Continued 31 Short Title: PM-15: Stress Test in Conservatively Treated Patients PM-15: AMI: Non-Invasive Stress Testing Before Discharge in Conservatively Treated Patients Measure Description: Percentage of patients, age 18 y, hospitalized with AMI, who are initially conservatively managed (have not received invasive coronary angiography) and with documentation in the hospital record that a noninvasive stress testing was performed before discharge. Numerator Patients with AMI who are initially conservatively managed and who received a noninvasive stress test prior to discharge Denominator All patients with AMI who are initially treated with a conservative management strategy (medical therapies alone without invasive coronary angiography as a planned initial therapy) 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 acute care Denominator Exceptions Documentation of a medical reason for not receiving a noninvasive stress test before discharge (eg, contraindications to noninvasive stress testing [for instance, patients with intolerance to dobutamine or vasodilator, or patients with ongoing ischemia], terminal illness/futile, not candidate for invasive strategy or revascularization) Documentation of a patient reason for not receiving a noninvasive stress test before discharge (eg, patient choice not to undergo ischemic work-up or to postpone to the outpatient setting) Documentation of cross-over from an initial conservative management to undergo invasive coronary angiography without the need for a noninvasive stress test (as in the case of recurrent spontaneous ischemia) 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 Some patients with AMI who are managed conservatively (eg, managed with medical therapies, with coronary angiography not planned as an initial treatment strategy) have high-risk coronary artery disease. 