Numerator Patients with AMI who are prescribed a beta blocker* at hospital discharge *Appropriate beta blockers to be used in patients with AMI and LVSD are: bisoprolol, carvedilol, extended-release metoprolol. Denominator All patients with AMI 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 a beta blocker at hospital discharge (eg, beta-blocker allergy or intolerance, advanced heart block and no pacemaker, significant bradycardia or hypotension prior to discharge, active asthma or reactive airways disease, increased risk of heart failure/cardiogenic shock, recent history of cocaine or methamphetamine use with signs of acute intoxication) 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 Beta blockers are excellent anti-ischemic and antianginal medications that decrease myocardial oxygen demand by reducing the heart rate, blood pressure, and contractility. They also reduce cardiac automaticity and the risk of VF after MI. In addition, they improve coronary perfusion by prolonging diastole. Oral beta blockers should therefore be administered to all patients with MI without contraindications for their use. Common contraindications for beta blockers use include heart failure or risk for cardiogenic shock, bradycardia, hypotension, heart block, or active bronchospasm, or acute cocaine ingestion. Patients with initial contraindications to beta blockers in the first 24 h after an AMI should be reevaluated to determine their subsequent eligibility. 