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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 2026 version to

Table Options
Measure Information 2026 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)
CMS eCQM ID CMS135v14
CBE ID* 0081e
MIPS Quality ID 005
Measure Steward 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 ACE inhibitor or ARB or ARNI therapy during the measurement period

Measure Scoring Proportion measure
Measure Type Process
Stratification

None

Risk Adjustment

None

Rationale

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...

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Clinical Recommendation Statement

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) (Heidenreich et al., 2022).

In patients with previous or...

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Improvement Notation

Higher score indicates better quality

Definition

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...

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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.

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

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Initial Population

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%

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 ACE inhibitor or ARB or ARNI therapy during the measurement period

Numerator Exclusions

None

Denominator Exceptions

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...

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Telehealth Eligible Yes
Next Version No Version Available
Previous Version

Header

TRN

Measure Section

Source of Change

Changed the 'eCQM Identifier (Measure Authoring Tool)' field name to 'CMS ID' based on tooling updates.

CMS ID

Standards/Technical Update

Updated the eCQM version number.

eCQM Version Number

Annual Update

Updated the generic measurement period from 'January 1, 20XX through December 31, 20XX' to specify 'January 1, 2026 through December 31, 2026' based on tooling updates.

Measurement Period

Standards/Technical Update

Removed 'PCPI(R) Foundation (PCPI[R])' as a Measure Developer to reflect active Measure Developers.

Measure Developer

Annual Update

Updated copyright.

Copyright

Annual Update

Updated disclaimer.

Disclaimer

Annual Update

Changed 'Numerator Exclusions' field to read 'None' instead of 'Not Applicable' when no exclusions are present.

Numerator Exclusions

Standards/Technical Update

Updated grammar, wording, and/or formatting to improve readability and consistency.

Multiple Sections

Annual Update

Logic

TRN

Measure Section

Source of Change

Updated Measure Primary CQL Library Name from 'HFACEIorARBorARNIforLVSD' to 'CMS135HFACEIorARBorARNIforLVSDQDM' for alignment with the CQL Style Guide.

Definitions

Standards/Technical Update

Updated the version number of the Global Common Functions Library to v9.0.000 and the library name from 'MATGlobalCommonFunctionsQDM' to 'CQMCommonQDM.'

Definitions

Annual Update

Updated the version number of the HFCommonDefinitionsQDM library to 5.0.000.

Definitions

Annual Update

Updated aliases for qualifying encounters 1-2 in 'Is Adults With Two Qualifying Outpatient Encounters and One Heart Failure Outpatient Encounter During the Measurement Period' definition in HFCommonDefinitionsQDM library for clarification. Changed alias for 'Encounter1' to 'InitialEncounter', and alias for 'Encounter2' to 'SubsequentEncounter.'

Definitions

Measure Lead

Updated CQL to include 'Has Medical or Patient Reason for Not Ordering ACEI or ARB or ARNI' logic directly in denominator exceptions definition due to MADiE tooling limitation. Next AU, we will be able change the CQL back so that we are referencing the definitions appropriately, as the MADiE tooling limitation will be remediated.

Definitions

ONC Project Tracking System (JIRA) : MADIE-2076

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

Definitions

Standards/Technical Update

Updated Measure Primary CQL Library Name from 'HFACEIorARBorARNIforLVSD' to 'CMS135HFACEIorARBorARNIforLVSDQDM' for alignment with the CQL Style Guide.

Functions

Standards/Technical Update

Updated the version number of the Global Common Functions Library to v9.0.000 and the library name from 'MATGlobalCommonFunctionsQDM' to 'CQMCommonQDM.'

Functions

Annual Update

Updated the version number of the HFCommonDefinitionsQDM library to 5.0.000.

Functions

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.

TRN

Measure Section

Source of Change

Value Set 'Ejection Fraction' (2.16.840.1.113883.3.526.3.1134): Added 24 LOINC codes (104145-8, 104146-6, 104147-4, 104148-2, 104149-0, 104150-8, 104151-6, 104152-4, 104153-2, 104154-0, 104155-7, 104157-3, 104243-1, 104244-9, 104245-6, 104246-4, 104247-2, 104251-4, 104252-2, 104253-0, 104254-8, 104255-5, 104256-3, 104258-9) based on code system/terminology updates.

Terminology

Annual Update

Value Set 'Heart Transplant Complications' (2.16.840.1.113762.1.4.1178.56): Added 3 SNOMEDCT codes (15960101000119104, 15960701000119100, 15960861000119108) based on code system/terminology updates. Added 6 SNOMEDCT codes (432843002, 431186002, 233934000, 432773004, 233933006, 431896008) based on SME/expert recommendations.

Terminology

Annual Update

Value Set 'Office Visit' (2.16.840.1.113883.3.464.1003.101.12.1001): Added 1 SNOMEDCT code (185349003) based on review by technical experts, SMEs and/or public feedback.

Terminology

Annual Update

Replaced Value Set 'ONC Administrative Sex' (2.16.840.1.113762.1.4.1) with Value Set 'Federal Administrative Sex' (2.16.840.1.113762.1.4.1021.121) to represent Supplemental Data Element 'SDE Sex' based on revised standards.

Terminology

Standards/Technical Update

Value Set 'Patient Reason' (2.16.840.1.113883.3.526.3.1008): Added 1 SNOMEDCT code (1296859006) based on code system/terminology updates. Added 1 SNOMEDCT code (31021000119100) based on public comment/implementer feedback. Deleted 2 SNOMEDCT codes (281399006, 105480006) based on code system/terminology updates.

Terminology

Annual Update

Value Set 'Pregnancy' (2.16.840.1.113883.3.526.3.378): Added 1 SNOMEDCT code (1290152008) based on code system/terminology updates. Deleted 1 SNOMEDCT code (237244005) based on code system/terminology updates.

Terminology

Annual Update

Last Updated: May 07, 2025