Back to top
Top
U.S. flag

An official website of the United States government

Dot gov

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Https

Secure .gov websites use HTTPS
A lock ( ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) or Angiotensin Receptor-Neprilysin Inhibitor (ARNI) Therapy for Left Ventricular Systolic Dysfunction (LVSD)

Compare Versions of: "Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) or Angiotensin Receptor-Neprilysin Inhibitor (ARNI) Therapy for Left Ventricular Systolic Dysfunction (LVSD)"

The Compare function compares two years of the measure specifications found in the header of the measure's HTML. It does not include a comparison of any information in the body of the HTML, e.g., population criteria, Clinical Quality Language, or value sets.

Strikethrough text highlighted in red indicates information changed from the previous version. Text highlighted in green indicates information updated in the new eCQM version.

Compare version to

Measure Information 2022 Performance Period 2023 Performance Period 2024 Performance Period
Title Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) or Angiotensin Receptor-Neprilysin Inhibitor (ARNI) Therapy for Left Ventricular Systolic Dysfunction (LVSD) Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) or Angiotensin Receptor-Neprilysin Inhibitor (ARNI) Therapy for Left Ventricular Systolic Dysfunction (LVSD) Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) or Angiotensin Receptor-Neprilysin Inhibitor (ARNI) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
CMS eCQM ID CMS135v10 CMS135v11 CMS135v12
CBE ID 0081e 0081e 0081e
MIPS Quality ID 005 005 005
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 ACE inhibitor or ARB or ARNI therapy either within a 12-month period when seen in the outpatient setting OR at each hospital discharge

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 ACE inhibitor or ARB or ARNI therapy during the measurement period

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 ACE inhibitor or ARB or ARNI therapy during the measurement period

Definition *See CMS135v10.html *See CMS135v11.html

Prescribed - prescription given to the patient for ACE inhibitor or ARB or ARNI therapy at one or more visits in the measurement period OR patient already taking ACE inhibitor or ARB or ARNI therapy as documented in current medication list.

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.

Initial Population

All patients aged 18 years and older with a diagnosis of heart failure

All patients aged 18 years and older with two qualifying encounters during the measurement period and a diagnosis of heart failure

All patients aged 18 years and older with two qualifying encounters during the measurement period and a diagnosis of heart failure

Numerator

Patients who were prescribed ACE inhibitor or ARB or ARNI therapy either within a 12-month period when seen in the outpatient setting OR at each hospital discharge

Patients who were prescribed or already taking ACE inhibitor or ARB or ARNI therapy during the measurement period

Patients who were prescribed or already taking ACE inhibitor or ARB or ARNI therapy during the measurement period

Numerator Exclusions

Not Applicable

Not Applicable

Not Applicable

Denominator

Equals Initial Population with a current or prior LVEF < 40%

Equals Initial Population with a current or prior LVEF <= 40%

Equals Initial Population with a current or prior LVEF <= 40%

Denominator Exclusions

None

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

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

Denominator Exceptions

Documentation of medical reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., hypotensive patients who are at immediate risk of cardiogenic shock, hospitalized patients who have experienced marked azotemia, allergy, intolerance, other medical reasons).

Documentation of patient reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., patient declined, other patient reasons).

Documentation of system reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., other system reasons).

Documentation of medical reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., pregnancy, renal failure due to ACEI, allergy, intolerance, other medical reasons).

Documentation of patient reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., patient declined, other patient reasons).

Documentation of medical reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., pregnancy, renal failure due to ACEI, allergy, intolerance, other medical reasons).

Documentation of patient reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., patient declined, other patient reasons).

Measure Steward American Heart Association-American Stroke Association American Heart Association American Heart Association
Measure Scoring Proportion measure Proportion measure Proportion measure
Measure Type Process measure Process measure Process measure
Improvement Notation

Higher score indicates better quality

Higher score indicates better quality

Higher score indicates better quality

Guidance

This eCQM is to be reported as patient-based or episode-based, depending on the clinical setting. To satisfy this measure, it must be reported for all heart failure patients at least once during the measurement period if seen in the outpatient setting. If the patient has an eligible inpatient discharge during the measurement period, as defined in the measure logic, it is expected to be reported at each hospital discharge.

The requirement of two or more visits used in Population Criteria 1 is to establish that the eligible professional or eligible clinician has an existing relationship with the patient.

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

Eligible clinicians who have given a prescription for or whose patient is already taking an Angiotensin-Converting Enzyme Inhibitor (ACEI) or Angiotensin Receptor Blocker (ARB) would meet performance for this measure. Other combination therapies that consist of an ACEI plus diuretic, ARB + neprilysin inhibitor (ARNI), ARB plus diuretic, ACEI plus calcium channel blocker, ARB plus calcium channel blocker, or ARB plus calcium channel blocker plus diuretic would also meet performance for this measure.

This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.

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 if seen in the outpatient setting.

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

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.

Eligible clinicians who have given a prescription for or whose patient is already taking an Angiotensin-Converting Enzyme Inhibitor (ACEI) or Angiotensin Receptor Blocker (ARB) would meet performance for this measure. Other combination therapies that consist of an ACEI plus diuretic, ARB + neprilysin inhibitor (ARNI), ARB plus diuretic, ACEI plus calcium channel blocker, ARB plus calcium channel blocker, or ARB plus calcium channel blocker plus diuretic would also meet performance for this measure.

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

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.

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

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.

In order for the Ejection Fraction result pathway to be recognized as below 40%, the result must be reported as a number with unit of %. A text string of "below 40%" or "ejection fraction between 35 and 40%" will not be recognized through electronic data capture. Although, this criteria can also be met using the Diagnosis pathway if specified as "Moderate or Severe."

Eligible clinicians who have given a prescription for or whose patient is already taking an Angiotensin-Converting Enzyme Inhibitor (ACEI) or Angiotensin Receptor Blocker (ARB) would meet performance for this measure. Other combination therapies that consist of an ACEI plus diuretic, ARB + neprilysin inhibitor (ARNI), ARB plus diuretic, ACEI plus calcium channel blocker, ARB plus calcium channel blocker, or ARB plus calcium channel blocker plus diuretic would also meet performance for this measure.

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

Telehealth Eligible Yes Yes Yes
Rationale *See CMS135v10.html *See CMS135v11.html

Use of ACE inhibitor, ARB, or ARNI therapy has been associated with improved outcomes in patients with reduced LVEF. Long-term therapy with ARBs have also been shown to reduce morbidity and mortality, especially in ACE inhibitor–intolerant patients. More recently, ARNI therapy has also been shown to more significantly improve outcomes, such that the newest guidelines recommend replacement of ACE inhibitors or ARBs with ARNI therapy in eligible patients. However, despite the benefits of these drugs, use of ACE inhibitor, ARB, or ARNI remains suboptimal.

Stratification *See CMS135v10.html *See CMS135v11.html

None

Risk Adjustment *See CMS135v10.html *See CMS135v11.html

None

Clinical Recommendation Statement *See CMS135v10.html *See CMS135v11.html

In patients with Heart Failure with Reduced Ejection Fraction (HFrEF) and New York Heart Association (NYHA) class II to III symptoms, the use of ARNI is recommended to reduce morbidity and mortality (Class I, Level of Evidence A) (ACC/AHA/HFSA, 2022).

In patients with previous or current symptoms of chronic HFrEF, the use of ACEi is beneficial to reduce morbidity and mortality when the use of ARNI is not feasible (Class I, Level of Evidence A) (ACC/AHA/HFSA, 2022).

In patients with previous or current symptoms of chronic HFrEF who are intolerant to ACEi because of cough or angioedema and when the use of ARNI is not feasible, the use of ARB is recommended to reduce morbidity and mortality. (Class I, Level of Evidence A) (ACC/AHA/HFSA, 2022).

In patients with chronic symptomatic HFrEF NYHA class II or III who tolerate an ACEi or ARB, replacement by an ARNI is recommended to further reduce morbidity and mortality (Class I, Level of Evidence B-R) (ACC/AHA/HFSA, 2022).

ARNI should not be administered concomitantly with ACEi or within 36 hours of the last dose of an ACEi (Class II: Harm, Level of Evidence B-R) (ACC/AHA/HFSA, 2022).

ARNI should not be administered to patients with any history of angioedema (Class III: Harm, Level of Evidence C-LD) (ACC/AHA/HFSA, 2022).

ACEi should not be administered to patients with any history of angioedema (Class III: Harm, Level of Evidence C-LD) (ACC/AHA/HFSA, 2022).

Drugs Commonly Used for Stage C HFrEF (abbreviated to align with focus of measure to include only ACE inhibitors, ARB and ARNI therapy)

Drug Initial Daily Dose(s) Target Dose(s) Mean Doses Achieved in

Clinical Trials

ACEi

Captopril 6.25 mg 3 times 50 mg 3 times 122.7 mg total daily

Enalapril 2.5 mg twice 10 to 20 mg twice 16.6 mg total daily

Fosinopril 5 to 10 mg once 40 mg once N/A

Lisinopril 2.5 to 5 mg once 20 to 40 mg once 32.5 to 35.0 mg total daily

Perindopril 2 mg once 8 to 16 mg once N/A

Quinapril 5 mg twice 20 mg twice N/A

Ramipril 1.25 to 2.5 mg once 10 mg once N/A

Trandolapril 1 mg once 4 mg once N/A

ARB

Candesartan 4 to 8 mg once 32 mg once 24 mg total daily

Losartan 25 to 50 mg once 50 to 150 mg once 129 mg total daily

Valsartan 20 to 40 mg twice 160 mg twice 254 mg total daily

ARNI

Sacubitril- 49/51 mg twice 97/103 mg twice 182/193 mg

valsartan (sacubitril/valsartan) (sacubitril/valsartan) (sacubitril/valsartan) total

(therapy may be initiated daily

at 24/26 mg twice)

Next Version No Version Available
Previous Version No Version Available
Specifications
Attachment Size
CMS135v11.html 86.94 KB
CMS135v11.zip 84.53 KB
CMS135v11-TRN.xlsx 22.43 KB
eCQM Jira Issue Tracker
*Note there may be more tickets in the eCQM Tracker - ONC Project Tracking System (Jira) for this measure. Only tickets tagged with their associated CMS measure ID appear.

Header

  • Updated name of measure steward.

    Measure Section: Measure Steward

    Source of Change: Measure Lead

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated disclaimer.

    Measure Section: Disclaimer

    Source of Change: Standards/Technical Update

  • Updated rationale to align with most recent guidelines.

    Measure Section: Rationale

    Source of Change: Measure Lead

  • Update clinical recommendation statement to align with most recent guidelines.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Updated version number of the Quality Data Model (QDM) used in the measure specification to v5.6.

    Measure Section: Guidance

    Source of Change: Standards/Technical Update

  • Updated guidance to spell out first use of abbreviations for clarity and consistency.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Updated initial population statement to align with measure logic requiring at least two qualifying encounters.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Updated the denominator statement to include patients with a left ventricular ejection fraction (LVEF) less than or equal to 40% to align with clinical guidelines.

    Measure Section: Denominator

    Source of Change: Measure Lead

  • Added denominator exclusions for patients with a history of heart transplant or with a Left Ventricular Assist Device (LVAD), because these patients were not included in clinical treatment trials for low LVEF heart failure.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Updated the numerator statement to more closely align with measure logic.

    Measure Section: Numerator

    Source of Change: Measure Lead

  • Removed system reason denominator exception due to wide-availability of medications.

    Measure Section: Denominator Exceptions

    Source of Change: Measure Lead

  • Updated denominator exception statement to better align with specific medical conditions in the logic.

    Measure Section: Denominator Exceptions

    Source of Change: Measure Lead

  • Removed Population 2, the inpatient population, from the measure to address implementer feedback and keep measure intent contained to the outpatient setting.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Revised language to harmonize with other measures.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

Logic

  • Updated the logic to include an LVEF less than or equal to 40% to align with clinical guidelines.

    Measure Section: Denominator

    Source of Change: Measure Lead

  • Added denominator exclusions to the logic excluding patients with a history of heart transplant or a Left Ventricular Assist Device (LVAD), heart transplant-related diagnoses, and LVAD-related diagnoses, because these patients were not included in clinical treatment trials for low LVEF heart failure.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Removed system reason denominator exception due to wide-availability of medications.

    Measure Section: Denominator Exceptions

    Source of Change: Measure Lead

  • Updated encounter logic definition name by adding 'History of' to align with intent of capturing patients with a history of left ventricular systolic dysfunction (LVSD).

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Removed Population 2, the inpatient population, from the measure to address implementer feedback and keep measure intent contained to the outpatient setting.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Replaced the Global.CalendarAgeInYearsAt function with the native CQL function AgeInYearsAt to take advantage of existing CQL features and increase human readability. As a result of this change, the LOINC code 21112-8 is no longer required and has been removed from the Terminology section of the human readable specification.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.

    Measure Section: Multiple Sections

    Source of Change: Standards/Technical Update

  • Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v7.0.000.

    Measure Section: Multiple Sections

    Source of Change: Standards/Technical Update

  • Updated the version of the Quality Data Model (QDM) to 5.6 and Clinical Quality Language (CQL) to 1.5.

    Measure Section: Multiple Sections

    Source of Change: Standards/Technical Update

Value set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

  • Value set Medical Reason (2.16.840.1.113883.3.526.3.1007): Deleted 1 SNOMED CT code (397745006) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Ejection Fraction (2.16.840.1.113883.3.526.3.1134): Added 3 LOINC codes (93644-3, 93645-0, 93646-8) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set ACE Inhibitor or ARB Ingredient (2.16.840.1.113883.3.526.3.1489): Added 2 RxNorm codes (1091643, 1656328) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set ACE Inhibitor or ARB or ARNI (2.16.840.1.113883.3.526.3.1139): Added 7 RxNorm codes (1798281, 1806884, 251856, 251857, 401965, 401968, 1996254) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Removed value set System Reason (2.16.840.1.113883.3.526.3.1009) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Left Ventricular Assist Device Related Diagnoses (2.16.840.1.113762.1.4.1178.58) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Left Ventricular Assist Device Placement (2.16.840.1.113762.1.4.1178.61) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Removed direct reference code LOINC code (21112-8) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Heart Transplant Related Diagnoses (2.16.840.1.113762.1.4.1178.56) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Heart Transplant (2.16.840.1.113762.1.4.1178.33) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Removed value set Discharge Services - Hospital Inpatient (2.16.840.1.113883.3.464.1003.101.12.1007) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Replaced value set Renal Failure Due to ACE Inhibitor (2.16.840.1.113883.3.526.3.1151) with direct reference code SNOMED CT code (422593004) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Mar 04, 2024