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

Last updated: May 17, 2016

CMS Measure ID: CMS145v4
Version: 4
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: American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)
National Quality Strategy Domain: Effective Clinical Care
Next Version: Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%)
Previous Version: Coronary Artery Disease (CAD): Beta-Blocker Therapy—Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%)
Measure Score: Proportion
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 2014, 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 of Encounter, Performed is to establish that the eligible professional has an existing relationship with the patient.

Specifications

Release Notes

Header

  • Clinical Recommendation Statement updated.
  • Copyright updated.
  • Definition updated.
  • Denominator statement updated.
  • Disclaimer updated.
  • eMeasure version number incremented.
  • Guidance updated.
  • Rate Aggregation updated.
  • Reference updated.
  • eMeasure version number incremented from 4.0.000 to 4.1.000.

Logic

  • Changed data type of 'result' or 'finding' to 'performed'
  • Introduced occurrencing on variables to enforce that the same instance of a clinical event is used throughout the measure when the logic within the variable does not limit the event to a single instance, e.g., FIRST or MOST RECENT.
  • Introduced the new timing operator 'overlaps' to replace two lines of logic (AND/AND NOT) or to enforce when an event or set of events occur to meet the measure intent.
  • Introduced variable $CADEncounters145 to allow re-use of logical expressions and reduce redundancy/complexity.
  • Logic for Population Criteria 2, Denominator updated to reflect the clinical recommendation statement revision.
  • Replaced 'ORs' with 'Union of' operator to provide a mechanism for specifying that qualifying event(s) must be a member of at least one of the data elements being unioned (if appropriate for measure intent).
  • Replaced 'Patient Characteristic Birthdate' with 'Age at' operator.
  • Replaced 'starts before or during' (SBOD) with 'starts before end of' (SBE).
  • The top level logical operator for the Numerator Exclusions, Denominator Exclusions, Denominator Exceptions, and Measure Population Exclusions defaults to 'OR'.

Value Sets

  • Value set Patient Reason (OID 2.16.840.1.113883.3.526.3.1008): Deleted 1 SNOMED code (30164005).

XML

  • This measure contains multiple Population Criteria sections. The earlier version of this measure contained mismatches between the applicable Population Criteria human readable narrative sections and their associated computer-readable sections in the XML file. This issue has been corrected.

External Resources