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

Last updated: May 9, 2019

CMS Measure ID: CMS135v8
Version: 8
NQF Number: 81e
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 or ARNI 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 or ARNI 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 or ARNI therapy (e.g., 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 or ARNI therapy (e.g., patient declined, other patient reasons).

Documentation of system reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., other system reasons).

Measure Steward: PCPI(R) Foundation (PCPI[R])
Domain: Effective Clinical Care
Previous Version:
Measure Scoring: Proportion
Measure Type: Process
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: 005
Meaningful Measure: Management of Chronic Conditions

Specifications

Release Notes

Header

  • Updated header statements to include ARNI therapy to align with previous and current measure specificationinfo-icon and guidance.

    Measure Section: eCQMinfo-icon Title

    Source of Change: Measure Lead

  • Updated eCQM version number.

    Measure Section: eCQM Version number

    Source of Change: Measure Lead

  • Added 'e' to NQFinfo-icon number.

    Measure Section: NQF Number

    Source of Change: Standards Update

  • Updated header statements to include ARNI therapy to align with previous and current measure specification and guidance.

    Measure Section: Description

    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 header statements to include ARNI therapy to align with previous and current measure specification and guidance.

    Measure Section: Rate Aggregation

    Source of Change: Measure Lead

  • Updated clinical recommendation statement to align with current guidelines.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Updated references to align with American Psychological Association (APA) style.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Updated references.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Updated header statements to include ARNI therapy to align with previous and current measure specification and guidance.

    Measure Section: Definition

    Source of Change: Measure Lead

  • Updated header statements to include ARNI therapy to align with previous and current measure specification and guidance.

    Measure Section: Numeratorinfo-icon

    Source of Change: Measure Lead

  • Updated header statements to include ARNI therapy to align with previous and current measure specification and guidance.

    Measure Section: Denominator Exceptionsinfo-icon

    Source of Change: Measure Lead

  • Updated parenthetical citations to align with American Psychological Association (APA) style.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

Logic

  • In Population Criteria 2, replaced Quality Data Model (QDM)info-icon datatype 'Medication, Order' with 'Medication, Discharge' to improve alignmentinfo-icon with measure intent in capturing medication at inpatient discharge.

    Measure Section: Numerator

    Source of Change: Measure Lead

  • Added ‘Patient Reason for ACE Inhibitor or ARB Decline’ value setinfo-icon (2.16.840.1.113883.3.526.3.1140) as a negation rationale attribute in ‘Medical Patient or System Reason for Not Ordering ACEI or ARB or ARNI Outpatient’ and ‘Medical Patient or System Reason for No ACEI or ARB or ARNI at Inpatient Discharge’ definitions for consistency in capturing a patient reason denominator exceptioninfo-icon.

    Measure Section: Denominator Exceptions

    Source of Change: Standards Update

  • In Population Criteria 2, replaced Quality Data Model (QDM) datatype 'Medication, Not Ordered' with 'Medication, Not Discharged' to improve alignment with measure intent.

    Measure Section: Denominator Exceptions

    Source of Change: Measure Lead

  • Revised applicable definition titles to reflect modified Quality Data Model (QDM) 'Medication' datatype used within Population Criteria 2 Numerator and Denominator Exceptions.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Removed ‘Patient Declined ACE Inhibitor or ARB Inpatient’ and ‘Patient Declined ACE Inhibitor or ARB Outpatient’ definitions due to a change in how the value set is applied to the denominator exception.

    Measure Section: Definitions

    Source of Change: Standards Update

  • Updated the names of Clinical Quality Language (CQL)info-icon definitions, functions, and/or aliases for clarification and to align with CQL Style Guideinfo-icon.

    Measure Section: Definitions and Functions

    Source of Change: Standards Update

  • Updated Clinical Quality Language (CQL) expression to conform with the HL7info-icon Standard: Clinical Quality Language Specification, Release 1 STUinfo-icon 3 (CQL 1.3).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated definitions and functions in the Measure Authoring Tool (MATinfo-icon) Global Common Functions Library to align with standards changes, Clinical Quality Language (CQL) Style Guide, and to include two new functions related to calculating hospital stays.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-4.0.000).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

Value Set

The VSACinfo-icon is the source of truth for the value set content, please visit the VSAC for downloads of current value setsinfo-icon.

  • Value set Patient Provider Interaction (2.16.840.1.113883.3.526.3.1012): Deleted 6 SNOMED CT codes (12843005, 18170008, 19681004, 207195004, 4525004, 439708006).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Heart Failure (2.16.840.1.113883.3.526.3.376): Deleted 4 ICD-10-CM codes (I50.810, I50.811, I50.812, I50.813). Added 33 SNOMED CT codes and deleted 10 SNOMED CT codes (10335000, 128404006, 277639002, 359617009, 367363000, 426012001, 5053004, 60856006, 66989003, 80479009).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Direct reference code for Birth date (LOINC Code (21112-8)) now displayed in Human Readable.

    Measure Section: Terminology

    Source of Change: Annual Update

  • ​Removed code systeminfo-icon versions from direct reference codes. Please refer to Appendix A of the Electronic Clinical Quality Measureinfo-icon Logic and Implementation Guidance document for a list of code system versions used in the eCQM specificationsinfo-icon for 2020 reporting/performance.

    Measure Section: Terminology

    Source of Change: Standards Update

  • Standardized purpose statement language in value sets across eCQMsinfo-icon. Value set purpose statements are visible in the Value Set Authority Center (VSAC) as well as the downloadable eCQM value set files.

    Measure Section: Terminology

    Source of Change: Measure Lead

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