Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)

Last updated: July 12, 2017

CMS Measure ID: CMS135v4
Version: 4
NQF Number: 0081
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 therapy either within a 12 month period when seen in the outpatient setting OR at each hospital discharge

Initial Patient 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 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 therapy (eg, 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 therapy (eg, patient declined, other patient reasons)
  • Documentation of system reason(s) for not prescribing ACE inhibitor or ARB therapy (eg, other system reasons)
Measure Steward: American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)
Domain: Effective Clinical Care
Next Version: Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
Previous Version: Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
Measure Score: Proportion
Improvement Notation:

Higher score indicates better quality

Guidance:

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 Count >=2 of Encounter, Performed is to establish that the eligible professional has an existing relationship with the patient.

Specifications

Release Notes

Header

  • Clinical Recommendation Statement updated.
  • Copyright updated.
  • Definition updated.
  • Disclaimer updated.
  • eMeasure version number incremented.
  • Guidance updated.
  • Reference updated.

Logic

  • Changed data type of 'result' or 'finding' to 'performed'.
  • Introduced occurrencing on variables to enforce that the same instance of a clinical event is used throughout the measure when the logic within the variable does not limit the event to a single instance, e.g., FIRST or MOST RECENT.
  • Introduced the new timing operator 'overlaps' to replace two lines of logic (AND/AND NOT) or to enforce when an event or set of events occur to meet the measure intent.
  • Introduced variable $HFEncounters135 to allow re-use of logical expressions and reduce redundancy/complexity .
  • Replaced 'ORs' with 'Union of' operator to provide a mechanism for specifying that qualifying event(s) must be a member of at least one of the data elements being unioned (if appropriate for measure intent).
  • Replaced 'Patient Characteristic Birthdate' with 'Age at' operator.
  • Replaced 'starts before or during' (SBOD) with 'starts before end of' (SBE).
  • The top level logical operator for the Numerator Exclusions, Denominator Exclusions, Denominator Exceptions, and Measure Population Exclusions defaults to 'OR'.

Value Sets

  • Value set ACE Inhibitor or ARB Ingredient (OID 2.16.840.1.113883.3.526.3.1489): Deleted 1 RXNORM code (864776).
  • Value set Patient Reason (OID 2.16.840.1.113883.3.526.3.1008): Deleted 1 SNOMED code (30164005).

External Resources