title: Quality of care of Medicare beneficiaries with acute myocardial infarction: who is included in quality improvement measurement?
abstract: OBJECTIVE
  To determine the proportion of older patients hospitalized with acute myocardial infarction (AMI) incorporated in a commonly used set of AMI quality indicators.
  
  
  METHODS
  Retrospective analysis of a medical record database.
  
  
  METHODS
  Nongovernmental U.S. acute care hospitals.
  
  
  METHODS
  Medicare patients hospitalized for AMI between January 1994 and February 1996.
  
  
  METHODS
  Proportion of patients aged 65 and older classified as ideal candidates (without absolute or relative contraindications) for six Centers for Medicare & Medicaid Services AMI quality indicators: aspirin (admission, discharge), beta-blocker (admission, discharge), angiotensin-converting enzyme (ACE) inhibitors at discharge, and time to reperfusion therapy.
  
  
  RESULTS
  Of the 149,996 patients eligible for admission therapies, 10.1% were ideal candidates for reperfusion therapy, 65.0% for aspirin, and 34.7% for beta-blockers. Of the 116,919 patients eligible for discharge therapies, 47.7% were ideal candidates for aspirin, 17.6% for beta-blockers, and 15.2% for ACE inhibitors. More than one-quarter (26.8%) of all patients were ineligible for any of the six quality indicators; this proportion increased with age, ranging from 23.7% of patients aged 65 to 69 to 30.2% of patients aged 85 and older.
  
  
  CONCLUSIONS
  A substantial proportion of older patients were not included in AMI process quality measurement, with the proportion excluded higher in successively older age groups. The data highlight the need for additional research to determine effective treatment strategies for patients for whom the evidence base for clinical decision-making remains weak.
authors.affiliation: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
authors.forename: Saif S
authors.initials: SS
authors.lastname: Rathore
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Wang
authors.forename: Martha J
authors.initials: MJ
authors.lastname: Radford
authors.forename: Diana L
authors.initials: DL
authors.lastname: Ordin
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005853:Geriatrics; D006760:Hospitalization; D006801:Humans; D008297:Male; D006278:Medicare; D009203:Myocardial Infarction / Q000188:drug therapy*; D011787:Quality of Health Care; D012189:Retrospective Studies; D014481:United States
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D001241:Aspirin