Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)

Last updated: October 25, 2017

CMS Measure ID: CMS144v6
Version: 6
NQF Number: 0083
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 beta-blocker 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 beta-blocker 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 beta-blocker therapy (eg, low blood pressure, fluid overload, asthma, patients recently treated with an intravenous positive inotropic agent, allergy, intolerance, other medical reasons).

Documentation of patient reason(s) for not prescribing beta-blocker therapy (eg, patient declined, other patient reasons).

Documentation of system reason(s) for not prescribing beta-blocker therapy (eg, other reasons attributable to the healthcare system).

Measure Steward: PCPI(R) Foundation (PCPI[R])
Domain: Effective Clinical Care
Previous Version: Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
Improvement Notation:

Higher score indicates better quality

Guidance:

LVEF < 40% corresponds to qualitative documentation of moderate dysfunction or severe dysfunction.

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.

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.

Beta-blocker therapy:

-For patients with prior LVEF < 40%, beta-blocker therapy should include bisoprolol, carvedilol, or sustained release metoprolol succinate.

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

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, 0083, 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 Beta Blocker Therapy Ingredient (2.16.840.1.113883.3.526.3.1493​) with value set Beta Blocker Therapy for LVSD (2.16.840.1.113883.3.526.3.1184) in the 'Medication, Order not done' logic. As a result, the Data Criteria (QDM Data Element) 'Medication, Order: Beta Blocker Therapy 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 Beta Blocker Therapy Ingredient (2.16.840.1.113883.3.526.3.1493​).

    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 Beta Blocker Therapy (2.16.840.1.113883.3.526.3.1174): Deleted 1 RXNORM code (198005).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Beta Blocker Therapy Ingredient (2.16.840.1.113883.3.526.3.1493): Deleted 37 RXNORM codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Beta Blocker Therapy (2.16.840.1.113883.3.526.3.1174): Added 3 RXNORM codes (1923422, 1923424, 1923426) and deleted 6 RXNORM codes (310811, 904567, 904579, 904601, 978577, 978581).

    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

External Resources