{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T15:16:56Z","timestamp":1781968616383,"version":"3.54.5"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Despite improvements on individual process of care measures for acute myocardial infarction (AMI), little is known about performance on a composite measure of AMI care that assesses the delivery of many components of high-quality AMI care. We sought to examine trends in patient- and hospital-level performance on a composite defect-free care measure, identify disparities in the performance across sociodemographic groups, and identify opportunities to further improve quality and outcomes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p>\n              We calculated the proportion of patients in the National Cardiovascular Data Registry\u2013Acute Coronary Treatment and Intervention Outcomes Network Registry\u2013Get With The Guidelines (now known as the Chest Pain - Myocardial Infarction Registry) between January 1, 2010, and December 31, 2017, receiving defect-free AMI care including guideline-recommended pharmacotherapy, timely provision of medical and reperfusion therapy, assessment of ventricular function, referral to cardiac rehabilitation, and smoking cessation counseling for patients with AMI. A total of 522\u2009800 patients at 222 hospitals were included. Overall, the proportion of patients receiving defect-free care significantly increased from 66.0% in 2010 to 77.1% in 2017 (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Improvements in performance were observed across all sociodemographic subgroups, with the greatest absolute improvement observed for black and Hispanic patients (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). However, absolute performance was consistently lower among older patients, women, black and Hispanic patients, and those with government insurance in 2017 (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001 for all). Improvements in care and reduced variation in performance were observed at the hospital level overall (2010, median [IQR] 67.2% [40.7%\u201376.3%]; 2017, median [IQR] 80.7% [73.1%\u201388.1%];\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) as well as across region, safety net status, teaching status, and proportion of patients who are nonwhite and have Medicaid insurance coverage (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001 for all).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Despite improvements in the proportion of patients with AMI receiving defect-free care overall and across sociodemographic groups, nearly 1 in 4 patients in 2017 still did not receive optimal care and absolute performance was consistently lower among older patients, women, black, and Hispanic patients. Composite measures of cardiovascular care, which assess the delivery of several evidence-based processes of care, can illuminate opportunities to improve the quality of care beyond that provided by conventional process measures.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.118.004983","type":"journal-article","created":{"date-parts":[[2019,3,15]],"date-time":"2019-03-15T09:01:05Z","timestamp":1552640465000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":26,"title":["Trends in Performance and Opportunities for Improvement on a Composite Measure of Acute Myocardial Infarction Care"],"prefix":"10.1161","volume":"12","author":[{"given":"Nihar R.","family":"Desai","sequence":"first","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., T.A., A.A., K.E.M., H.M.K., J.P.C.)."},{"name":"Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., A.A., K.E.M., H.M.K., J.P.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob A.","family":"Udell","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Women\u2019s College Hospital, Toronto General Hospital, University of Toronto, Ontario, Canada (J.A.U.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongfei","family":"Wang","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., T.A., A.A., K.E.M., H.M.K., J.P.C.)."},{"name":"Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., A.A., K.E.M., H.M.K., J.P.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica S.","family":"Spatz","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., T.A., A.A., K.E.M., H.M.K., J.P.C.)."},{"name":"Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., A.A., K.E.M., H.M.K., J.P.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kumar","family":"Dharmarajan","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., T.A., A.A., K.E.M., H.M.K., J.P.C.)."},{"name":"Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., A.A., K.E.M., H.M.K., J.P.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tariq","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., T.A., A.A., K.E.M., H.M.K., J.P.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard M.","family":"Julien","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA (H.M.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amarnath","family":"Annapureddy","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., T.A., A.A., K.E.M., H.M.K., J.P.C.)."},{"name":"Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., A.A., K.E.M., H.M.K., J.P.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhinav","family":"Goyal","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James A.","family":"de Lemos","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX (J.D.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederick A.","family":"Masoudi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; Colorado Cardiovascular Outcomes Research Consortium, Denver, CO (F.A.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepak L.","family":"Bhatt","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital Heart &amp; Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl E.","family":"Minges","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., T.A., A.A., K.E.M., H.M.K., J.P.C.)."},{"name":"Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., A.A., K.E.M., H.M.K., J.P.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harlan M.","family":"Krumholz","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., T.A., A.A., K.E.M., H.M.K., J.P.C.)."},{"name":"Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., A.A., K.E.M., H.M.K., J.P.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeptha P.","family":"Curtis","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., T.A., A.A., K.E.M., H.M.K., J.P.C.)."},{"name":"Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., A.A., K.E.M., H.M.K., J.P.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.05.008"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp078102"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2008.07.028"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.292.13.1563"},{"key":"e_1_3_4_6_2","first-page":"317","article-title":"Racial and ethnic disparities in cardiac catheterization for acute myocardial infarction in the United States, 1995\u20132001.","volume":"97","author":"Bertoni AG","year":"2005","unstructured":"Bertoni, AG, Goonan, KL, Bonds, DE, Whitt, MC, Goff, DC, Jr, Brancati, FL. 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