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

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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	CMS144v11	CMS144v12	CMS144v13	No Version Available
Previous Version	No Version Available	CMS144v10	CMS144v11	CMS144v12

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Specifications

Additional Resources for CMS144v10

CMS144v10-TRN.xlsx

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
Updated references.
Measure Section: Reference
Source of Change: Annual Update
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
Updated timing logic so that cardiac pacers in existence before the index encounter are considered for the denominator exception.
Measure Section: Denominator Exceptions
Source of Change: ONC Project Tracking System (Jira): QRDA-964
Updated Outpatient Encounter definitions to remove 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.

Removed value set Left Ventricular Systolic Dysfunction (2.16.840.1.113883.3.526.3.1091) based on applicability of a single code to represent clinical data.
Measure Section: Terminology
Source of Change: Annual Update
Value set Atrioventricular Block (2.16.840.1.113883.3.526.3.367): Added 4 SNOMED CT codes (102451000119107, 204383001, 284941000119107, 733125004) based on review by technical experts, SMEs, and/or public feedback. Added 3 ICD-10-CM codes (I44.0, I44.30, I44.39) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Cardiac Pacer in Situ (2.16.840.1.113883.3.526.3.368): Added 1 ICD-10-CM code (Z95.810) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
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
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