Continued 38 Short Title: QM-5: Inappropriate In-Hospital Use of NSAIDs QM-5: AMI: Inappropriate In-Hospital Use of NSAIDs Measure Description: Percentage of patients, age 18 y, hospitalized with AMI who are inappropriately prescribed NSAIDs during hospitalization. Numerator Patients with AMI who were prescribed NSAIDs (with the exception of aspirin) in the hospital For purposes of this measure, a noninclusive list of NSAIDs include these medications: Ibuprofen Ketoprofen Sulindac Naproxen Etodolac Fenoprofen Diclofenac Flurbiprofen Ketorolac Piroxicam Indomethacin Mefenamic Acid Meloxicam Celecoxib Nabumetone Oxaprozin Ketoprofen Meclofenamate Tolmeti Salsalate Denominator All patients with AMI Denominator Exclusions Patients age <18 y Denominator Exceptions Documentation of a medical reason for prescribing NSAIDs during the AMI hospitalization (eg, patient with refractory arthritis pain that is unresponsive to other analgesics) Measurement Period Encounter Sources of Data Medical record or other database (eg, administrative, clinical, registry). Attribution Measure reportable at the facility or provider level Care Setting Inpatient Rationale NSAIDs likely increase the risk of major adverse events in patients with myocardial infarction (eg, impaired infarct healing, possibly increased risk of rupture following transmural infarction, higher risk of accompanying acute kidney injury, and increased risk of gastrointestinal bleeding in at-risk AMI patients who are already receiving antithrombotic therapies).195,196 Clinical Recommendation(s) 2013 ACCF/AHA Guideline for the Management of Patients With ST-Elevation Myocardial Infarction12 1. Glucocorticoids and nonsteroidal anti-inflammatory drugs are potentially harmful for treatment of pericarditis after STEMI.197,198 (Class III, Level of Evidence: B) 2014 AHA/ACC Guideline for the Management of Patients With Non ST-Elevation Acute Coronary Syndromes11 1. 