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Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED)

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Measure Information 2023 Reporting Period
CMS Measure ID CMS996v3
NQF Number 3613e
Measure Description

Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival

Initial Population

All emergency department encounters for patients 18 years and older at the start of the encounter with a diagnosis of ST-segment elevation myocardial infarction (STEMI) during the measurement period

Denominator Statement

Equals Initial Population

Denominator Exclusions Patients with the following conditions are excluded from measure denominator: • Expired in the ED • Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplase Within 90 days before start of ED encounter: • Ischemic stroke • Significant facial and/or closed head trauma • Peptic ulcer • Intracranial or intraspinal surgery Within 21 days before end of ED encounter: • Major surgery Within 24 hours before start of ED encounter and during ED encounter: • Suspected aortic dissection • Severe neurologic impairment • Mechanical circulatory assist device placement, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device • Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation • Cardiopulmonary arrest, including: cardiac arrest, CPR, defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR At the start of ED encounter: • Bleeding or bleeding diathesis (excluding menses) • Known malignant intracranial neoplasm (primary or metastatic) • Known structural cerebral vascular lesion (e.g., AVM) • Advanced dementia • Pregnancy • Active oral anticoagulant therapy
Numerator Statement

Emergency department encounters with a diagnosis of STEMI:

- where time from ED arrival to fibrinolysis is 30 minutes or fewer;

OR

- where PCI is performed within 90 minutes of arrival for non-transfer patients;

OR

- where the patient is transferred within 45 minutes of ED arrival.

Numerator Exclusions

Not Applicable

Denominator Exceptions

None

Measure Steward Centers for Medicare & Medicaid Services (CMS)
Quality Domain Promote effective prevention and treatment of chronic disease
Measure Scoring Proportion measure
Measure Type Process measure
Improvement Notation

Improvement noted as an increase in the rate

Guidance

This eCQM is an episode-based measure and should be reported for each instance of an ED encounter during the measurement period for patients with a STEMI.

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

Meaningful Measure Management of Chronic Conditions
Telehealth Eligible No
Next Version No Version Available
Previous Version No Version Available

Measure Information 2023 Reporting Period
CMS Measure ID CMS996v3
NQF # 3613e
Measure Description

Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival

Initial Population

All emergency department encounters for patients 18 years and older at the start of the encounter with a diagnosis of ST-segment elevation myocardial infarction (STEMI) during the measurement period

Denominator Statement

Equals Initial Population

Denominator Exclusions

Patients with the following conditions are excluded from measure denominator:

• Expired in the ED

• Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplase

Within 90 days before start of ED encounter:

• Ischemic stroke

• Significant facial and/or closed head trauma

• Peptic ulcer

• Intracranial or intraspinal surgery

Within 21 days before end of ED encounter:

• Major surgery

Within 24 hours before start of ED encounter and during ED encounter:

• Suspected aortic dissection

• Severe neurologic impairment

• Mechanical circulatory assist device placement, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device

• Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation

• Cardiopulmonary arrest, including: cardiac arrest, CPR, defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR

At the start of ED encounter:

• Bleeding or bleeding diathesis (excluding menses)

• Known malignant intracranial neoplasm (primary or metastatic)

• Known structural cerebral vascular lesion (e.g., AVM)

• Advanced dementia

• Pregnancy

• Active oral anticoagulant therapy

Numerator Statement

Emergency department encounters with a diagnosis of STEMI:

- where time from ED arrival to fibrinolysis is 30 minutes or fewer;

OR

- where PCI is performed within 90 minutes of arrival for non-transfer patients;

OR

- where the patient is transferred within 45 minutes of ED arrival.

Numerator Exclusions

Not Applicable

Denominator Exceptions

None

Measure Steward Centers for Medicare & Medicaid Services (CMS)
Quality Domain Promote effective prevention and treatment of chronic disease
Measure Scoring Proportion measure
Measure Type Process measure
Improvement Notation

Improvement noted as an increase in the rate

Guidance

This eCQM is an episode-based measure and should be reported for each instance of an ED encounter during the measurement period for patients with a STEMI.

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

Meaningful Measure Management of Chronic Conditions
Telehealth Eligible No
Last Updated: May 23, 2022