OBJECTIVES:Evaluate the quality of care provided patients with acute myocardial infarction and compare with similar national and regional data.DESIGN:Case series.SETTING:The Strong Heart Study has extensive population-based data related to cardiovascular events among American Indians living in three rural regions of the United States.PARTICIPANTS:Acute myocardial infarction cases (72) occurring between 1/1/2001 and 12/31/2006 were identified from a cohort of 4549 participants.OUTCOME MEASURES:The proportion of cases that were provided standard quality of care therapy, as defined by the Healthcare Financing Administration and other national organizations.RESULTS:The provision of quality services, such as administration of aspirin on admission and at discharge, reperfusion therapy within 24 hours, prescription of beta blocker medication at discharge, and smoking cessation counseling were found to be 94%, 91%, 92%, 86% and 71%, respectively. The unadjusted, 30 day mortality rate was 17%.CONCLUSION:Despite considerable challenges posed by geographic isolation and small facilities, process measures of the quality of acute myocardial infarction care for participants in this American Indian cohort were comparable to that reported for Medicare beneficiaries nationally and within the resident states of this cohort.

Differences in utilization of health care services and the quality of those services between geographic regions of the United States exist. Public policy, guidelines, and health care organizations have attempted to address these differences. In 1992 the Healthcare Financing Administration, now the Center for Medicare/Medicaid Services (CMS), initiated the Cooperative Cardiovascular Project with the goal of improving the quality of care for acute myocardial infarction (AMI) nationally. Standards were developed for the evaluation of quality care based on the guidelines of the American College of Cardiology and the American Heart Association. The initial results from this national survey of AMI quality care was presented in 1998 and a follow-up survey reported in 2003. National performance since 1999 has been evaluated primarily on the basis of data from voluntary reporting systems, such as the National Registry of Myocardial Infarction, The National Cardiovascular Data Registry, the CMS and Hospital Quality Alliance Program (begun in 2004), and the American Heart Association’s Get With The Guidelines coronary artery disease program. There have been efforts to use these programs and quality measures to determine the role they play in the known cardiovascular disease disparities among minority populations. Cardiovascular disease accounts for a large proportion of morbidity and mortality among American Indians. Yet, studies of cardiovascular disease quality of care among American Indians are limited. The Strong Heart Study is a longitudinal cohort study of cardiovascular disease and its risk factors in American Indians. It is the longest-running population-based cohort study among American Indians with centers in three primarily rural geographic regions in the United States. It has rich demographic and clinical data including physician adjudicated cardiovascular events. In this study, we describe AMI quality care measures from the Strong Heart Study and then compare them to previously published studies from CMS.