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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)

General eCQM Information

CMS Measure ID CMS135v10
NQF Number 0081e
Measure 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

Initial Population All patients aged 18 years and older with a diagnosis of heart failure
Denominator Statement

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

Denominator Exclusions

None

Numerator Statement

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

Numerator Exclusions

Not Applicable

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).

Measure Steward American Heart Association-American Stroke Association
Domain Effective Clinical Care
Measure Scoring Proportion
Measure Type Process
Improvement Notation

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 (https://ecqi.healthit.gov/qdm) for more information on the QDM.

Quality ID 5
Meaningful Measure Management of Chronic Conditions
Telehealth Eligible Yes
Previous Version

Release Notes

Header

  • Updated the eCQM version number.

    Measure Section: eCQM Version Number

    Source of Change: Annual Update

  • Updated Measure Steward.

    Measure Section: Measure Steward

    Source of Change: Measure Lead

  • Updated Measure Developer.

    Measure Section: Measure Developer

    Source of Change: Measure Lead

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated disclaimer.

    Measure Section: Disclaimer

    Source of Change: Annual Update

  • Added ARNI medications to the medication dosing table to align with guidelines and specification.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Updated definition pertaining to Moderate to Severe LVSD to better align with logic.

    Measure Section: Definition

    Source of Change: Annual Update

Logic

  • Updated the Heart Failure Outpatient Encounter with Moderate or Severe LVSD and Heart Failure Inpatient Encounter with Moderate or Severe LVSD denominator definitions' timing from 'before' to 'starts before' to align timing with intent.

    Measure Section: Denominator

    Source of Change: Annual Update

  • Removed 'Medication, Active' from Population 2 numerator definition to align with standard capture of discharge medications.

    Measure Section: Numerator

    Source of Change: Annual Update

  • Added timing element to Pregnancy Diagnosis definition to prevent previous pregnancies from being captured in the measure.

    Measure Section: Denominator Exceptions

    Source of Change: Annual Update

  • Updated Outpatient Encounter definitions and removed FaceToFaceEncounter language to signal broadening of encounter type.

    Measure Section: Definitions

    Source of Change: Annual Update

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

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-6.2.000). Updated the 'Inpatient Encounter' definition to include a 'day of' timing clarification. Added the following timing functions: Normalize Interval, Has Start, Has End, Latest, Latest Of, Earliest, and Earliest Of. Please see individual measure details for application of specific timing functions.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Added new NormalizeInterval function to timing attributes to decrease implementation burden due to variable use of timing attributes for select QDM data types. The NormalizeInterval function was applied, where applicable, for the following data elements: Assessment, Performed; Device, Applied; Diagnostic Study, Performed; Intervention, Performed; Laboratory Test, Performed; Medication, Administered; Medication, Dispensed; Physical Exam, Performed; Procedure, Performed; Substance, Administered.

    Measure Section: Multiple Sections

    Source of Change: Standards 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 ACE Inhibitor or ARB or ARNI (2.16.840.1.113883.3.526.3.1139): Deleted 9 RxNorm codes (199622, 199707, 199708, 199709, 199816, 199817, 411434, 858921, 199937) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Heart Failure (2.16.840.1.113883.3.526.3.376): Added 1 SNOMED CT code (871617000) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Pregnancy (2.16.840.1.113883.3.526.3.378): Added 77 ICD-10-CM codes based on review by technical experts, SMEs, and/or public feedback. Deleted 19 ICD-10-CM codes based on review by technical experts, SMEs, and/or public feedback. Deleted 24 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Replaced value set Left Ventricular Systolic Dysfunction (2.16.840.1.113883.3.526.2.859) with direct reference code SNOMED CT code (134401001) based on applicability of a single code to represent clinical data.

    Measure Section: Terminology

    Source of Change: Annual Update

Last Updated: Jul 28, 2021