Designing a Comprehensive Strategy to Improve One Core Measure: Discharge of Patients With Myocardial Infarction or Heart Failure on ACE Inhibitors/ARBs

Calie Santana, Matthew Shaines, Peter Choi, Rohit Bhalla

Research output: Contribution to journalArticle

2 Scopus citations


Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ACEs/ARBs) have proven benefit for patients with myocardial infarction and heart failure; their use is a core measure of hospital quality for the Centers for Medicare and Medicaid Services. The authors' urban medical center has lower-than-average performance on this measure. The authors used published best practices to design and implement a comprehensive strategy to improve ACE/ARB performance with existing decision support and human resources. Chart reminders were targeted to providers of patients eligible for ACEs/ARBs but not receiving them. ACE/ARB performance increased 8.5% in postintervention patients compared with historical controls. The increase was 20.7% among patients not on ACEs/ARBs on admission (P =.03). Chronic kidney disease (CKD) was inversely associated with the effectiveness of the intervention. A comprehensive strategy can be effective in narrowing the performance gap even for populations with a high prevalence of CKD. However, future work is needed to improve performance among patients whose ACEs/ARBs are withheld during hospitalization.

Original languageEnglish (US)
Pages (from-to)398-405
Number of pages8
JournalAmerican Journal of Medical Quality
Issue number5
Publication statusPublished - Sep 1 2012



  • ACE inhibitors/ARBs
  • chart reminder
  • heart failure
  • intervention
  • myocardial infarction

ASJC Scopus subject areas

  • Health Policy

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