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ACE inhibitor therapy for patients with myocardial infarction
Purpose:
To help reduce the level of risk to health for NHS patients with myocardial infarction (MI) and ensure high
standards of primary health care and treatment delivered to them.
A number of trials have shown reduced mortality following MI with the use of ACE inhibitors that are also of benefit
in reducing adverse coronary events and progression of coronary arteriosclerosis without left ventricular systolic
dysfunction. There is evidence that angiotensin II antagonists have a similar effect.
Definition of indicator and its variants:
Proportion of patients with a history of MI who are treated with an ACE inhibitor or angiotensin II antagonist, unless
contraindications or side-effects are recorded.
Statistic
Sex
Age
group
Organisation
(see glossary)
Number and percent of
patients
P
All Ages
E, GOR, SHA,
PCO
Period
Current
data
FY 2009/10
File_worksheet Name
Trend data
09O_607PC_10_V1
Numerator:
Numerator data - Patients with a history of MI diagnosed after 1st April 2003 who are currently (measured as a
prescription within the 6 months before the reference date) treated with an ACE inhibitor or angiotensin II
antagonist, unless contraindications or side-effects are recorded.
Source of numerator data - Quality and Outcomes Framework (QOF).
Comments on numerator data - The data for this primary care indicator are derived from the Quality Management
Analysis System (QMAS) and supplied by the Prescribing Support Unit at The NHS Information Centre for health
and social care. The QOF is part of the General Medical Services (GMS) contract, with a focus on prevalence and
management of common chronic diseases at general practice level. It is aimed at measuring the achievement of
general practices against a set of evidence based negotiated standards and encouraging good practice.
The data to support the clinical quality indicators (i.e. clinical achievement data) are extracted from individual GP
practice clinical systems and sent automatically to QMAS once a month. Practices can make additional
submissions of clinical data at any time.
The ‘reference date’ is the specified date of patient records held by the general practice modelled for the end of the
st
QOF year (midnight 31 March). It is the same for the data from all practices and may differ from the date of data
submission.
Denominator:
Denominator data - All patients dignosed with MI excluding those who have been exception reported. Patients may
be exception reported for the following reasons:
st
•
MI diagnosis recorded before 1 April 2003;
•
registered in the three months before the reference date;
•
CHD exception reported in the 15 months before the reference date;
•
MI diagnosis recorded in the three months before the reference date;
•
persistent and expiring ACE inhibitor contraindications recorded;
•
persistent and expiring A2 antagonist contraindications recorded.
For more details regarding the description of the selection criteria and dataset rules of the relevant indicator set
see the following documentation available at: http://www.wmrlmc.co.uk/gms2/informationtechnology.htm
Source of denominator data - See “Numerator data”.
Comments on denominator data - The denominator is a count of patients for whom the clinical indicator should be
met. However, the selection rules do not provide the same opportunity for all patients included in the denominator
to take advantage of the full period (maximum number of months after the diagnosis) allowed by good practice for
the test, measurement or treatment to be undertaken (e.g. if good practice for angina patients allows for a
particular test to be conducted up to 12 months after diagnosis then patients diagnosed between four and 11
months before the reference date do not have the full period of 12 months for the test). Additionally, patients can
be removed from the denominator through the application of exception reporting.
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