Top Things to Know: 2024 AHA/ASA Performance and Quality Measures for Spontaneous Intracerebral Hemorrhage

Published: May 02, 2024

  1. Approximately 80,000 people experience ICH each year in the United States. Despite the significant functional disability and 30%-40% mortality after ICH, systems of care for ICH patients have long trailed that of acute ischemic stroke patients.
  2. The current performance measures are an update to the 2018 AHA/ASA Clinical Performance Measures for Adults Hospitalized with ICH and are based on the 2022 AHA/ASA Management of Spontaneous ICH Guideline.
  3. The scope of ICH patients in these performance measures includes patients presenting with acute, spontaneous, non-traumatic ICH without a known structural or macrovascular cause.
  4. These performance measures should not be applied to patients with chronic hemorrhage, exclusive microhemorrhages on magnetic resonance imaging, resolving known hemorrhage, or hemorrhagic conversion from prior ischemic stroke.
  5. The current performance measures differ from the 2018 AHA/ASA Clinical Performance Measures for Adults Hospitalized with ICH as they address both patients presenting to the hospital with ICH as well as patients who develop an acute spontaneous non-traumatic ICH during their hospitalization. In addition, measures were created to address both the pre and posthospital settings.
  6. These 15 performance measures encompass a wide spectrum of ICH patient care, from pre to posthospital settings, highlighting the importance of timely interventions.
  7. The measures also include 5 quality measures and address potential challenges in data collection, with the aim of future improvements.
  8. Both guideline recommendations and the smaller set of performance measures are inherently limited by the evidence available for patient care, so these performance measures cannot and do not encompass all the appropriate care for ICH patients.
  9. The measures may also serve as a guide to hospitals and ultimately be adopted by regulatory agencies.
  10. The goal of these performance measures is to provide a tool to implement guideline recommendations and improve the quality of ICH patient care.


Ruff IM, de Havenon A, Bergman DL, Dugue R, Frontera JA, Goldstein JN, Hemphill JC, Marulanda-Londono E, Prabhakaran S, Richards CT, Sunmonu NA, Vilar P, Wolfe SQ; on behalf of the American Heart Association/American Stroke Association. 2024 AHA/ASA spontaneous intracerebral hemorrhage performance measures: performance measuresfrom the American Heart Association/American Stroke Association. Stroke. Published online May 2, 2024. doi: 10.1161/STR.0000000000000464