New Level 1 Comprehensive Heart Attack Center Certification (CHAC)

Blue background with an anatomically correct heart. The background has a honeycomb design and infront of the heart are lines with dots. The overall effect is very "techy" in relation to cardiology
  • January 1, 1970

Launched on July 1, The Comprehensive Heart Attack Center (CHAC) certification adds new performance measures related to patient discharge orders not included in the existing Primary Heart Attack Center certification.  These new measures, backed by Level 1A evidence, include disease-appropriate medications (ACE inhibitors, ARBs, anti-platelet therapy, etc) prescribed at discharge and referral to an outpatient cardiac rehab program at discharge.  Encouraging providers to follow evidence-based guidelines is important because according to the American Heart Association, someone experiences a heart attack every 40 seconds.

We know that clear communication surrounding local referral options can increase the chance a patient suffering from a sudden heart attack will be seen quickly and be treated with the best available treatment. This concept precipitated a partnership between the American Heart Association and The Joint Commission, resulting in their most comprehensive hospital heart attack certification yet.

The American Heart Association, alongside the Joint Commission, a global driver of quality improvement and patient safety in health care, offer the certifications below to recognize institutions dedicated to following the latest science-based guidelines in heart attack care:

  • Level I: Comprehensive Heart Attack Center (CHAC)— This new certification level is for hospitals prepared to perform cardiac surgical services and primary PCI at any time
  • Level II: Primary Heart Attack Center (PHAC) — Ideal for hospitals consistently performing primary PCI.
  • Level III: Acute Heart Attack Ready (AHAR) — For heart attack systems of care referring hospitals that may or may not perform primary (emergency) percutaneous coronary interventions (PCI).
  • Comprehensive Cardiac Center — For hospitals providing care for every touch point in the cardiac care continuum.

Hospitals seeking this highest-level heart attack certification will be measured against the following 9 standardized performance measures

CHAC-1 ECG within 10 minutes of arrival at this
receiving center
Percentage of ST-elevation Myocardial Infarction
patients who present directly to receiving center and
receive an ECG within 10 minutes of arrival
CHAC-2 Primary PCI ≤ 90 minutes Percentage of direct admit (non-transfer) ST-elevation
Myocardial Infarction patients who received primary
PCI within 90 minutes of arrival at the receiving
center (door-to-door time). For admissions with
STEMI diagnosed on subsequent ECG, arrival
date/time is set to 0, and arrival to
primary PCI is set to subsequent ECG time to primary
CHAC-3 EMS FMC to PCI ≤ 90 minutes Percentage of ST-elevation Myocardial Infarction
patients transported directly to a receiving center by
EMS who received primary PCI within 90 minutes of
EMS first medical contact.
CHAC-4 Arrival at first facility to primary PCI ≤ 120
Percentage of ST-elevation Myocardial Infarction
patients transferred from a STEMI referring hospital
who received primary PCI within 120 minutes of
arrival at the first facility (STEMI referring hospital
door-to device time).
CHAC-5 ACE-Inhibitor or angiotensin receptor
blocker (ARB) for LVSD at discharge
Percentage of ST-elevation Myocardial Infarction
patients with left ventricular systolic dysfunction (EF<
40% or with moderate or severe LVSD) who are
prescribed an ACEI or ARB at hospital discharge
CHAC-6 Cardiac rehabilitation patient referral from
an inpatient setting
Percentage of patients hospitalized with ST-elevation
Myocardial Infarction who were referred to an
outpatient cardiac rehabilitation (CR) program during
their hospital stay
CHAC-7 ACE-Inhibitor or ARB prescribed at
discharge for NSTE-ACS
Percentage of patients hospitalized with non-ST
elevation-cute coronary syndrome (NSTE-ACS) with
reduced left ventricular ejection fraction (<40%) who
are prescribed an Angiotensin-Converting-Enzyme
Inhibitor (ACE Inhibitor) or an Angiotensin II Receptor
Blocker (ARB) at discharge
CHAC-8 Cardiac rehabilitation patient referral from
an inpatient setting for NSTE-ACS
Percentage of patients hospitalized with non-ST
elevation acute coronary syndrome (NSTE-ACS) who
were referred to an outpatient cardiac rehabilitation
(CR) program
CHAC-9 Dual antiplatelet therapy prescribed at
discharge (NSTEMI)
Percentage of medically managed patients with non
ST elevation-acute coronary syndrome (NSTE-ACS)
who were prescribed duel antiplatelet therapy (aspirin
and appropriate P2Y12 inhibitor) at discharge

As intensive cardiac rehab program educators, this new certification is welcome news. The implications are far-reaching as noted by prominent medical professionals:

“Because of the nation’s aging population and the importance of timely treatment, cardiac and stroke systems of care are more important than ever...Having certified hospitals in a community can help systems of care function more effectively, with clear direction on where to take patients”  
- Edward Jauch, M.D., member of the American Heart Association Quality Certification Science Committee and chair of the Department of Research at UNC Health Sciences, in Asheville, North Carolina
“This comprehensive framework ensures all patients have access to appropriate, comprehensive heart attack care when it matters...Providing evidence-based care that improves quality and outcomes for patients is central to the work of the American Heart Association. The new certification joins our existing heart attack certifications to help hospitals elevate their cardiac programs, improving consistency of care for every patient.”
- Mariell Jessup, M.D., FAHA, chief science and medical officer at the American Heart Association.

This article was written by a former Pritikin ICR employee.

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