Improving Care for AMI Patients
Guidelines for CIHI Discharge Abstract Database Project 224
Goal: Prevent deaths among patients hospitalized for acute myocardial infarction (AMI)
by ensuring the reliable delivery of evidence-based care.
Discussion: Studies have shown that patients with AMI should receive specified
components of care in order to reduce morbidity and mortality. The total number and
type of care components a patient receives during the hospital course and postdischarge may vary based on clinical condition and other co-morbidities. The American
College of Cardiology/American Heart Association have identified several important
components which hospitals may wish to track through this project field. Those that
have been endorsed by Safer Healthcare Now! are asterisked below.
Inclusion: The data elements included in Project 224 are specifically applicable to AMI
patients with an ICD-10-CA Most Responsible Diagnosis (MRDx) of I21.0 – I21.9.
Some facilities may wish to apply these guidelines to a broader group of cardiac patients
(those with acute coronary syndrome – ACS). The components of care are organized
by the following categories:
Section 1: Early interventions
 Early aspirin**
 Timely thrombolysis**
 Timely Percutaneous Cardiac Intervention (PCI)**
Section 2: Medications at discharge:
 Aspirin**
 Beta blockers**
 ACE inhibitors/ARB**
 Cholesterol lowering agent
 Clodpidogrel
 Nitroglycerin
 Other medication - defined by facility
Section 3: Other interventions
 Smoking cessation**
 Dietary advice
 Exercise advice
 Patient education
 Follow-up care
Data collection notes
Many facilities have developed forms, completed by clinical staff, to provide coders with
clear guidance on whether the criteria for the following data elements have been met. If
documentation is not found that this care was either provided or contraindicated,
the measure should be considered as not being met.
Concurrent data collection has been used by some hospitals to collect data while
patients are still in the hospital. Clinical staff complete a small number of data elements,
such as those found on the sample form below. Note that this form includes only those
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data required for the Safer Healthcare Now! measures. The information on this form
could be adapted for your facility, as appropriate.
Sample Form – Safer Healthcare Now! Data Elements
This patient has had an acute myocardial infarction (AMI) or heart attack 
This patient had an ST elevation or LBBB on ECG

Early measures
This patient received the following care during the specified time frames after arrival at the
hospital:
For ST elevation MI patients only
Thrombolysis within 30 minutes
PCI within 90 minutes
 yes
For all AMI patients
Aspirin within 24 hours
 yes
no
 contraindicated
no
 contraindicated
no
 contraindicated
 yes
Medications at discharge
This patient has been prescribed the following medications (or counseled to continue this
medication if taking pre-arrival)
Aspirin
ACE inhibitor/ARB
Beta Blocker
 yes
 yes
 yes
Smoking cessation
This patient has been counseled to stop smoking
AND/OR has been offered nicotine replacement
AND/OR has been referred to cardiac rehabilitation
no
no
no
 yes
 contraindicated
 contraindicated
 contraindicated
no
 not a smoker
Some hospitals have developed a “discharge checklist” which includes data elements in
the Improved Care for AMI bundle. This checklist is completed by nursing staff prior to
discharging the patient from hospital. Other hospitals have identified AMI patients in the
emergency department. As soon as the patient is diagnosed or identified as possible
AMI, a data collection sheet is placed on the record. Throughout the course of the
hospital stay, hospital staff check for the interventions and document each as it is either
completed or identified as contraindicated. The data collection sheet remains in the
medical record after discharge, and provides the documentation required by coders.
Note that clinical staff have considerable guidance in how to complete this
documentation, through the “Getting Started Kit: Improved Care for AMI How –to Guide”
available on the Safer Healthcare Now! website (www.saferhealthcarenow.ca).
Field 18: Project number.
Field Length
Field Status
Valid Data
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Specifications
3 character
Optional in all P/T
224
2
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

The number 224 is assigned by CIHI to identify the Improving Care for AMI
Patients Project. Project 224 must not be used for other projects.
Project 224 can only be coded once per abstract.
If more than 5 special projects reported in an abstract, Project 224 should be
reported in the first 5 lines.
Section 1: Early interventions
Field 1: Early administration of aspirin
Specifications
Field Length
1 character
Field Status
Optional
Valid Data
Y Yes
N No
C Contraindicated
X This data element not collected
This element identifies cardiac patients who received aspirin within 24 hours before or
after hospital arrival
 Code Y (yes) if there is documentation in the chart that the patient was given
aspirin within 24 hours before or after hospital arrival
 Code N (no) if there is no documentation that the patient was administered
aspirin within the recommended time frame, and no contraindications for
administration of aspirin are provided
 Code C (contraindicated) if the patient was not administered aspirin, but a
contraindication is documented.
 Code X if your facility is not participating in data collection of this element.
Field 2: ST elevation or LBBB MI
Field Length
Field Status
Valid Data
Specifications
1 character
Optional
Y Yes – ST elevation or LBBB
N No – No ST elevation or LBBB
X This data element not collected
This data element identifies AMI patients who have a ST elevation or LBBB on ECG
closest to the hospital. Note that Fields 3 and 4 apply only to this subset of AMI patients.
Detailed rules are required to identify these patients (available through
www.saferhealthcarenow.ca). It is essential that identification of these patients come
from the interpretation in the chart – do NOT measure ST segments or attempt to
identify a LBBB on the ECG tracing.
Field 3: Timely Thrombolysis
Field Length
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Specifications
1 character
3
Field Status
Valid Data
Optional
Y Yes
N No
C Patient does not meet criteria for
this measure
X This data element not collected
This element identifies cardiac patients who received thrombolysis within an optimal time
frame. It is focused on the subset of patients with ST elevation or LBBB on ECG closest
to the hospital (Field 2 = Y) AND who received thrombolytic therapy within 6 hours of
arrival.
 Code Y (yes) if patient meets conditions and there is documentation in the chart
that the patient received thrombolytic therapy within 30 minutes of arrival.
 Code N (no) if patient meets conditions but the patient was administered
thrombolysis more than 30 minutes after arrival
 Code C (Patient does not meet criteria for this measure) if the patient does not
have ST elevation or LBBB, OR if patient did not receive thrombolysis within 6
hours of arrival.
 Code X if your facility is not participating in data collection of this element.
Field 4: Timely Percutaneous Coronary Intervention (PCI)
Specifications
Field Length
1 character
Field Status
Optional
Valid Data
Y Yes
N No
C Patient does not meet criteria for
this measure
X This data element not collected
This element identifies cardiac patients who received PCI within an optimal time frame.
It is focused on the subset of patients with a ST elevation or LBBB on ECG closest to the
hospital (Field 2 = Y) AND who had PCI performed within 24 hours of hospital arrival
AND who did not receive thrombolytic agent in the hospital.




Code Y (yes) if patient meets conditions above and there is documentation in the
chart that PCI was performed within 90 minutes of arrival.
Code N (no) if patient meets conditions, but the PCI was performed more than 90
minutes after arrival
Code C (Patient does not meet criteria for this measure) if the patient does not
have ST elevation or LBBB, OR if PCI was not performed within 24 hours OR if
the patient received thrombolysis in the hospital.
Code X if your facility is not participating in data collection of this element.
Section 2: Medications at Discharge
Field 5: Aspirin at discharge
Specifications
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Field Length
Field Status
Valid Data
1 character
Optional
Y Yes
N No
C Contraindicated
X This data element not collected
This element identifies cardiac patients who received aspirin at time of hospital
discharge.
 Code Y (yes) if there is documentation in the chart that the patient was
prescribed aspirin at hospital discharge.
 Code N (no) if there is no documentation that the patient was prescribed aspirin,
and no contraindications for administration of aspirin are provided
 Code C (contraindicated) if the patient was not administered aspirin, and a
contraindication is documented.
 Code X if your facility is not participating in data collection of this element.
Field 6: Beta Blocker at discharge
Field Length
Field Status
Valid Data
Specifications
1 character
Optional
Y Yes
N No
C Contraindicated
X This data element not collected
This data element identifies patients who are prescribed beta blockers at hospital
discharge.
 Code Y (yes) if there is documentation in the chart that the patient was given
beta blockers at hospital discharge.
 Code N (no) if there is no documentation that the patient was prescribed beta
blockers, and no contraindications for administration of beta blockers are
provided.
 Code C (contraindicated) if the patient was not administered beta blockers, but a
contraindications is documented.
 Code X if your facility is not currently participating in data collection of this
element.
Field 7 – ACEI or ARB at discharge
Specifications
Field Length
1 character
Field Status
Optional
Valid Data
Y Yes
N No
C Contraindicated
X This data element not collected
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This data element records patients with Left Ventricular Systolic Dysfunction (LVSD;
ICD-10-CA I51.8) who were prescribed for Angiotensin Converting Enzyme Inhibitor
(ACEI) or Angiotensin Receptor Blockers (ARB) at hospital discharge




Code Y (yes) if there is documentation in the chart that the patient was given
ACEI or ARB at time of discharge
Code N (no) if there is no documentation that the patient was prescribed
ACEI/ARB, and no contraindications are provided.
Code C (contraindicated) if the patient was not administered ACEI/ARB, but a
contraindication is documented.
Code X if your facility is not currently participating in data collection of this
element.
Field 8 – Cholesterol Lowering Agent
Specifications
Field Length
1 character
Field Status
Optional
Valid Data
Y Yes
N No
C Contraindicated
X This data element not collected
This element records patients who were prescribed a cholesterol lowering agent at
discharge.
 Code Y (yes) if there is documentation in the chart that the patient was given a
cholesterol lowering agent at time of discharge. Code N (no) if there is no
documentation that the patient was prescribed cholesterol lowering agent, and no
contraindications are provided.
 Code C (contraindicated) if the patient was not prescribed cholesterol lowering
agent, but a contraindication is documented.
 Code X if your facility is not currently participating in data collection of this
element
Field 9 – Clopidogrel (Plavix)
Field Length
Field Status
Valid Data
Specifications
1 character
Optional
Y Yes
N No
C Contraindicated
X This data element not collected
This element records patients who were prescribed clopidogrel at discharge.
 Code Y (yes) if there is documentation in the chart that the patient was given
clopidogrel at time of discharge.
 Code N (no) if there is no documentation that the patient was prescribed
clopidogrel, and no contraindications are provided.
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
Code C (contraindicated) if the patient was not prescribed clopidogrel, but a
contraindication is documented.
Code X if your facility is not currently participating in data collection of this
element
Field 10 – Nitroglycerin at discharge
Specifications
Field Length
1 character
Field Status
Optional
Valid Data
Y Yes
N No
C Contraindicated
X This data element not collected
This element records patients who were prescribed nitroglycerin at discharge.
 Code Y (yes) if there is documentation in the chart that the patient was given
nitroglycerin (in spray, pill or patch form) at time of discharge.
 Code N (no) if there is no documentation that the patient was prescribed
nitroglycerin, and no contraindications are provided.
 Code C (contraindicated) if the patient was not prescribed nitroglycerin, but a
contraindication is documented.
 Code X if your facility is not currently participating in data collection of this
element
Field 11 – Optional, For Facility Use
Specifications
Field Length
1 character
Field Status
Optional
Valid Data
Alphanumeric
Section 3: Non pharmacological therapy at discharge
Field 12: Smoking Cessation
Field Length
Field Status
Valid Data
Specifications
1 character
Optional
Y Yes
N No
C Contraindicated/not a smoker
X This data element not collected
This element records patients who have been provided with smoking cessation advice or
therapy. This may consist of provision of/referral to smoking cessation counseling,
pharmacological therapy, or referral to a cardiac rehabilitation program.
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


Code Y (yes) if there is documentation in the chart that the patient was provided
with smoking cessation counseling and/or therapy.
Code N (no) if the patient there is no documentation that the patient was
provided with smoking cessation counseling and/or therapy.
Code C (contraindicated) if there is documentation that the patient is a nonsmoker (defined as not having smoked within the past year)
Code X if your facility is not currently participating in data collection of this
element.
Field 13: Dietary advice
Field Length
Field Status
Valid Data
Specifications
1 character
Optional
Y Yes
N No
X This data element not collected
This element records patients who have been provided with dietary advice and
recommended a diet that is low in fat and cholesterol.
Field 14: Exercise advice
Field Length
Field Status
Valid Data
Specifications
2 character (right justified)
Optional
Y Yes
N No
X This data element not collected
This element records patients who have been provided with recommendations for
regular aerobic exercise, or referred to a cardiac rehabilitation program.
Field 15: Patient education
Field Length
Field Status
Valid Data
Specifications
2 character (right justified)
Optional
Y Yes
N No
X This data element not collected
This element records patients who have been provided with patient education. This
education should include information about lifestyle changes and drug therapies
important for secondary prevention of cardiovascular disease; recognizing symptoms of
a heart attack and calling 911 promptly.
Field 16: Follow-up care
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Field Length
Field Status
Valid Data
Specifications
3 characters (right justified)
Optional
Y Yes
N No
X This data element not collected
This element records whether a post-discharge appointment has been booked with a
physician. This appointment could be with either a general practitioner/family physician
or specialist physician.
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