Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%)

Last updated: July 12, 2017

CMS Measure ID: CMS145v6
Version: 6
NQF Number: 0070
Measure Description:

Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12 month period who also have a prior MI or a current or prior LVEF <40% who were prescribed beta-blocker therapy

Initial Patient Population:

All patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12 month period

Denominator Statement:

Equals Initial Population who also have prior (within the past 3 years) MI or a current or prior LVEF <40%

Denominator Exclusions:

None

Numerator Statement:

Patients who were prescribed beta-blocker therapy

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

Documentation of medical reason(s) for not prescribing beta-blocker therapy (eg, 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 health care system).

Measure Steward: PCPI(R) Foundation (PCPI[R])
Domain: Effective Clinical Care
Previous Version: Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%)
Improvement Notation:

Higher score indicates better quality

Guidance:

Beta-blocker therapy:

- For patients with prior MI, beta-blocker therapy includes any agent within the beta-blocker drug class. As of 2015, no recommendations or evidence are cited in current stable ischemic heart disease guidelines for preferential use of specific agents

- For patients with prior LVEF <40%, beta-blocker therapy includes the following: 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.

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.

Specifications

Release Notes

Header

  • ​Incremented eMeasure Version number.

    Section: eMeasure Version number

    Source: Measure Lead

  • Added NQF Number.

    Section: NQF Number

    Source: Measure Lead

  • Added 'National Quality Forum.'

    Section: Endorsed By

    Source: Measure Lead

  • ​Updated Copyright.

    Section: Copyright

    Source: Annual Update

  • ​Updated Disclaimer.

    Section: Disclaimer

    Source: Measure Lead

  • Removed 'resolved' to align with measure language and specifications.

    Section: Rate Aggregation

    Source: Measure Lead

  • ​​Updated Rationale.

    Section: Rationale

    Source: Measure Lead

  • Updated References.

    Section: Reference

    Source: Measure Lead

  • ​Updated Guidance.

    Section: Guidance

    Source: Measure Lead

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

    Section: Guidance

    Source: Measure Lead

Logic

  • Population 1: 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. Population 2: Replaced value set Beta Blocker Therapy Ingredient (2.16.840.1.113883.3.526.3.1493​) with value set Beta Blocker Therapy (2.16.840.1.113883.3.526.3.1174) 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.

    Section: Denominator Exceptions

    Source: 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.

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

    Section: None

    Source: None

  • 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).

    Section: None

    Source: None

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

    Section: None

    Source: None

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

    Section: None

    Source: None

  • Value set Cardiac Surgery (2.16.840.1.113883.3.526.3.371): Added 3 SNOMEDCT codes (418551006, 418824004, 419132001).

    Section: None

    Source: None

  • Removed term types BN, PIN, and MIN from Beta Blocker Therapy Ingredient (OID 2.16.840.1.113883.3.526.3.1493​) value set.

    Section: None

    Source: JIRA (CQM-1812)

External Resources