Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)

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Measure Information	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)
CMS eCQM ID	CMS144v11	CMS144v12	CMS144v13
CBE ID*	0083e	0083e	0083e
MIPS Quality ID	008	008	008
Measure Steward	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 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
Measure Type	Process	Process	Process
Stratification	*See CMS144v11.html	None	None
Risk Adjustment	*See CMS144v11.html	None	None
Rationale	*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. Show more > 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. Show less	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. Show more > 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. Show less
Clinical Recommendation Statement	*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) Show more > 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) Show less	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) Show more > 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) Show less
Improvement Notation	Higher score indicates better quality	Higher score indicates better quality	Higher score indicates better quality
Definition	*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. Show more > 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. Show less	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. Show more > 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. Show less
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 QDM page for more information on the QDM. Show more > 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. Show less	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. Show more > 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. Show less	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. Show more > 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. Show less
Initial Population	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%
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	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 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
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). Documentat... ion of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient declined, other patient reasons) Show more > 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) Show less	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). Documentat... ion of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient declined, other patient reasons). Show more > 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). Show less	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). Documentat... ion of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient declined, other patient reasons). Show more > 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). Show less
Telehealth Eligible	Yes	Yes	Yes
Next Version	CMS144v12	CMS144v13	No Version Available
Previous Version	No Version Available	CMS144v11	CMS144v12

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CMS144v13-TRN.xlsx

Header

Updated the eCQM version number.
Measure Section:
eCQM Version Number
Source of Change:
Annual Update
Changed all references from NQF to CBE to identify the consensus-based entity role.
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CBE Number
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Annual Update
Updated copyright.
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Copyright
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Annual Update
Updated disclaimer.
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Disclaimer
Source of Change:
Annual Update
Updated Guidance to remove any instances of 'Eligible Professional(s)' to align with other eCQMs.
Measure Section:
Guidance
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Measure Lead
Updated grammar, wording, and/or formatting to improve readability and consistency.
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Multiple Sections
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Annual Update
Updated references and measure header to reflect current evidence and new or updated literature.
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Multiple Sections
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Measure Lead

Logic

Renamed value set to 'Payer Type' to more accurately reflect the contents and intent of the value set.
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Definitions
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Standards/Technical Update
Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.
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Definitions
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Standards/Technical Update
Updated the version number of the HFCommonDefinitions library to v3.0.000 and the library name from 'HFCommonDefinitions' to 'HFCommonDefinitionsQDM.'
Measure Section:
Definitions
Source of Change:
Annual Update
Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v8.0.000 and the library name from 'MATGlobalCommonFunctions' to 'MATGlobalCommonFunctionsQDM.'
Measure Section:
Definitions
Source of Change:
Annual Update
Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v8.0.000 and the library name from 'MATGlobalCommonFunctions' to 'MATGlobalCommonFunctionsQDM.'
Measure Section:
Functions
Source of Change:
Annual Update
Updated the version number of the HFCommonDefinitions library to v3.0.000 and the library name from 'HFCommonDefinitions' to 'HFCommonDefinitionsQDM.'
Measure Section:
Functions
Source of Change:
Annual 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 Arrhythmia (2.16.840.1.113883.3.526.3.366): Deleted 1 SNOMED CT code (251166008) based on terminology update.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set Asthma (2.16.840.1.113883.3.526.3.362): Added 2 SNOMED CT codes (10674791000119101, 10676271000119104) based on terminology update. Deleted 1 SNOMED CT code (424199006) based on terminology update.
Measure Section:
Terminology
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Annual Update
Value set Beta Blocker Therapy Ingredient (2.16.840.1.113883.3.526.3.1493): Added 3 RxNorm codes (10824, 1813, 49737) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead
Value set Bradycardia (2.16.840.1.113883.3.526.3.412): Added 1 SNOMED CT code (444605001) based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
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Measure Lead
Value set Cardiac Pacer (2.16.840.1.113762.1.4.1178.53): Added 2 SNOMED CT codes (1231779006, 1234788003) based on terminology update.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set Care Services in Long Term Residential Facility (2.16.840.1.113883.3.464.1003.101.12.1014): Deleted 9 CPT codes (99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Value set Heart Rate (2.16.840.1.113883.3.526.3.1176): Added 1 LOINC code (11328-2) based on applicability of value set and/or OID.
Measure Section:
Terminology
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Annual Update
Value set Heart Transplant Complications (2.16.840.1.113762.1.4.1178.56): Added 1 SNOMED CT code (12224461000119108) based on terminology update.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set Home Healthcare Services (2.16.840.1.113883.3.464.1003.101.12.1016): Deleted 1 CPT code (99343) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead
Value set Nursing Facility Visit (2.16.840.1.113883.3.464.1003.101.12.1012): Deleted 1 CPT code (99318) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead
Value set Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001): Deleted 2 SNOMED CT codes (30346009, 37894004) based on review by technical experts, SMEs, and/or public feedback. Deleted 1 CPT code (99201) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead
Value set Outpatient Consultation (2.16.840.1.113883.3.464.1003.101.12.1008): Deleted 1 CPT code (99241) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead
Value set (2.16.840.1.114222.4.11.3591): Renamed to Payer Type based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update