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

Last updated: September 14, 2018

CMS Measure ID: CMS135v7
Version: 7
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 Populationinfo-icon 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:
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 two or more visits is to establish that the eligible professionalinfo-icon or eligible clinicianinfo-icon 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 denominatorinfo-icon logic. A range that is inclusive of or greater than 40% would not meet the measure requirement.

Eligible cliniciansinfo-icon 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.

Quality ID: 5
Meaningful Measure: Management of Chronic Conditions

Specifications

Release Notes

Header

  • Updated Version Number.

    Measure Section: eMeasure Version 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

  • Added Rate Aggregation instruction to highlight the difference between the two populations, which includes guidance on calculating a single performance rate.

    Measure Section: Rate Aggregation

    Source of Change: JIRAinfo-icon (CQMinfo-icon-2515)

  • ​​Updated Guidance statement regarding two or more visits to remove reference to QDMinfo-icon expression logic.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Added Guidance regarding combination therapies that will meet the intent of the measure.

    Measure Section: Guidance

    Source of Change: Expert Work Group Review

Logic

  • Updated timing operator to ensure that medication is active at the time of the end of the encounter.

    Measure Section: Numeratorinfo-icon

    Source of Change: Measure Lead

  • Added 'AuthorDateTime' attribute to QDM datatypes that include negation rationale: ‘Diagnostic, Performed’, ‘Intervention Performed’, ‘Encounter, Performed’, ‘Laboratory Test, Performed’, ‘Medication, Administered’, ‘Physical Exam, Performed’, ‘Procedure, Performed’, ‘Substance Administered’ to conform with QDM 5.3 changes.

    Measure Section: Denominator Exceptionsinfo-icon

    Source of Change: Standards Update

  • Updated timing operator to ensure that allergy or intolerance is active at the time of the end of the encounter.

    Measure Section: Denominator Exceptions

    Source of Change: Measure Lead

  • Replaced 'Allergy, Intolerance' datatypes with 'Allergy/Intolerance' category to conform with QDM 5.3 changes.

    Measure Section: Denominator Exceptions

    Source of Change: Standards Update

  • Split population criteria into two separate populations: patients who are seen in the outpatient setting, and patients at each hospital discharge. This will ensure measure performance is assessed at the appropriate types of encounters.

    Measure Section: Multiple Sections

    Source of Change: JIRA (CQM-2515)

  • Added supplemental timing attributes to most datatypes in QDM 5.3 to facilitate accurate retrieval of time related information within CQLinfo-icon logic. Timing attributes now include a time interval, such as prevalence period or relevant period, and/or actual time of documentation with Author Datetime. Relevant period is the general method to describe start and stop times for datatypes. Prevalence period is used for some datatypes to more accurately define onset and abatement times.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Assigned cardinality to each attribute to be more explicit in guiding specificationinfo-icon and implementation of QDM data elements. Cardinality refers to the number of instances of the attribute that can be included in the measure description. Cardinality for most attributes is 0.. 1 (i.e., can occur up to 1 time), but some attributes have a cardinality of 0.. * (i.e., can occur multiple times).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • CQL libraries contain sets of CQL definitions, or CQL expression statements. A context statement, patient or population, can now be used in a CQL library to clearly establish how the subsequent list of CQL expressions will be interpreted. A 'Population' context will interpret the CQL expression with reference to the entire population of the item being counted, patients or encounters. A 'Patient' context will interpret the CQL expression with reference to a single patient. Context statements are not required, but one or more context statements may be used within a library to help clarify how the CQL expressions will be interpreted. Patient context is the default if none is specified.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Removed the 'Face-To-Face Interaction' data element and added relevant SNOMED codes to the Encounter Grouping value setsinfo-icon to better align between the SNOMED and CPT encounter codes.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Replaced measure-defined definitions with similar definitions and functions from CQL shared libraries for consistency across measures.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated measure logic from Quality Data Model (QDM)-based logic to Clinical Quality Language (CQL)-based logic. Information on CQL can be found at the eCQI Resource centerinfo-icon (https://ecqi.healthit.gov/cql). Information about specific versions of the new standards in use for CMS reporting periods can be found at the eCQI Resource Center (https://ecqi.healthit.gov/ecqm-tools-key-resources). Switching from QDM to CQL brings with it many changes, as well as enhanced expression capability, but only those changes with significant impact will be outlined in technical release notes. For example, in the case of timing operators, changes may only be summarized if those changes impact the measure calculation.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

Value Setinfo-icon

The VSACinfo-icon 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 (2.16.840.1.113883.3.526.3.1139): Deleted 1 RXNORM code (247516).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001): Added SNOMEDCT extensional value set (2.16.840.1.113883.3.464.1003.101.11.1264) including 7 codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Outpatient Consultation (2.16.840.1.113883.3.464.1003.101.12.1008): Added SNOMEDCT extensional value set (2.16.840.1.113883.3.464.1003.101.11.1266) including 3 codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Nursing Facility Visit (2.16.840.1.113883.3.464.1003.101.12.1012): Added SNOMEDCT extensional value set (2.16.840.1.113883.3.464.1003.101.11.1261) including 2 codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Care Services in Long-Term Residential Facility (2.16.840.1.113883.3.464.1003.101.12.1014): Added SNOMEDCT extensional value set (2.16.840.1.113883.3.464.1003.101.11.1262) including 2 codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Home Healthcare Services (2.16.840.1.113883.3.464.1003.101.12.1016): Added SNOMEDCT extensional value set (2.16.840.1.113883.3.464.1003.101.11.1265) including 11 codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Patient Reason (2.16.840.1.113883.3.526.3.1008): Deleted 1 SNOMEDCT code (385648002).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Heart Failure (2.16.840.1.113883.3.526.3.376): Deleted 2 SNOMEDCT codes (359620001, 77737007).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Pregnancy (2.16.840.1.113883.3.526.3.378): Deleted 11 ICD10CM codes (O00.1, O00.10, O00.11, O00.2, O00.20, O00.21, O00.8, O00.9, O33.7, O34.21, Z36).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Payer (2.16.840.1.114222.4.11.3591): Added 11 SOP codes (299, 32127, 32128, 391, 517, 524, 614, 621, 622, 623, 629) and deleted 3 SOP codes (63, 64, 69).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Face-to-Face Interaction (2.16.840.1.113883.3.464.1003.101.12.1048): Removed Face-to-Face Interaction.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Payer (2.16.840.1.114222.4.11.3591): Deleted 1 SOP code (24).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

External Resources