Numerator Eligible* patients with AMI who are prescribed an aldosterone antagonist at hospital discharge *Eligible AMI patients for an aldosterone antagonist are patients with no contraindications who are already receiving an ACE inhibitor and beta blocker, and who have an EF 40%, and either HF or diabetes mellitus (aldosterone antagonists are appropriately used when the ACE inhibitor and/or beta blocker cannot be used or tolerated). Denominator All post-AMI patients who: [a] are receiving an ACE inhibitor and a beta blocker; AND [b] have a LVEF 40%; AND [c] have either diabetes mellitus or HF 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 prescribing an aldosterone antagonist at hospital discharge (eg, allergy or intolerance to aldosterone antagonist, significant renal dysfunction [Cr >2.5 mg/dL in men; >2.0 mg/dL in women], hyperkalemia [K >5.0 mEq/L]) Patient currently enrolled in a clinical trial related to AMI (eg, trials involving renin-angiotensin-aldosterone system inhibitors) 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 The EPHESUS (Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival) study demonstrated benefits from adding eplerenone, a selective aldosterone antagonist, to ACE inhibitors or ARBs (in 87% of patients) and beta blockers (75%), including a 15% and 17% reduction in overall and cardiovascular mortality, respectively. 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. 