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Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF less than 40%)

General eCQM Information

CMS Measure ID CMS145v10
NQF Number 0070e
Measure Description

Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12-month period who also have a prior MI or a current or prior LVEF < 40% who were prescribed beta-blocker therapy

Initial Population All patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12-month period
Denominator Statement

Equals Initial Population who also have prior (within the past 3 years) MI or a current or prior LVEF <40%

Denominator Exclusions

None

Numerator Statement

Patients who were prescribed beta-blocker therapy

Numerator Exclusions

Not Applicable

Denominator Exceptions

Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., 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 health care system).

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

Beta-blocker therapy:

- For patients with prior MI, beta-blocker therapy includes any agent within the beta-blocker drug class. As of 2015, no recommendations or evidence are cited in current stable ischemic heart disease guidelines for preferential use of specific agents

- For patients with prior LVEF <40%, beta-blocker therapy includes the following: 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.

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.

If a patient has had a myocardial infarction (MI) within the past 3 years and a current or prior LVEF < 40% (or moderate or severe LVSD), the patient should only be counted in Population Criteria 1.

This eCQM is a patient-based 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 7
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

  • 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 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

  • Changed the timing of the check for moderate or severe LVSD in the Qualifying CAD Encounter and Moderate or Severe LVSD definition from ends to starts to account for end dates not often being documented.

    Measure Section: Multiple Sections

    Source of Change: ONC Project Tracking System (Jira): CQM-3890

  • Removed timing logic (minus one day) from the Qualifying CAD Encounter and Prior MI definition as it is no longer required due to another logic change.

    Measure Section: Multiple Sections

    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 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 Cardiac Surgery (2.16.840.1.113883.3.526.3.371): Added 3 SNOMED CT codes (67166004, 871496000, 871497009) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced value set Left Ventricular Systolic Dysfunction (2.16.840.1.113883.3.526.3.1091) 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

  • Value set Beta Blocker Therapy (2.16.840.1.113883.3.526.3.1174): Deleted 12 RxNorm codes (152916, 199277, 199494, 199495, 199717, 199786, 199787, 856713, 896983, 896987, 998693, 998695) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Coronary Artery Disease No MI (2.16.840.1.113883.3.526.3.369): Deleted 1 ICD-10-CM code (I24.1) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Aug 10, 2021