that middle-aged adults should receive
a flu vaccine. However, the authors
note that the interpretation of vaccine
effectiveness is complex and the vaccination may not be equally protective
against AMI the entire year. Four of
the six studies they examined on vaccinations were performed during the
flu season. Additionally, the effectiveness of the annual flu vaccine varies
depending on the circulating strain.
The timing of the vaccine is also important. The vaccine must be administered prior to the AMI event for it to
be a valid predictor of AMI risk.
The authors stress that physicians should be aware of the need
to offer flu vaccinations to patients
with cardiovascular disease, and that
McNamara and
colleagues add
that their
methodology
reflects accepted
standards for
publicly reported
outcome measures.
cardiologists should consider offering vaccination following an AMI,
prior to hospital discharge or during
cardiac rehabilitation or follow-up.
Additionally, cost-effectiveness studies
are needed to compare the flu vaccine
and primary and secondary prevention for AMI in order to further
inform preventative policy.
Barnes M, Heywood AE, Mahimbo A, et al.
Heart. 2015;0:1-10.
ACC.org/CSWN
Researchers
Develop First
Outcome Measures
for EHRs
A study recently published in Medical Care maps out the first outcome
measure to use with electronic health
records (EHRs), measuring 30-day
mortality after acute myocardial infarction (AMI).
Currently, the Centers for Medicare
and Medicaid Services (CMS) publicly
reported hospital outcome measures
use claims data for risk adjustment,
which many clinicians have expressed
concerns with. With the support of
CMS, Robert L. McNamara MD,
MHS, and colleagues developed an
eMeasure of hospital 30-day all-cause
risk-standardized mortality for patients
with AMI. Their goal was to create an
outcome measure that would be suitable for national public reporting by
using data elements that are routinely
collected in current practice, captured
in standards formats and feasibly
retrieved from current EHR systems.
The developed eMeasure was recently
endorsed by the National Quality
Forum (NQF).
Researchers used data from the
ACC/American Heart Association
Action Registry Get With the Guidelines, which captures information
about AMI patients at 450 hospitals
nationwide. They matched admissions for AMI in the registry that were
discharged between Jan. 1 and Dec.
31, 2009, with admissions for AMI
from CMS Medicare Part A discharged
during the same time period. The researchers also derived a cohort for the
validation in a similar fashion based
on the claims between Jan. 1 and Dec.
31, 2010. They then calculated the
hospital-specific risk-standardization
mortality rate at the ratio of predicted
number of death to expected number
of deaths, multiplied by the nation
adjusted mortality rate. Then,