Table 7

Outcomes Data Elements and Definitions

Element NameElement Definition
Outcomes
DeathThe patient died during this hospitalization.
Date and time of deathIndicate the patient's date and time of death.
Acute MI
  • The term acute MI should be used when there is evidence of myocardial necrosis in a clinical setting consistent with myocardial ischemia. Under these conditions, any one of the following criteria meets the diagnosis for MI:

  • • Detection of the rise and/or fall of cardiac biomarkers (preferably cTn) with at least 1 value above the 99th percentile and with at least 1 of the following

  •  - Symptoms of ischemia

  •  - New or presumed new significant ST-T changes or new LBBB

  •  - Development of pathological Q waves on the ECG

  •  - Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality

  •  - Identification of an intracoronary thrombus by angiography or autopsy

  • • Cardiac death with symptoms suggestive of myocardial ischemia and presumed new ischemic electrocardiographic

  •  changes or new LBBB, but death occurred before cardiac biomarkers were obtained or before cardiac biomarker values would be increased.

  • • PCI-related MI is arbitrarily defined by elevation of cTn values (≤5 times the 99th percentile URL) in patients with normal

  •  baseline values (≥99th percentile URL) or a rise in cTn values ≥20% if baseline values are elevated and stable or falling; in addition, either symptoms suggestive of myocardial ischemia or new ischemic electrocardiographic changes or angiographic findings consistent with a procedural complication or imaging demonstration of new loss of viable myocardium or new regional wall motion abnormality

  • • Stent thrombosis associated with MI when detected by coronary angiography or autopsy in the setting of myocardial ischemia and with a rise and/or fall of cardiac biomarker values with at least 1 value >99th percentile URL.

  • • CABG-related MI is arbitrarily defined by elevation of cardiac biomarker values (>10 times the 99th percentile URL) in patients with normal baseline cTn values (≥99th percentile URL) plus either new pathological Q waves or new LBBB, or angiographically documented new graft or new native coronary artery occlusion, or imaging evidence of new loss of viable myocardium.

  • • The 99th percentile is observed after the procedure in conjunction with symptoms suggestive of myocardial ischemia or new ischemic electrocardiographic changes or angiographic findings consistent with a procedural complication or imaging demonstration of new loss of viable myocardium or in patients with a preprocedure elevated biomarker that is stable or falling, a rise of biomarker values ≥20% in conjunction with the PCI-related criteria stated above.

Recurrent MI
  • Reinfarction occurs when there are clinical signs and symptoms of ischemia that are distinct from the presenting ischemic event and meeting at least 1 of the following criteria:

  • 1. Spontaneous (before or without revascularization, >48 h after PCI, and/or after CABG)

  •  A. New, significant Q waves in at least 2 contiguous leads of an ECG that were not present with the presenting ischemic event

  •  B. Patients whose most recent cardiac markers drawn before reinfarction, which were normal, require an increase in CK-MB or troponin above the 99th percentile ULN, which is at least ≥20% above the most recent value.

  • 2. Within 48 h after PCI:

  •  A. Patients with normal biomarker values (preprocedure) who then develop an increase in biomarker values >5 times the 99th percentile URL or if the baseline values are elevated and are stable or falling, a rise of cTn values ≥20%. In addition, symptoms suggestive of myocardial ischemia or new ischemic electrocardiographic changes or angiographic findings consistent with a procedural complication or imaging demonstration of new loss of viable myocardium are required.

  •  Note: Some patients presenting with ACS will not have biomarker elevations before the PCI. Elevated biomarkers after PCI in these cases do not necessarily mean a reinfarction occurred.

  •  B. Stent thrombosis associated with MI when detected by coronary angiography or autopsy in the setting of myocardial ischemia and with a rise and/or fall of cardiac biomarker values with at least 1 value above the 99th percentile URL

  •  C. For patients with elevated baseline (preprocedure) cardiac biomarkers, there are 2 possible scenarios. In these scenarios, electrocardiographic changes or symptoms are not required to qualify.

  •   i. Patients with cardiac markers above the ULN (preprocedure) assumed to be in the midst of an acute MI

  •   ii. Patients with elevated biomarkers with a characteristic rise and fall in biomarker levels preprocedure most likely have completed their presenting infarct. Further rises in cardiac markers must be ≥20% above the most recent value to be coded as reinfarction.

  •  D. Patients with new, significant Q waves in at least 2 contiguous leads of an ECG that were not present with the presenting ischemic event

  • 3. Within 48 h after CABG: A CABG-related MI is defined by elevation of cardiac biomarker values >10 times the 99th percentile URL in patients with normal baseline cTn values (≤99th percentile URL) plus either new pathological Q waves or new LBBB or angiographically documented new graft or new native coronary artery occlusion or imaging evidence of new loss of viable myocardium or new regional wall motion abnormality.

  • Note: Patients with cardiac biomarkers above the ULN before CABG require the increase in biomarkers to be ≥20% above the most recent value associated with symptoms/signs of myocardial ischemia.

Reinfarction dateIndicate the date when the clinical signs and symptoms of the reinfarction first occurred.
Recurrent rest angina with electrocardiographic changesRecurrent ischemic pain occurring at rest (and believed to be cardiac in origin) with associated electrocardiographic changes
Recurrent rest angina without electrocardiographic changesRecurrent ischemic pain occurring at rest (and believed to be cardiac in origin) without associated electrocardiographic changes
Unstable angina requiring hospitalization
  • Unstable angina requiring hospitalization is defined as:

  •  1. Ischemic discomfort (angina or symptoms thought to be equivalent) ≥10 min in duration occurring

  •   • at rest, or

  •   • in an accelerating pattern with frequent episodes associated with progressively decreased exercise capacity

  •  2. Prompting an unscheduled hospitalization within 24 h of the most recent symptoms. Hospitalization is defined as an admission to an inpatient unit or a visit to an emergency department that results in at least a 24 h stay (or a change in calendar date if the hospital admission or discharge times are not available)

  •  3. At least one of the following:

  •   a. New or worsening ST or T wave changes on resting ECG (in the absence of confounders, such as LBBB or LVH)

  •   • Transient ST elevation (duration <20 min)

  •    New ST elevation at the J point in 2 contiguous leads with the cut-points: ≥0.1 mV in all leads other than leads V2-V3 where the following cut-points apply: ≥0.2 mV in men ≥40 y (≥0.25 mV in men <40 y) or ≥0.14 mV in women

  •   • ST depression and T-wave changes

  •    New horizontal or down-sloping ST depression ≥0.05 mV in two contiguous leads and/or new T inversion ≥0.3 mV in 2 contiguous leads with prominent R wave or R/S ratio >1.

  •   b. Definite evidence of inducible myocardial ischemia as demonstrated by:

  •   • an early positive exercise stress test, defined as ST elevation or ≥2 mm ST depression prior to 5 METS, or

  •   • stress echocardiography (reversible wall motion abnormality), or

  •   • myocardial scintigraphy (reversible perfusion defect), or

  •   • MRI (myocardial perfusion deficit under pharmacologic stress) and believed to be responsible for the myocardial ischemic symptoms/signs.

  •   c. Angiographic evidence of new or worse ≥70% lesion and/or thrombus in an epicardial coronary artery that is believed to be responsible for the myocardial ischemic symptoms/signs.

  •   d. Need for coronary revascularization procedure (PCI or CABG) for the presumed culprit lesion(s). This criterion would be fulfilled if revascularization was undertaken during the unscheduled hospitalization, or subsequent transfer to another institution without interceding home discharge.

  •  4. Negative cardiac biomarkers.

Heart failure
  • Indicate if there is physician documentation or report of either new-onset or acute reoccurrence of heart failure.

  • Heart failure is defined as physician documentation or report of any of the following clinical symptoms of heart failure described as unusual dyspnea on light exertion, recurrent dyspnea occurring in the supine position, fluid retention; or the description of rales, jugular venous distention, or pulmonary edema on physical exam. A low ejection fraction without clinical presentation does not qualify as heart failure.

  • *Note: Killip class 2 is defined as rales over ≤50% of the lung fields or the presence of an S3. Killip class 3 is defined as rales over >50% of the lung fields. Either class would qualify as a “yes.”

Heart failure dateIndicate the date of the acute reoccurrence of heart failure.
Cardiogenic shock
  • Indicate if the patient developed cardiogenic shock in your facility. Cardiogenic shock is defined as a sustained (>30 min) episode of systolic blood pressure <90 mm Hg and/or cardiac index <2.2 L/min per square meter determined to be secondary to cardiac dysfunction and/or the requirement for parenteral inotropic or vasopressor agents or mechanical support (e.g., IABP, extracorporeal circulation, VADs) to maintain blood pressure and cardiac index above those specified levels.

  • Note: Transient episodes of hypotension reversed with IV fluid or atropine do not constitute cardiogenic shock. The hemodynamic compromise (with or without extraordinary supportive therapy) must persist for at least 30 min.

Cardiogenic shock date
  • Indicate the date when a diagnosis for cardiogenic shock was made.

Stroke
  • Indicate whether the patient has a history of stroke, which is defined as an acute episode of neurological dysfunction caused by focal or global brain, spinal cord, or retinal vascular injury as a result of hemorrhage or infarction.

  • If present, record stroke type:

  • • Ischemic stroke

  • • Intracerebral hemorrhage

  • • Subarachnoid hemorrhage

  • • Unknown type

  • If ischemic, list the most likely etiologies:

  • • Large artery atherosclerosis of the extracranial vessels (e.g., carotid)

  • • Large artery atherosclerosis of the intracranial vessels (e.g., middle cerebral artery stenosis)

  • • Cardioembolism

  • • Small-vessel occlusion (lacunar)

  • • Ischemic stroke of other determined etiology (e.g., arterial dissection)

  • • Ischemic stroke of undetermined etiology

Stroke dateIndicate the date of onset of stroke symptoms.
Type of stroke
  • Indicate if the patient experienced a hemorrhagic or ischemic stroke with documentation on imaging (e.g., CT scan or MRI of hemorrhage in the cerebral parenchyma or a subdural or subarachnoid hemorrhage). Evidence of hemorrhagic stroke obtained from lumbar puncture, neurosurgery, or autopsy can also confirm the diagnosis.

  • Note: If stroke occurs during sleep, last awake time may be used.

Bleeding (TIMI major, TIMI minor, or none)
  • An episode of bleeding is defined by the TIMI criteria as

  • • Major: overt clinical bleeding (or documented intracranial or retroperitoneal hemorrhage) associated with a drop in hemoglobin of ≥5 g/dL (0.5 g/L) or in hematocrit of ≥15% (absolute)

  • Note: A patient who experiences an intracranial hemorrhage should be considered to have a major hemorrhage.

  • • Minor: overt clinical bleeding associated with a fall in hemoglobin of 3 to <5 g/dL or in hematocrit of 9% to ≤15% (absolute)

  • • None: no bleeding event that meets the major or minor definition

  • Note: In calculating the fall in hemoglobin or hematocrit, a transfusion of whole blood or packed RBCs is counted as 1 g/dL hemoglobin or 3% absolute in hematocrit. This would be in addition to the actual fall in hemoglobin or hematocrit.

GUSTO bleeding classification (42)
  • Indicate the GUSTO bleeding classification:

  • • Severe: either intracranial hemorrhage or bleeding that causes hemodynamic compromise and requires intervention

  • • Moderate: bleeding that requires blood transfusion but does not result in hemodynamic compromise

  • • Mild: bleeding that does not meet the criteria for either severe or moderate bleeding

Bleeding eventIndicate if there was a bleeding event observed and documented in the medical record that was associated with a hematocrit drop of ≥10% and/or a hemoglobin drop of ≥3 g/dL or that required transfusion or surgical intervention.
Location of bleeding
  • Indicate the location thought to be responsible for the bleeding event. Choose all that apply:

  • • Access site

  • • Retroperitoneal

  • • GI

  • • GU

  • • Other

Bleeding event dateIndicate the date of the suspected bleeding event.
Surgical or procedural interventionIndicate if the suspected bleeding event required a surgical or procedural intervention. Interventions may include surgery, protamine (heparin reversal agent), fibrin injection, transfusion of blood products, angioplasty, or stenting. Prolonged pressure does not qualify as an intervention, but ultrasonic guided compression after making a diagnosis of pseudoaneurysm does qualify.
TransfusionIndicate if there was a nonautologous transfusion(s) of either whole blood or packed RBCs.
Units of blood givenIndicate the units of blood given.
Date of first RBC transfusionIndicate the date of the first RBC transfusion.
RBC transfusion related to CABGIndicate if any RBC/whole blood transfusion was related to CABG. If any units were given for reasons not related to CABG, check “No.” Check “Yes” only if all transfusions given were related to CABG.
ThrombocytopeniaPlatelet count dropped to either <50,000/mm3 or between 50,000 and <100,000/mm3; the level should be noted. This platelet count should be confirmed as not being pseudothrombocytopenia (i.e., platelet clumping in citrated blood).
Cardiac rupture/ventricular septal defectRupture of the ventricular myocardium as documented by cardiac echocardiography, ventriculography, pericardiocentesis, cardiac surgery, and/or autopsy. Rupture could be of the free wall or the ventricular septum. Included in this category is frank papillary muscle rupture.
Atrial arrhythmiaA new episode or acute recurrence of atrial fibrillation/flutter.
Supraventricular tachycardiaA new episode or acute recurrence of supraventricular tachycardia requiring treatment (supraventricular tachycardia that requires cardioversion or drug therapy, or is sustained for >1 min).
Ventricular arrhythmiaVT or VF requiring cardioversion and/or IV antiarrhythmics.
High-degree AV blockHigh-level AV block defined as third-degree AV block or second-degree AV block with bradycardia requiring pacing.
Discharge
Date of dischargeIndicate the month, day, and year the patient was discharged from acute care, left against medical advice, or died during this stay.
Discharge destination
  • Indicate the patient's destination after discharge.

  • Choose 1 of the following:

  • • Home

  • • Extended care/transitional care unit

  • • Other hospital

  • • Nursing home

  • • Hospice

  • • Other

Discharge status
  • Discharge status: the place or setting to which the patient was discharged:

  • • Discharged to home care or self-care (routine discharge)

  • • Discharged/transferred to a short-term general hospital for inpatient care

  • • Discharged/transferred to SNF with Medicare certification in anticipation of covered skilled care

  • • Discharged/transferred to an ICF

  • • Discharged/transferred to another type of institution not defined elsewhere in this code list

  • • Discharged/transferred to home under care of organized home health service organization in anticipation of covered skilled care

  • • Left against medical advice or discontinued care

  • • Died

  • • Died in a medical facility (e.g., hospital, SNF, ICF, or freestanding hospice)

  • • Discharged/transferred to a federal healthcare facility

  • • Hospice: home

  • • Hospice: medical facility

  • • Discharged/transferred to hospital-based, Medicare-approved swing bed

  • • Discharged/transferred to an IRF, including rehabilitation distinct part units of a hospital

  • • Discharged/transferred to a Medicare-certified LTCH

  • • Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare

  • • Discharged/transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital

  • • Discharged/transferred to a CAH

Discharge status (alive versus dead)
  • Indicate whether the patient was alive or dead at discharge from hospitalization during which the procedure occurred.

  • • Alive

  • • Dead

Primary cause of death*
  • Indicate the primary cause of death:

  • • Cardiovascular death:

  •  - Acute MI

  •  - Sudden cardiac death

  •  - Death due to heart failure

  •  - Death due to stroke

  •  - Death due to cardiovascular procedures

  •  - Death due to cardiovascular hemorrhage

  •  - Death due to other cardiovascular causes

  • • Noncardiovascular death: defined as any death with a specific cause that is not thought to be cardiovascular in nature:

  •  - Pulmonary

  •  - Renal

  •  - GI

  •  - Hepatobiliary

  •  - Pancreatic

  •  - Infection (includes sepsis)

  •  - Inflammatory (e.g., SIRS/immune [including autoimmune])

  •  - Hemorrhage that is neither cardiovascular bleeding nor a stroke

  •  - Noncardiovascular procedure or surgery

  •  - Trauma

  •  - Suicide

  •  - Prescription drug reaction or overdose

  •  - Nonprescription drug reaction or overdose

  •  - Neurological (noncardiovascular)

  •  - Malignancy

  •  - Other noncardiovascular cause of death

  • • Undetermined cause of death: refers to death not attributable to either cardiovascular or noncardiovascular cause

Acute care transferIndicate if the patient was transferred to another acute-care center (hospital) for further management.
Date/time of transferIndicate the date and time the patient was transferred to another acute-care center (hospital) for further management.
Days in ICU
  • Total number of days the patient spent in an intensive care bed at the index hospital only, either consecutively or intermittently. To count days:

  • • Find the ICU/CCU admit date/time and the date/time patient was transferred to another unit (telemetry or unmonitored bed)

  • • For every 24-h period, count 1 d

  • • For any partial day remaining, round up if ≥12 h and round down if <12 h

  • In the case of an in-hospital infarct in which the patient is already in an ICU bed, record the number of days spent in ICU/CCU after the diagnosis of MI was made.

Final diagnosis of the admission event
  • • STEMI is defined as an ACS in which there is cardiac marker evidence of myocardial necrosis (e.g., positive cTn or CK-MB) and new (or presumably new if no prior ECG is available) ST-segment elevation or LBBB on the admission ECG. (For a complete definition, please see “MI” in the “Outcomes” section.)

  • • NSTEMI is defined as an ACS in which there is cardiac marker evidence of myocardial necrosis (e.g., positive cTn or CK-MB) without new ST-segment elevation. (For a complete definition, please see “MI” in the “Outcomes” section.)

  • • BBB/uncertain type: For a complete definition, please see “MI” in the “Outcomes” section.

  • • UA is defined as angina pectoris (or equivalent type of ischemic discomfort) with any 1 of the 3 following features:

  •  1. Angina occurring at rest and prolonged, usually ≥10 min

  •  2. New-onset angina of at least CCS classification III severity

  •  3. Recent acceleration of angina reflected by an increase in severity of at least 1 CCS class to at least CCS class III

  •  The patient must also not have any biochemical evidence of necrosis.

  •  Definite/probable UA: Patients with clinical history consistent with the diagnosis of UA as described above, in whom ischemia has been confirmed by the presence of ST changes on the initial ECG or in association with recurrent rest pain, by a positive stress test, negative cardiac biomarkers, and no evidence of acute MI.

  •  Possible UA is present when an acute ischemic process has not been excluded as a possible cause of the presenting symptoms or the clinical history is consistent with UA, but no diagnostic test (noted above) was performed to confirm the diagnosis.

  • • Stable CAD: The patient has a clinical diagnosis or prior history of CAD, but after evaluation in the hospital, the episode of discomfort was not thought to have represented UA.

  • • Noncardiac chest pain: Pain in the chest, neck, arms, or abdomen (or other clinical manifestation) not clearly exertional or not otherwise consistent with pain or discomfort of myocardial ischemic origin.

  •  Examples:

  •  1. If a patient was admitted with rest pain but had negative cardiac markers and then on day 3 developed recurrent pain, and if it was determined that an MI had occurred, the event prompting admission should be coded as “unstable angina” here. The MI on day 3 should be recorded in the “Outcomes” section as a postadmission MI.

  •  2. If a patient was admitted with rest pain and the initial cardiac markers were negative but the enzymes drawn over the subsequent 24 h became positive, this is most consistent with an NSTEMI as the admission event.

Comfort measures only
  • Indicate if there was physician/nurse practitioner/physician assistant documentation that the patient was receiving comfort measures only.

  • • Comfort measures only are commonly referred to as “palliative care” in the medical community and “comfort care” by the general public. Palliative care includes attention to the psychological and spiritual needs of the patient and support for the dying patient and the patient's family. Usual interventions are not received because a medical decision was made to limit care to comfort measures only.

  • • Comfort measures only are not equivalent to a DNR order, living will, no code, or no heroic measure.

Primary inpatient service
  • Indicate the specialty of the attending physician who primarily cared for the patient according to the most frequent and consistent notations in the medical record.

  • Choose 1 of the following:

  • • Cardiology

  • • Internal medicine

  • • Family practice

  • • Hospital medicine (primary professional focus on general medical care of hospitalized patients)

  • • Other

Clinical trialIndicate if the patient signed an informed consent to participate in a clinical trial during his or her hospitalization, even if the investigational medication, device, or procedure was never initiated.
Smoking cessation counselingIndicate if there was documentation in the medical record that smoking cessation advice or counseling was given during this hospital stay.
Weight management counselingAdvice is given or counseling conducted by a physician or nurse for patients who are >120% of ideal weight for height. Particular emphasis on weight loss may be given for patients with hypertension, elevated triglycerides, or elevated glucose levels.
Diet counselingAdvice is given or a discussion conducted by a physician, nurse, or registered dietitian encouraging diet counseling. This can include consumption of low-cholesterol foods; moderate restriction of sodium intake; emphasis on consumption of fruits, vegetables, and low-fat dairy products; and increased consumption of omega-3 fatty acids.
Exercise counselingIndicate if advice was given or discussion conducted by a physician, nurse, or exercise specialist or nurse encouraging patients to engage in a minimum of 30–60 min of physical activity daily or at least 3–4 times weekly.
Cardiac rehabilitationIndicate if advice was given or discussion conducted with the patient (by physician, nurse, or other personnel) about the importance of joining a cardiac rehabilitation program or an appointment made.
Follow-up
ReadmissionReadmission to a hospital
Readmission dateDate the patient was readmitted
Readmission reason
  • Reasons for admission (include all that apply):

  • • MI (documented)

  • • UA

  • • Angina (without MI)

  • • PCI

  • • CABG

  • • CHF (without MI)

  • • Arrhythmia or conduction disturbance (without MI)

  • • Sudden cardiac arrest

  • • Chest pain ultimately found to be noncardiac in nature

  • • Stroke/other cardiovascular problem

  • • Noncardiovascular problem

BNP or NT pro-BNPIndicate the results of BNP or first NT pro-BNP. If done, enter the numerical value and specify which assay type was done.
LDLIndicate the value of LDL cholesterol. If the value is reported using a “>” symbol (e.g., “>300”), record the number only (e.g., “300”).
HDLIndicate the value of HDL cholesterol. If the value is reported using a “>” symbol (e.g., “>300”), record the number only (e.g., “300”).
Hemoglobin A1cIndicate value and date performed.
MIDocumented evidence of an MI. For a complete definition, please see “MI” in the “Outcomes” section.
Cardiac catheterizationCardiac catheterization (with or without revascularization) procedure performed since the previous visit/contact
PCIPCI performed since the previous visit/contact
CABGCABG performed since the previous visit/contact
Angina status
  • CCS classes of angina:

  • • Class 0: none

  • • Class I: ordinary physical activity, such as walking or climbing stairs, does not cause angina. Angina occurs with strenuous, rapid, or prolonged exertion at work or recreation.

  • • Class II: slight limitation of ordinary activity. Angina occurs on walking or climbing stairs rapidly, walking uphill, walking or climbing stairs after meals,or in cold, in wind, or under emotional stress, or only during the few hours after awakening. Angina occurs on walking >2 blocks on the level and climbing >1 flight of ordinary stairs at a normal pace and in normal conditions.

  • • Class III: marked limitation of ordinary physical activity. Angina occurs on walking 1 to 2 blocks on the level and climbing 1 flight of stairs in normalconditions and at a normal pace.

  • • Class IV: inability to perform any physical activity without discomfort—anginal symptoms may be present at rest.

NYHA functional class
  • If heart failure is present, indicate NYHA class.

  • Choose 1 of the following:

  • • Class I: patients with cardiac disease but without resulting limitations of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea.

  • • Class II: patients with cardiac disease resulting in a slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, or dyspnea.

  • • Class III: patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea.

  • • Class IV: patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms are present even at rest or minimal exertion.

DeathThe patient has died since the previous visit/contact. This category includes all deaths regardless of cause of death.
Date of deathIndicate the date of death.
Primary cause of death
  • Indicate the primary cause of death:

  • • Cardiovascular death:

  •  - Acute MI

  •  - Sudden cardiac death

  •  - Death due to heart failure

  •  - Death due to stroke

  •  - Death due to cardiovascular procedures

  •  - Death due to cardiovascular hemorrhage

  •  - Death due to other cardiovascular causes

  • • Noncardiovascular death is defined as any death with a specific cause that is not thought to be cardiovascular in nature:

  •  - Pulmonary

  •  - Renal

  •  - GI

  •  - Hepatobiliary

  •  - Pancreatic

  •  - Infection (includes sepsis)

  •  - Inflammatory (e.g., SIRS/immune [including autoimmune])

  •  - Hemorrhage that is neither cardiovascular bleeding nor a stroke

  •  - Noncardiovascular procedure or surgery

  •  - Trauma

  •  - Suicide

  •  - Prescription drug reaction or overdose

  •  - Nonprescription drug reaction or overdose

  •  - Neurological (noncardiovascular)

  •  - Malignancy

  •  - Other noncardiovascular cause of death

  • • Undetermined cause of death: refers to death not attributable to either cardiovascular or noncardiovascular cause

Medication use
  • • Acetylsalicylic acid/antiplatelet: aspirin, clopidogrel, or ticlopidine; other (e.g., dipyridamole)

  • • ACE inhibitors: Some common generic forms are captopril, enalapril, lisinopril, and ramipril.

  • • Beta blocker: Some forms of IV beta blockers are atenolol, metoprolol, propranolol, timolol, esmolol, and labetalol. Some generic forms of oral beta blockers include atenolol, metoprolol, nadolol, pindolol, propranolol, timolol, acebutolol, bucindolol, bisoprolol, labetalol, and carvedilol.

  • • Lipid lowering: Types of agents include statins (HMG Co-A reductase inhibitors), fibrates, nicotinic acid, and resin drugs (cholestyramine). Frequently prescribed drugs are cholestyramine, colestipol, probucol, gemfibrozil, lovastatin, atorvastatin, simvastatin, fluvastatin, pravastatin, and other Class I–indicated cardiovascular medication—ARB and aldosterone antagonists.

  • A complete listing of cardiac medications could also be collected.

ARB indicates angiotensin receptor blocker; ACE, angiotensin-converting enzyme; ACS, acute coronary syndromes; AV, atrioventricular; BBB, bundle-branch block; BNP, brain natriuretic peptide; CABG, coronary artery bypass graft; CAD, coronary artery disease; CAH, critical access hospital; CCS, Canadian Cardiovascular Society; CCU, coronary care unit; CHF, congestive heart failure; CK-MB, creatine kinase MB isoenzyme; CT, computed tomography; cTn, cardiac troponin; DNR, do not resuscitate; ECG, electrocardiogram; GI, gastrointestinal; GU, genitourinary; GUSTO, Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries; HDL, high-density lipoprotein; IABP, intra-aortic balloon pump; ICF, intermediate care facility; ICU, intensive care unit; IRF, inpatient rehabilitation facility; IV, intravenous; LBBB, left bundle branch block; LDL, low-density lipoprotein; LTCH, long-term care hospital; MI, myocardial infarction; MRI, magnetic resonance imaging; NSTEMI, non-ST-segment elevation myocardial infarction; NT-proBNP, N-terminal prohormone of brain natriuretic enzyme; NYHA, New York Heart Association; PCI, percutaneous coronary intervention; RBCs, red blood cells; SIRS, systemic inflammatory response syndrome; SNF, skilled nursing facility; STEMI, ST-segment elevation myocardial infarction; TIMI, Thrombolysis in Myocardial Infarction; VAD, ventricular assist device; VF, ventricular fibrillation; VT, ventricular tachycardia; UA, unstable angina; ULN, upper limit of normal; and URL, upper reference limit.