Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
Compare Versions of: "Heart Failure (HF): Beta-Blocker 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 | 2025 Performance Period |
|---|---|---|---|---|
| Title | Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) | Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) | Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) | Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) |
| CMS eCQM ID | CMS144v10 | CMS144v11 | CMS144v12 | CMS144v13 |
| CBE ID* | 0083e | 0083e | 0083e | 0083e |
| MIPS Quality ID | 008 | 008 | 008 | 008 |
| Measure Steward | American Heart Association-American Stroke Association | American Heart Association | American Heart Association | American Heart Association |
| 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 beta-blocker 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 beta-blocker 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 beta-blocker 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 beta-blocker therapy during the measurement period |
| Measure Scoring | Proportion measure | Proportion measure | Proportion measure | Proportion measure |
| Measure Type | Process | Process | Process | Process |
| Stratification | *See CMS144v10.html | *See CMS144v11.html |
None |
None |
| Risk Adjustment | *See CMS144v10.html | *See CMS144v11.html |
None |
None |
| Rationale | *See CMS144v10.html | *See CMS144v11.html |
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. |
Beta blockers improve survival and reduce hospitalization for patients with stable heart failure with reduced ejection fraction (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 | *See CMS144v10.html | *See CMS144v11.html |
In patients with HFrEF, with current or previous symptoms, use of 1 of the 3 beta blockers proven to reduce mortality (e.g., bisoprolol, carvedilol, sustained-release metoprolol succinate) is recommended to reduce mortality and hospitalizations (Class I, Level of Evidence A) (ACC/AHA/HFSA, 2022). 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) Target 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 25-50 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) |
In patients with HFrEF, with current or previous symptoms, use of 1 of the 3 beta blockers proven to reduce mortality (e.g., bisoprolol, carvedilol, sustained-release metoprolol succinate) is recommended to reduce mortality and hospitalizations (Class I, Level of Evidence A) (Heidenreich, 2022). 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) Target 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 25-50 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 |
Higher score indicates better quality |
Higher score indicates better quality |
Higher score indicates better quality |
| Definition | *See CMS144v10.html | *See CMS144v11.html |
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. |
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 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. 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. 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 used in Population Criteria 1 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 5.5. 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. 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 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. 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." 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 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. 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." 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 clinician has an existing relationship with the patient. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
| 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 |
All patients aged 18 years and older with two qualifying encounters during the measurement period and a diagnosis of heart failure on or before at least one qualifying encounter |
| 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% |
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 |
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 beta-blocker 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 beta-blocker therapy during the measurement period |
Patients who were prescribed or already taking beta-blocker therapy during the measurement period |
Patients who were prescribed or already taking beta-blocker therapy during the measurement period |
| Numerator Exclusions |
Not Applicable |
Not Applicable |
Not Applicable |
Not Applicable |
| Denominator Exceptions |
Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., low blood pressure, fluid overload, asthma, patients recently treated with an intravenous positive inotropic agent, allergy, intolerance, other medical reasons). Documentation of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient declined, other patient reasons). Documentation of system reason(s) for not prescribing beta-blocker therapy (e.g., other reasons attributable to the healthcare system). |
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) |
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). |
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). |
| Telehealth Eligible | Yes | Yes | Yes | Yes |
| Next Version | No Version Available | |||
| Previous Version | No Version Available |
Additional Resources for CMS144v11
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 references.
Measure Section: Reference
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 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
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
Replaced 'Device, Applied' with 'Procedure, Performed' in Cardiac Pacer Implanted expression to align with current QDM.
Measure Section: Denominator Exceptions
Source of Change: Measure Lead
Replaced timing operator 'overlaps after' with 'starts before end of' to allow use of 'NormalizeInterval' function, where applicable.
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
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
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
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
Added the 'NormalizeInterval' function to 'Procedure, Performed', 'Physical Exam, Performed', and 'Diagnosis' to decrease implementation burden due to variable use of timing attributes.
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
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 Cardiac Pacer in Situ (2.16.840.1.113883.3.526.3.368): Added 1 SNOMED CT code (443325000) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Bradycardia (2.16.840.1.113883.3.526.3.412): Added 2 SNOMED CT codes (1142110005, 1142111009) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Beta Blocker Therapy for LVSD (2.16.840.1.113883.3.526.3.1184): Added 4 RxNorm codes (1999031, 1999033, 1999035, 1999037) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Beta Blocker Therapy Ingredient (2.16.840.1.113883.3.526.3.1493): Added 2 RxNorm codes (31555, 9947) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Asthma (2.16.840.1.113883.3.526.3.362): Added 1 SNOMED CT code (762521001) based on terminology update. Deleted 2 SNOMED CT codes (304527002, 708038006) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Arrhythmia (2.16.840.1.113883.3.526.3.366): Added 26 SNOMED CT codes 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
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
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
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
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 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
Added value set Cardiac Pacer (2.16.840.1.113762.1.4.1178.53) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
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
Removed value set Cardiac Pacer (2.16.840.1.113883.3.526.3.1193) based on review by technical experts, SMEs, and/or public feedback.
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