Therefore, in the absence of contraindications, post-MI patients with HF may benefit from adding an aldosterone antagonist to an ACE inhibitor or ARB, and a beta blocker. Monitoring of patients renal function, electrolytes (screening for hyperkalemia, in particular), and blood pressure should be undertaken.11,12,29 Clinical Recommendation(s) 2013 ACCF/AHA Guideline for the Management of Patients With ST-Elevation Myocardial Infarction12 1. An aldosterone antagonist should be given to patients with STEMI and no contraindications who are already receiving an ACE inhibitor and beta blocker and who have an EF less than or equal to 0.40 and either symptomatic HF or diabetes mellitus.29 (Class I, Level of Evidence: B) 2014 AHA/ACC Guideline for the Management of Patients with Non ST-Elevation Acute Coronary Syndromes11 1. Aldosterone blockade is recommended in post MI patients without significant renal dysfunction (creatinine >2.5 mg/dL in men or >2.0 mg/dL in women) or hyperkalemia (K +>5.0 mEq/L) who are receiving therapeutic doses of ACE inhibitor and beta blocker and have a LVEF 0.40 or less, diabetes mellitus, (Class I, Level of Evidence: A) ACC indicates American College of Cardiology; ACCF, American College of Cardiology Founcation; ACE, angiotensin-converting enzyme; AHA, American Heart Association; AMI, acute myocardial infarction; ARB, angiotensin receptor blockers; Cr, creatinine; EF, ejection fraction; K, potassium; HF, heart failure; LVEF, left ventricular ejection fraction; MI, myocardial infarction; and STEMI, ST-elevation myocardial infarction. Appendix A. 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. 