STEMI timing and possible exclusion

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    • Type: Hosp Outpt eCQMs - Hospital Outpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • 917 301 5340
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      Thank you for your inquiry regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). The measure captures three potential numerators for patients that arrive to the ED with a STEMI diagnoses: fibrinolytic therapy within 30 minutes, percutaneous coronary intervention (PCI) procedure within 90 minutes, or discharge to acute care facility within 45 minutes.

      We agree that it is appropriate for physicians to document STEMI since the presence/absence of symptoms as well time from symptom onset will guide the care pathway. The 2025 ACC/AHA/ACEP/NAEMSP/SCAI guidelines describe various scenarios as evidence is continuing to evolve in this population of late presentation STEMI. The guidelines note that coronary revascularization should be considered for patients with late presentations with continued signs and symptoms of ischemia. In stable, asymptomatic patients with an occluded artery >48 hours from symptom onset, those patients would likely benefit from expedited evaluation. If the decision is made to medically mange patients, they will likely fit under the third numerator (transfer to acute care).
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      Thank you for your inquiry regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). The measure captures three potential numerators for patients that arrive to the ED with a STEMI diagnoses: fibrinolytic therapy within 30 minutes, percutaneous coronary intervention (PCI) procedure within 90 minutes, or discharge to acute care facility within 45 minutes. We agree that it is appropriate for physicians to document STEMI since the presence/absence of symptoms as well time from symptom onset will guide the care pathway. The 2025 ACC/AHA/ACEP/NAEMSP/SCAI guidelines describe various scenarios as evidence is continuing to evolve in this population of late presentation STEMI. The guidelines note that coronary revascularization should be considered for patients with late presentations with continued signs and symptoms of ischemia. In stable, asymptomatic patients with an occluded artery >48 hours from symptom onset, those patients would likely benefit from expedited evaluation. If the decision is made to medically mange patients, they will likely fit under the third numerator (transfer to acute care).
    • CMS0996v5
    • CMS0996v4
    • It appears we are not appropriately treating patients regarding prompt door to balloon time.

      Hello, Please supply guidance regarding the following scenario: When patients come into the ED with a STEMi, that started a few days prior and ST elevations are present but Troponins are trending down, this is not necessarily a case for emergent PCI or fibrinolytics. What type of exclusion is available for this case, which is relatively common? When we work through the differential, physicians enter STEMI code into the ED record and then these cases enter the denominator. This causes us to look as though we are not appropriately treating patients when according to NYS, we excel in the area of prompt door to balloon time. Is there something we are not understanding or overlooking in this measure? We do not want the physicians to NOT document their thought process, and we feel it is appropriate for them to enter a STEMI diagnosis in the system even if is not an acute evolving STEMI. Also, we do not have the ability in our current certified module to include final coded dxs because they are missing the time stamp and cannot be attributed to the ED part of the encounter. Is there a solution that you can suggest? Maybe that you have encountered with other Organizations? 

            Assignee:
            Augustine Weber
            Reporter:
            Susan Maillis (Inactive)
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