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

Last updated: October 25, 2017

CMS Measure ID: CMS135v6
Version: 6
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: PCPI(R) Foundation (PCPI[R])
Domain: Effective Clinical Care
Previous Version: Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
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 Encounter, Performed 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.

Addendum Notes: Value Set content updated Sept 2017

Specifications

Release Notes

Header

  • ​Incremented eMeasure Version number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

  • Reverted to the parent NQF Number, 0081, for CMS documentation per guidance from National Quality Forum.

    Measure Section: NQF Number

    Source of Change: Measure Lead

  • ​Updated Copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • ​Updated Disclaimer.

    Measure Section: Disclaimer

    Source of Change: Measure Lead

  • Updated Guidance.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Added Guidance to provide clarification on what threshold range value(s) would satisfy the logic requirement for 'Ejection Fraction.'.

    Measure Section: Guidance

    Source of Change: Measure Lead

Logic

  • Replaced value set ACE Inhibitor or ARB Ingredient (2.16.840.1.113883.3.526.3.1489) with value set ACE Inhibitor or ARB (2.16.840.1.113883.3.526.3.1139) in the 'Medication, Order not done' logic. As a result, the Data Criteria (QDM Data Element) 'Medication, Order: ACE Inhibitor or ARB Ingredient' has been removed.

    Measure Section: Denominator Exceptions

    Source of Change: JIRA (CQM-1812)

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 term types BN, PIN, and MIN from value set ACE Inhibitor or ARB Ingredient (2.16.840.1.113883.3.526.3.1489) value set.

    Measure Section: QDM Data Elements

    Source of Change: JIRA (CQM-1812)

  • Value set Patient Reason (2.16.840.1.113883.3.526.3.1008): Added 1 SNOMEDCT code (713247000) and deleted 1 SNOMEDCT code (258147002).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Ejection Fraction (2.16.840.1.113883.3.526.3.1134): Added 8 LOINC codes (77889-4, 77890-2, 77891-0, 77892-8, 79990-8, 79991-6, 79992-4, 79993-2).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set ACE Inhibitor or ARB Ingredient (2.16.840.1.113883.3.526.3.1489): Deleted 68 RXNORM codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Pregnancy (2.16.840.1.113883.3.526.3.378): Removed ICD-9 extensional value set (2.16.840.1.113883.3.526.2.243).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set ACE Inhibitor or ARB (2.16.840.1.113883.3.526.3.1139): Deleted 10 RXNORM codes (1011718, 1011729, 199850, 199919, 251856, 310139, 401965, 401968, 858618, 858621).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

  • Value set Allergy to ACE Inhibitor or ARB (2.16.840.1.113883.3.526.3.1211): Added 1 SNOMEDCT code (609534005) and deleted 1 SNOMEDCT code (295050005).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

  • Value set Heart Failure (2.16.840.1.113883.3.526.3.376): Added 9 ICD10CM codes (I50.810, I50.811, I50.812, I50.813, I50.814, I50.82, I50.83, I50.84, I50.89).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

  • Value set Pregnancy (2.16.840.1.113883.3.526.3.378): Added 12 ICD10CM codes.

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

External Resources