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

Last updated: June 9, 2017

CMS Measure ID: CMS135v6
Version: 6
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 Population 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: Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
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 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

  • Reverted to the parent NQF Number, 0081, for CMS documentation per guidance from National Quality Forum.

    Section: NQF Number

    Source: Measure Lead

  • ​Updated Copyright.

    Section: Copyright

    Source: Annual Update

  • ​Updated Disclaimer.

    Section: Disclaimer

    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

  • Replaced value set ACE Inhibitor or ARB Ingredient (2.16.840.1.113883.3.526.3.1489) with value set ACE Inhibitor or ARB (2.16.840.1.113883.3.526.3.1139) in the 'Medication, Order not done' logic. As a result, the Data Criteria (QDM Data Element) 'Medication, Order: ACE Inhibitor or ARB 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.

  • Removed term types BN, PIN, and MIN from value set ACE Inhibitor or ARB Ingredient (2.16.840.1.113883.3.526.3.1489) value set.

    Section: None

    Source: 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).

    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 ACE Inhibitor or ARB Ingredient (2.16.840.1.113883.3.526.3.1489): Deleted 68 RXNORM codes.

    Section: None

    Source: None

  • Value set Pregnancy (2.16.840.1.113883.3.526.3.378): Removed ICD-9 extensional value set (2.16.840.1.113883.3.526.2.243).

    Section: None

    Source: None

External Resources