Numerator Patients with AMI with LVSD (defined as chart documentation of a LVEF <40% or a narrative description of LVSF consistent with moderate or severe systolic dysfunction) who are prescribed an ACEI or ARB* at hospital discharge *Fixed dose combination medications that contain ACEI or ARB therapy fulfill the numerator criteria if prescribed (eg, the ARNI, sacubitril/valsartan, contains the ARB valsartan and would fulfill the measure criteria if prescribed). Denominator All AMI patients with LVSD Denominator Exclusions Patients age <18 y Patients who leave against medical advice Patients who die during hospitalization Patients who are on comfort care measures only or hospice Patients who are transferred to another hospital for inpatient care Denominator Exceptions Documentation of medical reasons for not prescribing an ACEI and not prescribing an ARB at discharge (eg, allergy or intolerance to ACEI and ARB including: angioedema, hyperkalemia, hypotension, renal artery stenosis, worsening renal function) 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 ACEIs improve survival in patients with AMI, particularly in those with reduced LVEF. They attenuate LV remodeling and infarct expansion and have a variety of additional beneficial effects (effects on ischemic preconditioning, fibrinolysis, recurrent MI, sudden death). The SAVE (Survival and Ventricular Enlargement) trial demonstrated the benefits of captopril in reducing mortality, recurrent MI and HF hospitalization in AMI patients with an LVEF <40%, but without overt HF on entry.59 Other studies showed comparable findings.60,61 ARBs are reasonable alternatives to ACEIs in patients with AMI and LVSD and can be used for patients who are intolerant to ACEIs. 