Effectiveness of Care: Heart Disease

2008 National Healthcare Quality and Disparities Reports

The National Healthcare Quality Report (NHQR) is a comprehensive national overview of quality of health care in the United States. It is organized around four dimensions of quality of care: effectiveness, patient safety, timeliness, and patient centeredness.

Prevention of Heart Disease
Adults who received a blood pressure measurement in the last 2 years and can state whether their blood pressure was normal or high
Adults with hypertension with blood pressure <140/90 mm/Hg
Adults who received a blood cholesterol measurement in the last 5 years
Adult current smokers with a checkup in the last 12 months who received advice to quit smoking
Adults with obesity age 20 and over who were told by a doctor they were overweight
Adults with obesity who ever received advice from a health provider to exercise more
Adults with obesity who ever received advice from a health provider about eating fewer high-fat or high-cholesterol foods

Treatment of Heart Attack
Composite measure: Hospital patients with heart attack who received recommended hospital care (aspirin and beta blocker within 24 hours of admission, aspirin and beta blocker prescriptions at discharge, and smoking cessation counseling while hospitalized)
Hospital patients with heart attack who received aspirin within 24 hours of admission
Hospital patients with heart attack who were prescribed aspirin at discharge
Hospital patients with heart attack who received beta blocker within 24 hours of admission
Hospital patients with heart attack who were prescribed beta blocker at discharge
Hospital patients with heart attack and left ventricular systolic dysfunction who were prescribed ACE inhibitor or ARB at discharge
Smokers with heart attack who received smoking cessation counseling while hospitalized
Deaths per 1,000 adult hospital admissions with acute myocardial infarction (AMI)

Treatment of Heart Failure
Composite measure: Hospital patients with heart failure who received recommended hospital care (evaluation of left ventricular ejection fraction and ACE inhibitor or ARB prescription at discharge, if indicated, for left ventricular systolic dysfunction)
Hospital patients with heart failure who received an evaluation of left ventricular ejection fraction
Hospital patients with heart failure and left ventricular systolic dysfunction who were prescribed ACE inhibitor or ARB at discharge
Hospital admissions for congestive heart failure per 100,000 population
Deaths per 1,000 adult hospital admissions with congestive heart failure

Surgery for Heart Disease
Deaths per 1,000 adult hospital admissions with abdominal aortic aneurysm (AAA) repair
Deaths per 1,000 hospital admissions with coronary artery bypass surgery, age 40 and over
Deaths per 1,000 hospital admissions with percutaneous transluminal coronary angioplasty (PTCA), age 40 and over
 


Prevention of Heart Disease

Measure Title

Adults who received a blood pressure measurement in the last 2 years and can state whether their blood pressure was normal or high.

Measure Source

Healthy People 2010.

Table

Data table will not be presented this year.

Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health Interview Survey (NHIS).

Denominator

U.S. adult population age 18 and over.

Numerator

Number of adults age 18 and over who had their blood pressure measured within the preceding 2 years and can state their blood pressure level.

Top of Page


Prevention of Heart Disease

Measure Title

Adults with hypertension with blood pressure <140/90 mm/Hg.

Measure Source

Healthy People 2010.

Tables

4_1_2.1 Adults with hypertension whose blood pressure is under control, United States, 1999-2002 and 2003-2006.

Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health and Nutrition Examination Survey (NHANES).

Denominator

U.S. civilian noninstitutionalized adults age 18 and over either having elevated blood pressure (average systolic pressure of at least 140 mm Hg or average diastolic pressure of at least 90 mm Hg) or taking antihypertension medication.

Numerator

Subset of the denominator with average systolic blood pressure less than 140 mm Hg and average diastolic blood pressure less than 90 mm Hg based on average of three measurements and taking antihypertension medication.

Comments

Percentages are age adjusted to the 2000 standard population using three age groups: 18-39, 40-59, and 60 and over.

This measure is referred to as measure 12-10 in Healthy People 2010 documentation.

Top of Page


Prevention of Heart Disease

Measure Title

Adults who received a blood cholesterol measurement in the last 5 years.

Measure Source

Healthy People 2010.

State Tables

4_1_3.1 Adults who received a blood cholesterol measurement in the last 5 years, by State, 2001 and 2005.

State Data Source

Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

U.S. adult population age 18 and over.

State Numerator

Adults who have had their cholesterol checked within the last 5 years.

Comments

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5 of Tracking Healthy People 2010.

This measure is referred to as measure 12-15 in Healthy People 2010 documentation.

Top of Page


Prevention of Heart Disease

Measure Title

Adult current smokers with a checkup in the last 12 months who received advice to quit smoking.

Measure Source

Healthy People 2010.

National Tables

4_1_4.1 Adult current smokers with a checkup in the last 12 months who received advice to quit smoking, United States, 2002 and 2005.

4_1_4.2 Adult current smokers with a checkup in the last 12 months who received advice to quit smoking, United States, 2005, by:

  • Race.
  • Ethnicity.
  • Family income.
  • Education.

National Data Source

Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).

National Denominator

U.S. civilian adults with a positive Self-Administered Questionnaire (SAQ) weight who are current smokers, who had a routine checkup in the last 12 months, and who answered the question, “In the past 12 months, did a doctor advise you to stop smoking?” Nonresponses and “Don't know” responses were excluded.

National Numerator

Subset of the denominator population who indicated they had received advice to quit smoking.

State Tables

4_1_4.3 Adult current smokers who received advice to quit smoking, by State, 2001 and 2005.

State Data Source

Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

Adult current smokers age 18 and over with a physician visit in the past year.

State Numerator

Adult smokers who received advice to quit smoking.

Comments

The allowable responses to the MEPS question about smoking changed in 2003. Therefore, reported national rates may not be comparable with earlier years.

The national table reports data from the MEPS SAQ. See the MEPS entry in the Data Sources appendix for more information on the SAQ. Percentages in the State table are age adjusted to the 2000 standard population.

This measure is referred to as measure 1-3c in Healthy People 2010 documentation.

Nonresponses and “Don't know” responses to the SAQ question were excluded from the analysis.

Top of Page


Prevention of Heart Disease

Measure Title

Adults with obesity age 20 and over who were told by a doctor they were overweight.

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).

Tables

4_1_5.1 Adults with obesity age 20 and over who were told by a doctor they were overweight, United States, 1999-2002 and 2003-2006.

Data Source

CDC, NCHS, National Health and Nutrition Examination Survey (NHANES).

Denominator

Adults age 20 and over with a body mass index (BMI) of 30 or greater.

Numerator

Subset of the denominator who reported they were told by a doctor or health professional that they were overweight.

Comments

Estimates are age adjusted to the 2000 standard population using three age groups: 20-44, 44-64, and 65 and over for total, ethnicity, gender, and family income, and 25-44, 45-64, and 65 and over for education.

Top of Page


Prevention of Heart Disease

Measure Title

Adults with obesity who ever received advice from a health provider to exercise more.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).

Tables

4_1_6.1 Adults with obesity who ever received advice from a health provider to exercise more, United States, 2002 and 2005.

4_1_6.2 Adults with obesity who ever received advice from a health provider to exercise more, United States, 2005, by:

  • Race.
  • Ethnicity.
  • Family income.
  • Education.

Data Source

AHRQ, CFACT, MEPS.

Denominator

Adults age 18 and over with a body mass index (BMI) of 30 or greater.

Numerator

Subset of the denominator who reported they were given advice about exercise by a doctor or health professional.

Comments

BMI is based on reported height and weight.

Nonresponses and “Don't know” responses to the the Priority Conditions Section in Household Component, MEPS, question were excluded from the analysis.

This measure and its tables are also presented in other relevant sections of the National Healthcare Disparities Report.

Top of Page


Prevention of Heart Disease

Measure Title

Adults with obesity who ever received advice from a health provider about eating fewer high-fat or high-cholesterol foods.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).

Tables

4_1_7.1 Adults with obesity who ever received advice from a health provider about eating fewer high-fat or high-cholesterol foods, United States, 2002 and 2005.

4_1_7.2 Adults with obesity who ever received advice from a health provider about eating fewer high-fat or high-cholesterol foods, United States, 2005, by:

  • Race.
  • Ethnicity.
  • Family income.
  • Education.

Data Source

AHRQ, CFACT, MEPS.

Denominator

Adults age 18 and over with a body mass index (BMI) of 30 or greater.

Numerator

Subset of the denominator who reported they were advised by a doctor or health professional about restricting foods high in fat and cholesterol.

Comments

BMI is based on reported height and weight.

Nonresponses and “Don't know” responses to the Priority Conditions Section in Household Component, MEPS, question were excluded from the analysis.

Top of Page


Treatment of Heart Attack

Measure Title

Composite measure: Hospital patients with heart attack who received recommended hospital care (aspirin and beta blocker within 24 hours of admission, aspirin and beta blocker prescriptions at discharge, and smoking cessation counseling while hospitalized).

Measure Source

Centers for Medicare & Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

National Tables

4_2_1.1 Hospital patients with heart attack who received recommended hospital care, United States, 2005 and 2006.

National Data Source

CMS, Medicare Quality Improvement Organization (QIO) Program.

National Denominator

Discharged hospital patients with a principal diagnosis of acute myocardial infarction (AMI).

National Numerator

Subset of instances in which AMI denominator patients received recommended processes during the hospital stay: aspirin and beta blocker administered within 24 hours of admission, aspirin and beta blocker prescribed at discharge, and smoking cessation counseling given while patient was hospitalized.

State Tables

4_2_1.2 Hospital patients with heart attack who received recommended hospital care, by State, 2005 and 2006.

4_2_1.3 Hospital patients with heart attack who received recommended hospital care, by State, 2004 and 2007.

State Data Source

CMS, QIO.

CMS, Hospital Compare (HC).

State Denominator

Same as national.

State Numerator

Same as national.

Comments

International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for AMI include 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, and 410.91. The measure specifies exclusion of patients under age 18, patients transferred to another acute care or Federal hospital, patients transferred to hospice, patients who died, and patients who left against medical advice. Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

For State tables, recommended hospital care for AMI includes adminisering aspirin and beta blocker within 24 hours of hospital arrival and at discharge, giving a prescription of angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) at discharge to patients with left ventricular systolic dysfunction, and giving smoking cessation counseling to smoking patients. Data were downloaded from http://www.medicare.gov/Download/DownloadDB.asp in late April each year. Estimates were calculated using hospital-level scores.

Top of Page


Treatment of Heart Attack

Measure Title

Hospital patients with heart attack who received aspirin within 24 hours of admission.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

National Tables

4_2_2.1 Hospital patients with heart attack who received aspirin within 24 hours of admission, United States, 2005 and 2006.

National Data Source

CMS, Medicare Quality Improvement Organization (QIO) Program.

National Denominator

Discharged hospital patients with a principal diagnosis of acute myocardial infarction (AMI) without aspirin contraindication.

National Numerator

Subset of AMI denominator patients who received aspirin within 24 hours before or after hospital arrival.

State Tables

4_2_2.2 Hospital patients with heart attack who received aspirin within 24 hours of admission, by State, 2005 and 2006.

4_2_2.3 Hospital patients with heart attack who received aspirin within 24 hours of admission, by State, 2004 and 2007.

State Data Source

CMS, QIO.

CMS, Hospital Compare (HC).

State Denominator

Same as national.

State Numerator

Same as national.

Comments

International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for AMI include 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, and 410.91. The measure criteria exclude patients under age 18, patients transferred to another acute care or Federal hospital on day of arrival, transfers from other acute care hospitals, patients discharged, patients who died or left against medical advice on day of arrival, and patients with certain aspirin contraindications. Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

For State tables, data were downloaded from http://www.medicare.gov/Download/DownloadDB.asp in late April each year. Estimates were calculated using hospital-level scores.

Top of Page


Treatment of Heart Attack

Measure Title

Hospital patients with heart attack who were prescribed aspirin at discharge.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

National Tables

4_2_3.1 Hospital patients with heart attack who were prescribed aspirin at discharge, United States, 2005 and 2006.

National Data Source

CMS, Medicare Quality Improvement Organization (QIO) Program.

National Denominator

Discharged hospital patients with a principal diagnosis of acute myocardial infarction (AMI) without aspirin contraindication.

National Numerator

Subset of AMI denominator patients who were prescribed aspirin at hospital discharge.

State Tables

4_2_3.2 Hospital patients with heart attack who were prescribed aspirin at discharge, by State, 2005 and 2006.

4_2_3.3 Hospital patients with heart attack who were prescribed aspirin at discharge, by State, 2004 and 2007.

State Data Source

CMS, QIO.

CMS, Hospital Compare (HC).

State Denominator

Same as national.

State Numerator

Same as national.

Comments

International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for AMI include 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, and 410.91. The measure criteria exclude patients under age 18, patients transferred to another acute care or Federal hospital, patients who died, patients who left against medical advice, patients discharged to hospice, and patients with certain aspirin contraindications. Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

For State tables, data were downloaded from http://www.medicare.gov/Download/DownloadDB.asp in late April each year. Estimates were calculated using hospital-level scores.

Top of Page


Treatment of Heart Attack

Measure Title

Hospital patients with heart attack who received beta blocker within 24 hours of admission.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

National Tables

4_2_4.1 Hospital patients with heart attack who received beta blocker within 24 hours of admission, United States, 2005 and 2006.

National Data Source

CMS, Medicare Quality Improvement Organization (QIO) Program.

National Denominator

Discharged hospital patients with a principal diagnosis of acute myocardial infarction (AMI) without beta-blocker contraindication.

National Numerator

Subset of AMI denominator patients who received a beta blocker within 24 hours after hospital arrival.

State Tables

4_2_4.2 Hospital patients with heart attack who received beta blocker within 24 hours of admission, by State, 2005 and 2006.

4_2_4.3 Hospital patients with heart attack who received beta blocker within 24 hours of admission, by State, 2004 and 2007.

State Data Source

CMS, QIO.

CMS, Hospital Compare (HC).

State Denominator

Same as national.

State Numerator

Same as national.

Comments

International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for AMI include 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, and 410.91. The measure criteria exclude patients under age18, patients transferred to another acute care or Federal hospital, patients who died or were discharged to hospice, patients who left against medical advice, and patients with certain conditions or contraindications pertaining to beta blockers. Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

For State tables, data were downloaded from http://www.medicare.gov/Download/DownloadDB.asp in late April each year. Estimates were calculated using hospital-level scores.

Top of Page


Treatment of Heart Attack

Measure Title

Hospital patients with heart attack who were prescribed beta blocker at discharge.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

National Tables

4_2_5.1 Hospital patients with heart attack who were prescribed beta blocker at discharge, United States, 2005 and 2006.

National Data Source

CMS, Medicare Quality Improvement Organization (QIO) Program.

National Denominator

Discharged hospital patients with a principal diagnosis of acute myocardial infarction (AMI) without beta-blocker contraindication.

National Numerator

Subset of AMI denominator patients who were prescribed a beta blocker at hospital discharge.

State Tables

4_2_5.2 Hospital patients with heart attack who were prescribed beta blocker at discharge, by State, 2005 and 2006.

4_2_5.3 Hospital patients with heart attack who were prescribed beta blocker at discharge, by State, 2004 and 2007.

State Data Source

CMS, QIO.

CMS, Hospital Compare (HC).

State Denominator

Same as national.

State Numerator

Same as national.

Comments

International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for AMI include 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, and 410.91. Measure criteria exclude patients under age18, patients transferred to another acute care or Federal hospital, patients who died, patients who left against medical advice, patients discharged to hospice, and patients with certain beta-blocker contraindications. Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

For State tables, data were downloaded from http://www.medicare.gov/Download/DownloadDB.asp in late April each year. Estimates were calculated using hospital-level scores.

Top of Page


Treatment of Heart Attack

Measure Title

Hospital patients with heart attack and left ventricular systolic dysfunction who were prescribed ACE inhibitor or ARB at discharge.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

National Tables

4_2_6.1 Hospital patients with heart attack and left ventricular systolic dysfunction who were prescribed ACE inhibitor or ARB at discharge, United States, 2005 and 2006.

National Data Source

CMS, Medicare Quality Improvement Organization (QIO) Program.

National Denominator

Discharged hospital patients with a principal diagnosis of acute myocardial infarction (AMI) and documented left ventricular ejection fraction, without contraindication for angiotensin-converting enzyme (ACE) inhibitors or an angiotensin receptor blocker (ARB).

National Numerator

Subset of the denominator prescribed an ACE inhibitor or ARB medication at hospital discharge.

State Tables

4_2_6.2 Hospital patients with heart attack and left ventricular systolic dysfunction who were prescribed ACE inhibitor or ARB at discharge, by State, 2005 and 2006.

4_2_6.3 Hospital patients with heart attack and left ventricular systolic dysfunction who were prescribed ACE inhibitor or ARB at discharge, by State, 2004 and 2007.

State Data Source

CMS, QIO.

CMS, Hospital Compare (HC).

State Denominator

Discharged hospital patients with a principal diagnosis of acute myocardial infarction (AMI) and left ventricular ejection fraction, without contraindication for ACE inhibitors or an ARB.

State Numerator

Subset of the denominator prescribed ACE inhibitor or ARB medication at hospital discharge

Comments

Effective November 2004, CMS revised this measure to incorporate newly recognized treatment.

International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for AMI include 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, and 410.91. The measure criteria exclude patients under age18, patients transferred to another acute care or Federal hospital, patients who died, patients who left against medical advice, patients discharged to hospice, and patients with certain conditions or contraindications pertaining to the medications described in the measure. Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

For State tables, data were downloaded from http://www.medicare.gov/Download/DownloadDB.asp in late April each year. Estimates were calculated using hospital-level scores.

Top of Page


Treatment of Heart Attack

Measure Title

Smokers with heart attack who received smoking cessation counseling while hospitalized.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

National Tables

4_2_7.1 Smokers with heart attack who received smoking cessation counseling while hospitalized, United States, 2005 and 2006.

National Data Source

CMS, Medicare Quality Improvement Organization (QIO) Program.

National Denominator

Discharged hospital patients with a principal diagnosis of acute myocardial infarction (AMI) and a history of smoking cigarettes anytime during the year prior to hospital arrival.

National Numerator

Subset of AMI denominator patients who received smoking cessation advice or counseling during the hospital stay.

State Tables

4_2_7.2 Smokers with heart attack who received smoking cessation counseling while hospitalized, by State, 2005 and 2006.

4_2_7.3 Smokers with heart attack who received smoking cessation counseling while hospitalized, by State, 2004 and 2007.

State Data Source

CMS, QIO.

CMS, Hospital Compare (HC).

State Denominator

Same as national.

State Numerator

Same as national.

Comments

International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for AMI include 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, and 410.91. The measure specifies exclusion of patients under age 18, patients transferred to another acute care or Federal hospital, patients transferred to hospice, patients who died, and patients who left against medical advice. Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

For State tables, data were downloaded from http://www.medicare.gov/Download/DownloadDB.asp in late April each year. Estimates were calculated using hospital-level scores.

Top of Page


Treatment of Heart Attack

Measure Title

Deaths per 1,000 adult hospital admissions with acute myocardial infarction (AMI).

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Inpatient Quality Indicators (IQIs).

National Tables

4_2_8.1 Deaths per 1,000 adult hospital admissions with acute myocardial infarction (AMI) as principal diagnosis (excluding transfers to another hospital), United States, 2000 and 2005.

4_2_8.2 Deaths per 1,000 adult hospital admissions with acute myocardial infarction (AMI) as principal diagnosis (excluding transfers to another hospital), United States, 2005, by:

  • Race/ethnicity.

National Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS).

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

National Denominator

All hospital inpatient discharges age 18 and over with a principal diagnosis code of AMI (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, 410.91). Excludes patients transferring to another short-term hospital.

National Numerator

Number of deaths with a principal diagnosis code of AMI.

State Tables

4_2_8.3 Deaths per 1,000 adult hospital admissions with acute myocardial infarction (AMI) as principal diagnosis (excluding transfers to another hospital), by State, 2000 and 2005.

State Data Source

AHRQ, CDOM, HCUP, SID.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Rates are adjusted by age, gender, age-gender interactions, and All Patient Refined-Diagnosis Related Group (APR-DRG) risk of mortality score. When reporting is by age, the adjustment is by gender and APR-DRG risk of mortality score; when reporting is by gender, the adjustment is by age and APR-DRG risk of mortality score.

This table was created using version 3.1 of the AHRQ IQI software. This measure is referred to as IQI 15 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

The SID disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, VT, and WI.

This measure and its tables are also presented in other relevant sections of the National Healthcare Disparities Report.

Top of Page


Treatment of Heart Failure

Measure Title

Composite measure: Hospital patients with heart failure who received recommended hospital care (evaluation of left ventricular ejection fraction and ACE inhibitor or ARB prescription at discharge, if indicated, for left ventricular systolic dysfunction).

Measure Source

Centers for Medicare & Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

National Tables

4_3_1.1 Hospital patients with heart failure who received recommended hospital care (evaluation of left ventricular ejection fraction and ACE inhibitor or ARB prescription at discharge, if indicated, for left ventricular systolic dysfunction), United States, 2005 and 2006.

National Data Source

CMS, Medicare Quality Improvement Organizations Program (QIO).

National Denominator

Hospital patients discharged alive with a principal diagnosis of heart failure.

National Numerator

Subset of instances in which denominator heart failure patients received recommended processes during the hospital stay: evaluation of left ventricular ejection fraction and an angiotensin-converting enyzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) prescription at hospital discharge.

State Tables

4_3_1.2 Hospital patients with heart failure who received recommended hospital care (evaluation of left ventricular ejection fraction and ACE inhibitor or ARB prescription at discharge, if indicated, for left ventricular systolic dysfunction), by State, 2005 and 2006.

4_3_1.3 Hospital patients with heart failure who received recommended hospital care, by State, 2004 and 2007.

State Data Source

CMS, QIO.

CMS, Hospital Compare (HC).

State Denominator

Same as national.

State Numerator

Same as national.

Comments

International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for heart failure include 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 428.0, 428.1, 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, and 428.9.

Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

For State tables, recommended hospital care for heart failure includes evaluation of left ventricular ejection fraction and prescription of ACE inhibitor at discharge for patients with left ventricular systolic dysfunction. Data were downloaded from http://www.medicare.gov/Download/DownloadDB.asp in late April each year. Estimates were calculated using hospital-level scores.

Top of Page


Treatment of Heart Failure

Measure Title

Hospital patients with heart failure who received an evaluation of left ventricular ejection fraction.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

National Tables

4_3_2.1 Hospital patients with heart failure who received an evaluation of left ventricular ejection fraction, United States, 2005 and 2006.

National Data Source

CMS, Medicare Quality Improvement Organization (QIO) Program.

National Denominator

Hospital patients discharged alive with a principal diagnosis of heart failure.

National Numerator

Subset of heart failure patients with documentation in the hospital record that left ventricular ejection fraction was assessed before arrival or during hospitalization or was planned for after discharge.

State Tables

4_3_2.2 Hospital patients with heart failure who received an evaluation of left ventricular ejection fraction, by State, 2005 and 2006.

4_3_2.3 Hospital patients with heart failure who received an evaluation of left ventricular systolic function, by State, 2004 and 2007.

State Data Source

CMS, QIO.

CMS, Hospital Compare (HC).

State Denominator

Same as national.

State Numerator

Same as national.

Comments

International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for heart failure include 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 428.0, 428.1, 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, and 428.9.

Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

For State tables, data were downloaded from http://www.medicare.gov/Download/DownloadDB.asp in late April each year. Estimates were calculated using hospital-level scores.

Top of Page


Treatment of Heart Failure

Measure Title

Hospital patients with heart failure and left ventricular systolic dysfunction who were prescribed ACE inhibitor or ARB at discharge.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

National Tables

4_3_3.1 Hospital patients with heart failure and left ventricular systolic dysfunction who were prescribed ACE inhibitor or ARB at discharge, United States, 2005 and 2006.

National Data Source

CMS, Medicare Quality Improvement Organization (QIO) Program.

National Denominator

Hospital patients discharged alive with a principal diagnosis of heart failure, with documented left ventricular systolic dysfunction, and without contraindications for angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs).

National Numerator

Subset of the denominator prescribed an ACE inhibitor or ARB at hospital discharge.

State Tables

4_3_3.2 Hospital patients with heart failure and left ventricular systolic dysfunction who were prescribed ACE inhibitor or ARB at discharge, by State, 2005 and 2006.

4_3_3.3 Hospital patients with heart failure who were prescribed angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) for left ventricular systolic dysfunction (LVSD), by State, 2004 and 2007.

State Data Source

CMS, QIO.

CMS, Hospital Compare (HC).

State Denominator

Hospital patients discharged alive with a principal diagnosis of heart failure, with left ventricular systolic dysfunction, and without contraindications for ACE inhibitors or ARBs.

State Numerator

Subset of the denominator prescribed an ACE inhibitor or ARB at hospital discharge

Comments

Effective November 2004, CMS revised this measure to incorporate newly recognized treatment.

International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for heart failure include 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 428.0, 428.1, 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, and 428.9.

Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

For State tables, data were downloaded from http://www.medicare.gov/Download/DownloadDB.asp in late April each year. Estimates were calculated using hospital-level scores.

Top of Page


Treatment of Heart Failure

Measure Title

Hospital admissions for congestive heart failure per 100,000 population.

Measure Source

Healthy People 2010.

National Tables

4_3_4.1 Hospitalizations for congestive heart failure per 100,000 population, United States, 2006.

4_3_4.2 Hospitalizations for congestive heart failure per 100,000 population, United States, 2006, by:

  • Race.

National Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Hospital Discharge Survey (NHDS).

National Denominator

U.S. civilian population.

National Numerator

Number of discharges with a principal diagnosis of congestive heart failure (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 428.0).

State Tables

4_3_4.3 Adult hospital admissions for congestive heart failure (excluding patients with cardiac procedures, obstetric conditions, and transfers from other institutions) per 100,000 population, by State, 2000 and 2005.

State Data Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases (SID).

State Denominator

Civilian population, participating States.

State Numerator

Same as national.

Comments

Estimates of the civilian population, including institutionalized people, are from unpublished tabulations developed by the Population Division, U.S. Census Bureau, using estimates as of July 1 of the period of study, and are based on the 2000 census.

Data are age adjusted to the 2000 standard population using the age groups under 18 years, 18-44, 45-64, 65-74, and 75 years and over. Age-adjusted rates are weighted sums of age-specific rates. Race classification changed in 2000. Data for 2000 and later years may not be comparable with data from previous years.

This measure is referred to as measure 12-6 in Healthy People 2010 documentation. The age range has been modified from the original specification.

Top of Page


Treatment of Heart Failure

Measure Title

Deaths per 1,000 adult hospital admissions with congestive heart failure.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Inpatient Quality Indicators (IQIs).

National Tables

4_3_5.1 Deaths per 1,000 adult hospital admissions with congestive heart failure as principal diagnosis (excluding obstetric and neonatal adult hospital admissions and transfers to another hospital), United States, 2000 and 2005.

4_3_5.2 Deaths per 1,000 adult hospital admissions with congestive heart failure as principal diagnosis (excluding obstetric and neonatal adult hospital admissions and transfers to another hospital), United States, 2005, by:

  • Race/ethnicity.

National Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS).

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

National Denominator

All discharges with principal diagnosis code of congestive heart failure (CHF), age 18 and over (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 398.91, 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 428.0-428.9). Excludes patients transferring to another short-term hospital and obstetric and neonatal admissions.

National Numerator

Number of deaths with a principal diagnosis code of CHF.

State Tables

4_3_5.3 Deaths per 1,000 adult hospital admissions with congestive heart failure as principal diagnosis (excluding obstetric and neonatal adult hospital admissions and transfers to another hospital), by State, 2000 and 2005.

State Data Source

AHRQ, CDOM, HCUP, SID.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Rates are adjusted by age, gender, age-gender interactions, and All Patient Refined-Diagnosis Related Group (APR-DRG) risk of mortality score. When reporting is by age, the adjustment is by gender and APR-DRG risk of mortality score; when reporting is by gender, the adjustment is by age and APR-DRG risk of mortality score.

This table was created using version 3.1 of the AHRQ IQI software. This measure is referred to as IQI 16 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

The SID disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, VT, and WI.

Top of Page


Surgery for Heart Disease

Measure Title

Deaths per 1,000 adult hospital admissions with abdominal aortic aneurysm (AAA) repair.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Inpatient Quality Indicators (IQIs).

National Tables

4_4_1.1 Deaths per 1,000 adult hospital admissions with abdominal aortic aneurysm (AAA) repair (excluding obstetric and neonatal admissions and transfers to another hospital), United States, 2000 and 2005.

4_4_1.2 Deaths per 1,000 adult hospital admissions with abdominal aortic aneurysm (AAA) repair (excluding obstetric and neonatal adult hospital admissions and transfers to another hospital), United States, 2005, by:

  • Race/ethnicity.

National Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS).

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

National Denominator

Hospital inpatient discharges with an AAA repair procedure (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 38.34, 38.44, 38.64, 39.71) in any procedure field and a diagnosis code of AAA (ICD-9-CM 44.13, 44.14) in any field, excluding patients transferring to another short-term hospital and obstetric and neonatal admissions.

National Numerator

Number of deaths with an AAA repair surgery in any procedure field.

State Tables

4_4_1.3 Deaths per 1,000 adult hospital admissions with abdominal aortic aneurysm (AAA) repair (excluding obstetric and neonatal admissions and transfers to another hospital), by State, 2000 and 2005.

State Data Source

AHRQ, CDOM, HCUP, SID.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Rates are adjusted by age, gender, age-gender interactions, and All Patient Refined-Diagnosis Related Group (APR-DRG) risk of mortality score. When reporting is by age, the adjustment is by gender and APR-DRG risk of mortality score; when reporting is by gender, the adjustment is by age and APR-DRG risk of mortality score.

This table was created using version 3.1 of the AHRQ IQI software. This measure is referred to as IQI 11 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

The SID disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, VT, and WI.

Top of Page


Surgery for Heart Disease

Measure Title

Deaths per 1,000 hospital admissions with coronary artery bypass surgery, age 40 and over.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Inpatient Quality Indicators (IQIs).

National Tables

4_4_2.1 Deaths per 1,000 hospital admissions age 40 and over with coronary artery bypass graft (excluding obstetric and neonatal admissions and transfers to another hospital), United States, 2000 and 2005.

4_4_2.2 Deaths per 1,000 hospital admissions age 40 and over with coronary artery bypass graft (excluding obstetric and neonatal admissions and transfers to another hospital), United States, 2005, by:

  • Race/ethnicity.

National Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS).

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

National Denominator

Hospital inpatient discharges, age 40 and over, with a coronary artery bypass graft (CABG) (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 36.10-36.19) in any procedure field. Excludes patients transferring to another short-term hospital and obstetric and neonatal admissions.

National Numerator

Number of deaths with a code of CABG in any procedure field.

State Tables

4_4_2.3 Deaths per 1,000 hospital admissions age 40 and over with coronary artery bypass graft (excluding obstetric and neonatal admissions and transfers to another hospital), by State, 2000 and 2005.

State Data Source

AHRQ, CDOM, HCUP, SID.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Rates are adjusted by age, gender, age-gender interactions, and All Patient Refined-Diagnosis Related Group (APR-DRG) risk of mortality score. When reporting is by age, the adjustment is by gender and APR-DRG risk of mortality score; when reporting is by gender, the adjustment is by age and APR-DRG risk of mortality score.

This table was created using version 3.1 of the AHRQ IQI software. This measure is referred to as IQI 12 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

The SID disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, VT, and WI.

Top of Page


Surgery for Heart Disease

Measure Title

Deaths per 1,000 hospital admissions with percutaneous transluminal coronary angioplasty (PTCA), age 40 and over.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Inpatient Quality Indicators (IQIs).

National Tables

4_4_3.1 Deaths per 1,000 hospital admissions age 40 and over with percutaneous transluminal coronary angioplasties (excluding obstetric and neonatal admissions and transfers to another hospital), United States, 2000 and 2005.

4_4_3.2 Deaths per 1,000 hospital admissions age 40 and over with percutaneous transluminal coronary angioplasties (excluding obstetric and neonatal admissions and transfers to another hospital), United States, 2005, by:

  • Race/ethnicity.

National Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS).

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

National Denominator

Hospital inpatient discharges, age 40 and over, with percutaneous transluminal coronary angioplasties (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 00.66, 36.01, 36.02, 36.05) in any procedure field, excluding obstetric and neonatal admissions and transfers to another hospital.

National Numerator

Number of deaths with a code of PTCA in any procedure field.

State Tables

4_4_3.3 Deaths per 1,000 hospital admissions age 40 and over with percutaneous transluminal coronary angioplasties (excluding obstetric and neonatal admissions and transfers to another hospital), by State, 2000 and 2005.

State Data Source

AHRQ, CDOM, HCUP, SID.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Rates are adjusted by age, gender, age-gender interactions, and All Patient Refined-Diagnosis Related Group (APR-DRG) risk of mortality score. When reporting is by age, the adjustment is by gender and APR-DRG risk of mortality score; when reporting is by gender, the adjustment is by age and APR-DRG risk of mortality score.

This table was created using version 3.1 of the AHRQ IQI software. This measure is referred to as IQI 30 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

The SID disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, VT, and WI.

Return to Measure Specifications

Current as of September 2009
Internet Citation: Effectiveness of Care: Heart Disease: 2008 National Healthcare Quality and Disparities Reports. September 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr08/measurespec/heart_disease.html