eCQM Title | # Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
eCQM Identifier (Measure Authoring Tool) | 144 | eCQM Version Number | 11.1.000
NQF Number | 0083e | GUID | 8439f671-2932-4d4c-88ca-ea5faeacc89a
Measurement Period | January 1, 20XX through December 31, 20XX
Measure Steward | American Heart Association
Measure Developer | American Medical Association (AMA)
Measure Developer | PCPI(R) Foundation (PCPI[R])
Measure Developer | American Heart Association
Endorsed By | National Quality Forum
Description |
    Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) <= 40% who were prescribed or already taking beta-blocker therapy during the measurement period
Copyright |
    Copyright 2022 American College of Cardiology and American Heart Association. All Rights Reserved.
Disclaimer |
    The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications.

    The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain.

    Commercial uses of the Measure require a license agreement between the user and the American College of Cardiology (ACC) or the American Heart Association (AHA). Neither the ACC, nor AHA, nor their members shall be responsible for any use of the Measure.

    ACC and AHA encourage use of the Measure by other health care professionals, where appropriate.

    THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.

    Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The ACC and AHA and their members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications.

    CPT(R) contained in the Measure specifications is copyright 2004-2021 American Medical Association. LOINC(R) is copyright 2004-2021 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2021 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2021 World Health Organization. All Rights Reserved.

    The American Medical Association’s and the PCPI(R) Foundation’s significant past efforts and contributions to the performance measure are gratefully acknowledged.

    Due to technical limitations, registered trademarks are indicated by (R) or [R].
Measure Scoring | Proportion
Measure Type | Process
Stratification |
    None
Risk Adjustment |
    None
Rate Aggregation |
    None
Rationale |
    Beta blockers improve survival and reduce hospitalization for patients with stable heart failure and reduced LVEF (HFrEF). Treatment should be initiated as soon as a patient is diagnosed with reduced LVEF and does not have prohibitively low systemic blood pressure, fluid overload, or recent treatment with an intravenous positive inotropic agent. Beta blockers have also been shown to lessen the symptoms of heart failure, improve the clinical status of patients, and reduce future clinical deterioration. Despite these benefits, use of beta blockers in eligible patients remains suboptimal.
Clinical Recommendation Statement |
    In approximately half of patients with HFrEF, variable degrees of LV enlargement may accompany HFrEF. The definition of HFrEF has varied, with guidelines of left ventricular ejection fraction (LVEF) ≤35%, <40%, and ≤40%. Randomized controlled trials (RCTs) in patients with HF have mainly enrolled patients with HFrEF with an EF ≤35% or ≤40%, and it is only in these patients that efficacious therapies have been demonstrated to date. For the present guideline, HFrEF is defined as the clinical diagnosis of HF and EF ≤40%. (ACCF/AHA, 2013).

    Use of 1 of the 3 beta blockers proven to reduce mortality (e.g., bisoprolol, carvedilol, and sustained-release metoprolol succinate) is recommended for all patients with current or prior symptoms of HFrEF [heart failure with reduced ejection fraction], unless contraindicated, to reduce morbidity and mortality (Class I, Level of Evidence: A) (ACCF/AHA, 2013).

    Treatment with a beta blocker should be initiated at very low doses [see excerpt from guideline table below] followed by gradual increments in dose if lower doses have been well tolerated... Clinicians should make every effort to achieve the target doses of the beta blockers shown to be effective in major clinical trials. Even if symptoms do not improve, long-term treatment should be maintained to reduce the risk of major clinical events. Abrupt withdrawal of treatment with a beta blocker can lead to clinical deterioration and should be avoided (ACCF/AHA, 2013).

    Drugs Commonly Used for Stage C HFrEF (abbreviated to align with focus of measure to include only Beta-blocker therapy)
    Drug                               Initial Daily Dose(s)       Maximum Dose(s)        Mean Doses Achieved in Clinical Trials

    Beta Blockers
    Bisoprolol                         1.25 mg once               10 mg once                  8.6 mg/d
    Carvedilol                         3.125 mg twice            50 mg twice                  37 mg/d
    Carvedilol CR                  10 mg once                  80 mg once                   N/A
    Metoprolol succinate        12.5 to 25 mg once      200 mg once                159 mg/d
    extended release
    (metoprolol CR/XL)
Improvement Notation |
    Higher score indicates better quality
Reference |
    Reference Type: CITATION
    Reference Text: 'Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., . . . Wilkoff, B. L. (2013). 2013 ACCF/AHA Guideline for the Management of Heart Failure A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 128(16), e240–e327. doi: https://doi.org/10.1161/CIR.0b013e31829e8776'
Definition |
    LVEF <=40% corresponds to qualitative documentation of moderate dysfunction or severe dysfunction (LVSD). The LVSD may be determined by quantitative or qualitative assessment, which may be current or historical. Examples of a quantitative or qualitative assessment may include an echocardiogram:
    1) that provides a numerical value of LVSD or 2) that uses descriptive terms such as moderately or severely depressed left ventricular systolic function. Any current or prior ejection fraction study documenting LVSD can be used to identify patients.
Guidance |
    This eCQM is to be reported as patient-based. To satisfy this measure, it must be reported for all heart failure patients at least once during the measurement period.

    A range value should satisfy the logic requirement for 'Ejection Fraction' as long as the ranged observation value clearly meets the less than or equal to 40% threshold noted in the denominator logic. A range that is greater than 40% would not meet the measure requirement.

    Beta-blocker therapy:
    -For patients with prior LVEF <= 40%, beta-blocker therapy should include bisoprolol, carvedilol, or sustained release metoprolol succinate.

    The requirement of two or more visits is to establish that the eligible professional or eligible clinician has an existing relationship with the patient.

    This version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.
Transmission Format |
    TBD
Initial Population |
    All patients aged 18 years and older with two qualifying encounters during the measurement period and a diagnosis of heart failure
Denominator |
    Equals Initial Population with a current or prior LVEF <= 40%
Denominator Exclusions |
    Patients with a history of heart transplant or with a Left Ventricular Assist Device (LVAD) prior to the end of the outpatient encounter with Moderate or Severe LVSD
Numerator |
    Patients who were prescribed or already taking beta-blocker therapy during the measurement period
Numerator Exclusions |
    Not Applicable
Denominator Exceptions |
    Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., arrhythmia, asthma, bradycardia, hypotension, patients with atrioventricular block without cardiac pacer, observation of consecutive heart rates <50, allergy, intolerance, other medical reasons).

    Documentation of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient declined, other patient reasons)
Supplemental Data Elements |
    For every patient evaluated by this measure also identify payer, race, ethnicity and sex

## Table of Contents

- Population Criteria
- Definitions
- Functions
- Terminology
- Data Criteria (QDM Data Elements)
- Supplemental Data Elements
- Risk Adjustment Variables

### Population Criteria

- - Initial Population

    - -     AgeInYearsAt(date from start of "Measurement Period")>= 18
              and Count("Qualifying Encounter During Measurement Period")>= 2
              and exists "Heart Failure Outpatient Encounter"

- - Denominator

    - -     "Initial Population"
              and exists "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD"

- - Denominator Exclusions

    - -     "Has Heart Transplant"
              or "Has Heart Transplant Related Diagnosis"
              or "Has Left Ventricular Assist Device Implanted"
              or "Has Left Ventricular Assist Device Related Diagnosis"

- - Numerator

    - -     "Has Beta Blocker Therapy for LVSD Ordered"
              or "Is Currently Taking Beta Blocker Therapy for LVSD"

- - Numerator Exclusions

    - -     None

- - Denominator Exceptions

    - -     "Has Consecutive Heart Rates Less than 50"
              or "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"
              or "Has Arrhythmia Diagnosis"
              or "Has Hypotension Diagnosis"
              or "Has Asthma Diagnosis"
              or "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy"
              or "Has Bradycardia Diagnosis"
              or "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient"
              or "Atrioventricular Block without Cardiac Pacer"

- - Stratification

    - -     None

### Definitions

- - Atrioventricular Block without Cardiac Pacer

    - -     "Has Atrioventricular Block Diagnosis"
              and not "Has Diagnosis of Cardiac Pacer in Situ"
              and not "Has Cardiac Pacer Device Implanted"

  - Denominator

    - -     "Initial Population"
              and exists "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD"

  - Denominator Exceptions

    - -     "Has Consecutive Heart Rates Less than 50"
              or "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"
              or "Has Arrhythmia Diagnosis"
              or "Has Hypotension Diagnosis"
              or "Has Asthma Diagnosis"
              or "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy"
              or "Has Bradycardia Diagnosis"
              or "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient"
              or "Atrioventricular Block without Cardiac Pacer"

  - Denominator Exclusions

    - -     "Has Heart Transplant"
              or "Has Heart Transplant Related Diagnosis"
              or "Has Left Ventricular Assist Device Implanted"
              or "Has Left Ventricular Assist Device Related Diagnosis"

  - Has Allergy or Intolerance to Beta Blocker Therapy Ingredient

    - -     exists ( ["Allergy/Intolerance": "Beta Blocker Therapy Ingredient"]
              union ["Allergy/Intolerance": "Substance with beta adrenergic receptor antagonist mechanism of action (substance)"] ) BetaBlockerAllergyIntolerance
              with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
                such that BetaBlockerAllergyIntolerance.prevalencePeriod overlaps after ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod

  - Has Arrhythmia Diagnosis

    - -     exists ["Diagnosis": "Arrhythmia"] Arrhythmia
              with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
                such that Arrhythmia.prevalencePeriod overlaps ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod

  - Has Asthma Diagnosis

    - -     exists ["Diagnosis": "Asthma"] Asthma
              with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
                such that Asthma.prevalencePeriod overlaps ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod

  - Has Atrioventricular Block Diagnosis

    - -     exists ["Diagnosis": "Atrioventricular Block"] AtrioventricularBlock
              with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
                such that AtrioventricularBlock.prevalencePeriod overlaps ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod

  - Has Beta Blocker Therapy for LVSD Ordered

    - -     exists ["Medication, Order": "Beta Blocker Therapy for LVSD"] BetaBlockerOrdered
              with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
                such that BetaBlockerOrdered.authorDatetime during ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod

  - Has Bradycardia Diagnosis

    - -     exists ["Diagnosis": "Bradycardia"] Bradycardia
              with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
                such that Bradycardia.prevalencePeriod overlaps ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod

  - Has Cardiac Pacer Device Implanted

    - -     exists ["Procedure, Performed": "Cardiac Pacer"] ImplantedCardiacPacer
              with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
                such that ( Global."NormalizeInterval" ( ImplantedCardiacPacer.relevantDatetime, ImplantedCardiacPacer.relevantPeriod ) ) starts before
                end of ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod

  - Has Consecutive Heart Rates Less than 50

    - -     exists from
              ["Physical Exam, Performed": "Heart Rate"] HeartRate,
              "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
              let PriorHeartRate: Last(["Physical Exam, Performed": "Heart Rate"] MostRecentPriorHeartRate
                  where(Global."NormalizeInterval"(MostRecentPriorHeartRate.relevantDatetime, MostRecentPriorHeartRate.relevantPeriod))during ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod
                    and(Global."NormalizeInterval"(MostRecentPriorHeartRate.relevantDatetime, MostRecentPriorHeartRate.relevantPeriod))before Global."NormalizeInterval"(HeartRate.relevantDatetime, HeartRate.relevantPeriod)
                  sort by start of Global."NormalizeInterval"(relevantDatetime, relevantPeriod)
              )
              where Global."NormalizeInterval" ( HeartRate.relevantDatetime, HeartRate.relevantPeriod ) during ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod
                and HeartRate.result < 50 '{beats}/min'
                and PriorHeartRate.result < 50 '{beats}/min'

  - Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy

    - -     exists ( ["Diagnosis": "Allergy to Beta Blocker Therapy"]
              union ["Diagnosis": "Intolerance to Beta Blocker Therapy"] ) BetaBlockerAllergyOrIntoleranceDiagnosis
              with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
                such that BetaBlockerAllergyOrIntoleranceDiagnosis.prevalencePeriod overlaps after ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod

  - Has Diagnosis of Cardiac Pacer in Situ

    - -     exists ["Diagnosis": "Cardiac Pacer in Situ"] CardiacPacerDiagnosis
              with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
                such that CardiacPacerDiagnosis.prevalencePeriod overlaps after ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod

  - Has Heart Transplant

    - -     exists ["Procedure, Performed": "Heart Transplant"] HeartTransplant
              with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
                such that ( Global."NormalizeInterval" ( HeartTransplant.relevantDatetime, HeartTransplant.relevantPeriod ) ) starts before
                end of ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod

  - Has Heart Transplant Related Diagnosis

    - -     exists ["Diagnosis": "Heart Transplant Related Diagnoses"] HeartTransplantCondition
              with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
                such that ( Global."NormalizeInterval" ( HeartTransplantCondition.authorDatetime, HeartTransplantCondition.prevalencePeriod ) ) starts before
                end of ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod

  - Has Hypotension Diagnosis

    - -     exists ["Diagnosis": "Hypotension"] Hypotension
              with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
                such that Hypotension.prevalencePeriod overlaps ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod

  - Has Left Ventricular Assist Device Implanted

    - -     exists ["Procedure, Performed": "Left Ventricular Assist Device Placement"] LVADOutpatient
              with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
                such that ( Global."NormalizeInterval" ( LVADOutpatient.relevantDatetime, LVADOutpatient.relevantPeriod ) ) starts before
                end of ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod

  - Has Left Ventricular Assist Device Related Diagnosis

    - -     exists ["Diagnosis": "Left Ventricular Assist Device Related Diagnoses"] LVADCondition
              with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
                such that ( Global."NormalizeInterval" ( LVADCondition.authorDatetime, LVADCondition.prevalencePeriod ) ) starts before
                end of ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod

  - Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD

    - -     exists ["Medication, Not Ordered": "Beta Blocker Therapy for LVSD"] NoBetaBlockerOrdered
              with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
                such that NoBetaBlockerOrdered.authorDatetime during ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod
              where ( NoBetaBlockerOrdered.negationRationale in "Medical Reason"
                  or NoBetaBlockerOrdered.negationRationale in "Patient Reason"
              )

  - Heart Failure Outpatient Encounter

    - -     ( ["Encounter, Performed": "Care Services in Long Term Residential Facility"]
              union ["Encounter, Performed": "Home Healthcare Services"]
              union ["Encounter, Performed": "Nursing Facility Visit"]
              union ["Encounter, Performed": "Office Visit"]
              union ["Encounter, Performed": "Outpatient Consultation"] ) QualifyingEncounter
              with ["Diagnosis": "Heart Failure"] HeartFailure
                such that HeartFailure.prevalencePeriod overlaps QualifyingEncounter.relevantPeriod
              where QualifyingEncounter.relevantPeriod during "Measurement Period"

  - Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD

    - -     "Heart Failure Outpatient Encounter" HFOutpatientEncounter
              with "Moderate or Severe LVSD Findings" LVSDFindings
                such that Coalesce(LVSDFindings.prevalencePeriod, Global."NormalizeInterval"(LVSDFindings.relevantDatetime, LVSDFindings.relevantPeriod))starts before
                end of HFOutpatientEncounter.relevantPeriod

  - Initial Population

    - -     AgeInYearsAt(date from start of "Measurement Period")>= 18
              and Count("Qualifying Encounter During Measurement Period")>= 2
              and exists "Heart Failure Outpatient Encounter"

  - Is Currently Taking Beta Blocker Therapy for LVSD

    - -     exists ["Medication, Active": "Beta Blocker Therapy for LVSD"] ActiveBetaBlocker
              with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
                such that ActiveBetaBlocker.relevantPeriod overlaps after ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod

  - Moderate or Severe LVSD Findings

    - -     ( ["Diagnostic Study, Performed": "Ejection Fraction"] EjectionFraction
                where EjectionFraction.result <= 40 '%'
            )
              union ["Diagnosis": "Moderate or Severe LVSD"]
              union ( ["Diagnosis": "Left ventricular systolic dysfunction (disorder)"] LVSD
                  where LVSD.severity in "Moderate or Severe"
              )

  - Numerator

    - -     "Has Beta Blocker Therapy for LVSD Ordered"
              or "Is Currently Taking Beta Blocker Therapy for LVSD"

  - Qualifying Encounter During Measurement Period

    - -     ( ["Encounter, Performed": "Care Services in Long Term Residential Facility"]
              union ["Encounter, Performed": "Home Healthcare Services"]
              union ["Encounter, Performed": "Nursing Facility Visit"]
              union ["Encounter, Performed": "Office Visit"]
              union ["Encounter, Performed": "Outpatient Consultation"]
              union ["Encounter, Performed": "Patient Provider Interaction"] ) ValidEncounter
              where ValidEncounter.relevantPeriod during "Measurement Period"

  - SDE Ethnicity

    - -     ["Patient Characteristic Ethnicity": "Ethnicity"]

  - SDE Payer

    - -     ["Patient Characteristic Payer": "Payer"]

  - SDE Race

    - -     ["Patient Characteristic Race": "Race"]

  - SDE Sex

    - -     ["Patient Characteristic Sex": "ONC Administrative Sex"]

### Functions

- - Global.NormalizeInterval(pointInTime DateTime, period Interval<DateTime>)

    - -     if pointInTime is not null then Interval[pointInTime, pointInTime]
              else if period is not null then period
              else null as Interval<DateTime>

### Terminology

- code "Left ventricular systolic dysfunction (disorder)" ("SNOMEDCT Code (134401001)")
- code "Substance with beta adrenergic receptor antagonist mechanism of action (substance)" ("SNOMEDCT Code (373254001)")
- valueset "Allergy to Beta Blocker Therapy" (2.16.840.1.113883.3.526.3.1177)
- valueset "Arrhythmia" (2.16.840.1.113883.3.526.3.366)
- valueset "Asthma" (2.16.840.1.113883.3.526.3.362)
- valueset "Atrioventricular Block" (2.16.840.1.113883.3.526.3.367)
- valueset "Beta Blocker Therapy for LVSD" (2.16.840.1.113883.3.526.3.1184)
- valueset "Beta Blocker Therapy Ingredient" (2.16.840.1.113883.3.526.3.1493)
- valueset "Bradycardia" (2.16.840.1.113883.3.526.3.412)
- valueset "Cardiac Pacer" (2.16.840.1.113762.1.4.1178.53)
- valueset "Cardiac Pacer in Situ" (2.16.840.1.113883.3.526.3.368)
- valueset "Care Services in Long Term Residential Facility" (2.16.840.1.113883.3.464.1003.101.12.1014)
- valueset "Ejection Fraction" (2.16.840.1.113883.3.526.3.1134)
- valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
- valueset "Heart Failure" (2.16.840.1.113883.3.526.3.376)
- valueset "Heart Rate" (2.16.840.1.113883.3.526.3.1176)
- valueset "Heart Transplant" (2.16.840.1.113762.1.4.1178.33)
- valueset "Heart Transplant Related Diagnoses" (2.16.840.1.113762.1.4.1178.56)
- valueset "Home Healthcare Services" (2.16.840.1.113883.3.464.1003.101.12.1016)
- valueset "Hypotension" (2.16.840.1.113883.3.526.3.370)
- valueset "Intolerance to Beta Blocker Therapy" (2.16.840.1.113883.3.526.3.1178)
- valueset "Left Ventricular Assist Device Placement" (2.16.840.1.113762.1.4.1178.61)
- valueset "Left Ventricular Assist Device Related Diagnoses" (2.16.840.1.113762.1.4.1178.58)
- valueset "Medical Reason" (2.16.840.1.113883.3.526.3.1007)
- valueset "Moderate or Severe" (2.16.840.1.113883.3.526.3.1092)
- valueset "Moderate or Severe LVSD" (2.16.840.1.113883.3.526.3.1090)
- valueset "Nursing Facility Visit" (2.16.840.1.113883.3.464.1003.101.12.1012)
- valueset "Office Visit" (2.16.840.1.113883.3.464.1003.101.12.1001)
- valueset "ONC Administrative Sex" (2.16.840.1.113762.1.4.1)
- valueset "Outpatient Consultation" (2.16.840.1.113883.3.464.1003.101.12.1008)
- valueset "Patient Provider Interaction" (2.16.840.1.113883.3.526.3.1012)
- valueset "Patient Reason" (2.16.840.1.113883.3.526.3.1008)
- valueset "Payer" (2.16.840.1.114222.4.11.3591)
- valueset "Race" (2.16.840.1.114222.4.11.836)

### Data Criteria (QDM Data Elements)

- "Allergy/Intolerance: Beta Blocker Therapy Ingredient" using "Beta Blocker Therapy Ingredient (2.16.840.1.113883.3.526.3.1493)"
- "Allergy/Intolerance: Substance with beta adrenergic receptor antagonist mechanism of action (substance)" using "Substance with beta adrenergic receptor antagonist mechanism of action (substance) (SNOMEDCT Code 373254001)"
- "Diagnosis: Allergy to Beta Blocker Therapy" using "Allergy to Beta Blocker Therapy (2.16.840.1.113883.3.526.3.1177)"
- "Diagnosis: Arrhythmia" using "Arrhythmia (2.16.840.1.113883.3.526.3.366)"
- "Diagnosis: Asthma" using "Asthma (2.16.840.1.113883.3.526.3.362)"
- "Diagnosis: Atrioventricular Block" using "Atrioventricular Block (2.16.840.1.113883.3.526.3.367)"
- "Diagnosis: Bradycardia" using "Bradycardia (2.16.840.1.113883.3.526.3.412)"
- "Diagnosis: Cardiac Pacer in Situ" using "Cardiac Pacer in Situ (2.16.840.1.113883.3.526.3.368)"
- "Diagnosis: Heart Failure" using "Heart Failure (2.16.840.1.113883.3.526.3.376)"
- "Diagnosis: Heart Transplant Related Diagnoses" using "Heart Transplant Related Diagnoses (2.16.840.1.113762.1.4.1178.56)"
- "Diagnosis: Hypotension" using "Hypotension (2.16.840.1.113883.3.526.3.370)"
- "Diagnosis: Intolerance to Beta Blocker Therapy" using "Intolerance to Beta Blocker Therapy (2.16.840.1.113883.3.526.3.1178)"
- "Diagnosis: Left Ventricular Assist Device Related Diagnoses" using "Left Ventricular Assist Device Related Diagnoses (2.16.840.1.113762.1.4.1178.58)"
- "Diagnosis: Left ventricular systolic dysfunction (disorder)" using "Left ventricular systolic dysfunction (disorder) (SNOMEDCT Code 134401001)"
- "Diagnosis: Moderate or Severe LVSD" using "Moderate or Severe LVSD (2.16.840.1.113883.3.526.3.1090)"
- "Diagnostic Study, Performed: Ejection Fraction" using "Ejection Fraction (2.16.840.1.113883.3.526.3.1134)"
- "Encounter, Performed: Care Services in Long Term Residential Facility" using "Care Services in Long Term Residential Facility (2.16.840.1.113883.3.464.1003.101.12.1014)"
- "Encounter, Performed: Home Healthcare Services" using "Home Healthcare Services (2.16.840.1.113883.3.464.1003.101.12.1016)"
- "Encounter, Performed: Nursing Facility Visit" using "Nursing Facility Visit (2.16.840.1.113883.3.464.1003.101.12.1012)"
- "Encounter, Performed: Office Visit" using "Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001)"
- "Encounter, Performed: Outpatient Consultation" using "Outpatient Consultation (2.16.840.1.113883.3.464.1003.101.12.1008)"
- "Encounter, Performed: Patient Provider Interaction" using "Patient Provider Interaction (2.16.840.1.113883.3.526.3.1012)"
- "Medication, Active: Beta Blocker Therapy for LVSD" using "Beta Blocker Therapy for LVSD (2.16.840.1.113883.3.526.3.1184)"
- "Medication, Not Ordered: Beta Blocker Therapy for LVSD" using "Beta Blocker Therapy for LVSD (2.16.840.1.113883.3.526.3.1184)"
- "Medication, Order: Beta Blocker Therapy for LVSD" using "Beta Blocker Therapy for LVSD (2.16.840.1.113883.3.526.3.1184)"
- "Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity (2.16.840.1.114222.4.11.837)"
- "Patient Characteristic Payer: Payer" using "Payer (2.16.840.1.114222.4.11.3591)"
- "Patient Characteristic Race: Race" using "Race (2.16.840.1.114222.4.11.836)"
- "Patient Characteristic Sex: ONC Administrative Sex" using "ONC Administrative Sex (2.16.840.1.113762.1.4.1)"
- "Physical Exam, Performed: Heart Rate" using "Heart Rate (2.16.840.1.113883.3.526.3.1176)"
- "Procedure, Performed: Cardiac Pacer" using "Cardiac Pacer (2.16.840.1.113762.1.4.1178.53)"
- "Procedure, Performed: Heart Transplant" using "Heart Transplant (2.16.840.1.113762.1.4.1178.33)"
- "Procedure, Performed: Left Ventricular Assist Device Placement" using "Left Ventricular Assist Device Placement (2.16.840.1.113762.1.4.1178.61)"

### Supplemental Data Elements

- SDE Ethnicity

  - -     ["Patient Characteristic Ethnicity": "Ethnicity"]

- SDE Payer

  - -     ["Patient Characteristic Payer": "Payer"]

- SDE Race

  - -     ["Patient Characteristic Race": "Race"]

- SDE Sex

  - -     ["Patient Characteristic Sex": "ONC Administrative Sex"]

### Risk Adjustment Variables

- None

Measure Set |
    None