patients enrolled in clinical trials
  • Patients discharged/transferred to another hospital for inpatient care
  • Patients who left against medical advice or discontinued care
  • Patients who expired
  • Patients discharged/transferred to a federal health care facility
  • Patients discharged/transferred to hospice
  • Patients with BOTH a potential contraindication/reason for not prescribing an ACEI at discharge AND a potential contraindication/reason for not prescribing an ARB at discharge, as evidenced by one or more of the following:
         -   ACEI allergy AND ARB allergy
         -   Moderate or severe aortic stenosis
         -   Physician/advanced practice nurse/physician assistant (physician/APN/PA) documentation of BOTH a reason for not prescribing an ACEI at discharge AND a reason for not prescribing an ARB at discharge Note: Documentation of a reason for not prescribing one class (either ACEI or ARB) should be considered implicit documentation of a reason for not prescribing the other class for the following five conditions only:
              *  Angioedema
              *  Hyperkalemia
              *  Hypotension
              *  Renal artery stenosis
              *  Worsening renal function/renal disease/dysfunction
         -   Reason documented by physician/APN/PA for not prescribing an ARB at discharge AND an ACEI allergy
         -   Reason documented by physician/APN/PA for not prescribing an ACEI at discharge AND an ARB allergy

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