eCQM Title | 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) |
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eCQM Identifier (Measure Authoring Tool) | 135 | eCQM Version Number | 10.1.000 |
NQF Number | 0081e | GUID | 430ffc53-4122-4421-88cc-2edd8117bb3c |
Measurement Period | January 1, 20XX through December 31, 20XX | ||
Measure Steward | American Heart Association-American Stroke Association | ||
Measure Developer | American Medical Association (AMA) | ||
Measure Developer | PCPI(R) Foundation (PCPI[R]) | ||
Measure Developer | American Heart Association-American Stroke Association | ||
Endorsed By | National Quality Forum | ||
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 |
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Copyright |
Copyright 2021 American College of Cardiology and American Heart Association. All Rights Reserved. |
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Disclaimer |
The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measure require a license agreement between the user and the American College of Cardiology (ACC) or the American Heart Association (AHA). Neither the ACC, nor AHA, nor their members shall be responsible for any use of the Measure. ACC and AHA encourage use of the Measure by other health care professionals, where appropriate. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The ACC and AHA and their members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2020 American Medical Association. LOINC(R) is copyright 2004-2020 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2020 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2020 World Health Organization. All Rights Reserved. The American Medical Association’s and the PCPI(R) Foundation’s significant past efforts and contributions to the performance measure are gratefully acknowledged. Due to technical limitations, registered trademarks are indicated by (R) or [R]. |
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Measure Scoring | Proportion | ||
Measure Type | Process | ||
Stratification |
None |
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Risk Adjustment |
None |
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Rate Aggregation |
This measure is intended to have one reporting rate, which aggregates the following populations into a single performance rate for reporting purposes: - Population 1: Patients who were prescribed ACE inhibitor or ARB or ARNI therapy within a 12-month period when seen in the outpatient setting - Population 2: Patients who were prescribed ACE inhibitor or ARB or ARNI therapy at each hospital discharge For the purposes of this measure, a single performance rate can be calculated as follows: Performance Rate = (Numerator 1 + Numerator 2)/ [(Denominator 1 - Denominator Exceptions 1) + (Denominator 2 - Denominator Exceptions 2)] |
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Rationale |
In the absence of contraindications, ACE inhibitors, ARB, or ARNI therapy is recommended for all patients with symptoms of heart failure and reduced left ventricular systolic function. Recent trial data have shown ARNI to be superior to ACE inhibitor or ARB therapy, however an ACE inhibitor or ARB should still be used for patients in which an ARNI is contraindicated. Given that ARNI is a newer therapy, uptake has been slow despite updated guideline recommendations that support its use. All pharmacologic agents included in this measure have been shown to decrease the risk of death and hospitalization for patients with heart failure. |
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Clinical Recommendation Statement |
The use of ACE inhibitors is beneficial for patients with prior or current symptoms of chronic HFrEF to reduce morbidity and mortality (Class I, Level of Evidence A) (ACC/AHA/HFSA, 2017). Treatment with an ACE inhibitor should be initiated at low doses [see excerpt from guideline table below], followed by gradual dose increments if lower doses have been well tolerated... Clinicians should attempt to use doses that have been shown to reduce the risk of cardiovascular events in clinical trials. If these target doses of an ACE inhibitor cannot be used or are poorly tolerated, intermediate doses should be used with the expectation that there are likely to be only small differences in efficacy between low and high doses. Abrupt withdrawal of treatment with an ACE inhibitor can lead to clinical deterioration and should be avoided (ACCF/AHA, 2013). Drugs Commonly Used for Stage C HFrEF (abbreviated to align with focus of measure to include only ACE inhibitors, ARB and ARNI therapy) Drug Initial Daily Dose(s) Maximum Dose(s) Mean Doses Achieved in Clinical Trials ACE Inhibitors Captopril 6.25 mg 3 times 50 mg 3 times 122.7 mg/d Enalapril 2.5 mg twice 10 to 20 mg twice 16.6 mg/d Fosinopril 5 to 10 mg once 40 mg once N/A Lisinopril 2.5 to 5 mg once 20 to 40 mg once 32.5 to 35.0 mg/d Perindopril 2 mg once 8 to 16 mg once N/A Quinapril 5 mg twice 20 mg twice N/A Ramipril 1.25 to 2.5 mg once 10 mg once N/A Trandolapril 1 mg once 4 mg once N/A Angiotensin Receptor Blockers Candesartan 4 to 8 mg once 32 mg once 24 mg/d Losartan 25 to 50 mg once 50 to 150 mg once 129 mg/d Valsartan 20 to 40 mg twice 160 mg twice 254 mg/d ARNI Sacubitril/ 49/51 mg twice (sacubitril 97/103 mg twice 375 mg/d; target dose: valsartan valsartan) (therapy may be (sacubitril/ 24/26 mg, 49/51 mg OR initiated at 24/26 mg twice) valsartan) 97/103 mg twice The use of ARBs to reduce morbidity and mortality is recommended in patients with current or prior symptoms of chronic HFrEF who are intolerant to ACE inhibitors because of cough or angioedema (Class I, Level of Evidence A) (ACC/AHA/HFSA, 2017). ARBs are reasonable to reduce morbidity and mortality as alternatives to ACE inhibitors as first-line therapy for patients with HFrEF, especially for patients already taking ARBs for other indications, unless contraindicated (Class IIa, Level of Evidence: A) (ACCF/AHA, 2013). Addition of an ARB may be considered in persistently symptomatic patients with HFrEF who are already being treated with an ACE inhibitor and a beta blocker in whom an aldosterone antagonist is not indicated or tolerated (Class IIb, Level of Evidence: A) (ACCF/AHA, 2013). The clinical strategy of inhibition of the renin-angiotensin system with ACE inhibitors (Level of Evidence A), or ARBs (Level of Evidence A) or ARNI (Level of Evidence B-R) in conjunction with evidence-based beta-blockers, and aldosterone antagonists in selected patients, is recommended for patients with chronic HFrEF to reduce morbidity and mortality (Class I) (ACC/AHA/HFSA, 2017). In patients with chronic symptomatic HFrEF NYHA class II or III who tolerate an ACE inhibitor or ARB, replacement by an ARNI is recommended to further reduce morbidity and mortality (Class I, Level of Evidence: B-R) (ACC/AHA/HFSA, 2017). ARNI should not be administered concomitantly with ACE inhibitors or within 36 hours of the last dose of an ACE inhibitor (Class III, Level of Evidence B-R) (ACC/AHA/HFSA, 2017). ARNI should not be administered to patients with a history of angioedema (Class III Recommendation, Level of Evidence C-EO) (ACC/AHA/HFSA, 2017). For the hospitalized patient: In patients with HFrEF experiencing a symptomatic exacerbation of HF requiring hospitalization during chronic maintenance treatment with GDMT [guideline-directed medical therapy; GDMT represents optimal medical therapy as defined by ACCF/AHA guideline-recommended therapies (primarily Class I)], it is recommended that GDMT be continued in the absence of hemodynamic instability or contraindications (Class I, Level of Evidence: B) (ACCF/AHA, 2013). |
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Improvement Notation |
Higher score indicates better quality |
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Reference |
Reference Type: CITATION Reference Text: 'Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., … Wilkoff, B. L. (2013). 2013 ACCF/AHA Guideline for the Management of Heart Failure A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 128(16), e240–e327. doi: https://doi.org/10.1161/CIR.0b013e31829e8776' |
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Reference |
Reference Type: CITATION Reference Text: 'Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Colvin, M. M., … Westlake, C. (2017). 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation,136(6), e137–e161. doi: 10.1161/cir.0000000000000509' |
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Definition |
Prescribed-Outpatient setting: prescription given to the patient for ACE inhibitor or ARB or ARNI therapy at one or more visits in the measurement period OR patient already taking ACE inhibitor or ARB or ARNI therapy as documented in current medication list. Prescribed-Inpatient setting: prescription given to the patient for ACE inhibitor or ARB or ARNI therapy at discharge OR ACE inhibitor or ARB or ARNI therapy to be continued after discharge as documented in the discharge medication list. LVEF < 40% corresponds to qualitative documentation of moderate dysfunction or severe dysfunction (LVSD). The LVSD may be determined by quantitative or qualitative assessment, which may be current or historical. Examples of a quantitative or qualitative assessment may include an echocardiogram: 1) that provides a numerical value of LVSD or 2) that uses descriptive terms such as moderately or severely depressed left ventricular systolic function. Any current or prior ejection fraction study documenting LVSD can be used to identify patients. |
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Guidance |
This eCQM is to be reported as patient-based or episode-based, depending on the clinical setting. 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 used in Population Criteria 1 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. Eligible clinicians 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. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM. |
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Transmission Format |
TBD |
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Initial Population |
All patients aged 18 years and older with a diagnosis of heart failure |
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Denominator |
Equals Initial Population with a current or prior LVEF < 40% |
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Denominator Exclusions |
None |
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Numerator |
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 |
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Numerator Exclusions |
Not Applicable |
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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). |
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Supplemental Data Elements |
For every patient evaluated by this measure also identify payer, race, ethnicity and sex |
exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 18 ) and Count("Qualifying Encounter During Measurement Period")>= 2 and exists "Heart Failure Outpatient Encounter"
"Initial Population 1" and exists "Heart Failure Outpatient Encounter with Moderate or Severe LVSD"
None
"Has ACEI or ARB or ARNI Ordered Outpatient" or "Is Currently Taking ACEI or ARB or ARNI Outpatient"
None
"Has Medical Patient or System Reason for Not Ordering ACEI or ARB or ARNI Outpatient" or "Has Allergy or Intolerance to ACEI or ARB or ARNI Ingredient Outpatient" or "Has Diagnosis of Allergy or Intolerance to ACEI or ARB Outpatient" or "Has Diagnosis of Pregnancy Outpatient" or "Has Diagnosis of Renal Failure Due to ACEI Outpatient"
None
exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 18 ) and exists "Heart Failure Inpatient Encounter"
"Initial Population 2" and exists "Heart Failure Inpatient Encounter with Moderate or Severe LVSD"
None
"Has ACEI or ARB or ARNI at Inpatient Discharge"
None
"Has Medical Patient or System Reason for No ACEI or ARB or ARNI at Inpatient Discharge" or "Has Allergy or Intolerance to ACEI or ARB or ARNI Ingredient Inpatient" or "Has Diagnosis of Allergy or Intolerance to ACEI or ARB Inpatient" or "Has Diagnosis of Pregnancy Inpatient" or "Has Diagnosis of Renal Failure Due to ACEI Inpatient"
None
"Initial Population 1" and exists "Heart Failure Outpatient Encounter with Moderate or Severe LVSD"
"Initial Population 2" and exists "Heart Failure Inpatient Encounter with Moderate or Severe LVSD"
"Has Medical Patient or System Reason for Not Ordering ACEI or ARB or ARNI Outpatient" or "Has Allergy or Intolerance to ACEI or ARB or ARNI Ingredient Outpatient" or "Has Diagnosis of Allergy or Intolerance to ACEI or ARB Outpatient" or "Has Diagnosis of Pregnancy Outpatient" or "Has Diagnosis of Renal Failure Due to ACEI Outpatient"
"Has Medical Patient or System Reason for No ACEI or ARB or ARNI at Inpatient Discharge" or "Has Allergy or Intolerance to ACEI or ARB or ARNI Ingredient Inpatient" or "Has Diagnosis of Allergy or Intolerance to ACEI or ARB Inpatient" or "Has Diagnosis of Pregnancy Inpatient" or "Has Diagnosis of Renal Failure Due to ACEI Inpatient"
exists ["Medication, Discharge": "ACE Inhibitor or ARB or ARNI"] ACEIOrARBOrARNIAtDischarge with "Heart Failure Inpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFInpatientEncounter such that ACEIOrARBOrARNIAtDischarge.authorDatetime during ModerateOrSevereLVSDHFInpatientEncounter.relevantPeriod
exists ["Medication, Order": "ACE Inhibitor or ARB or ARNI"] ACEIOrARBOrARNIOrdered with "Heart Failure Outpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter such that ACEIOrARBOrARNIOrdered.authorDatetime during ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod
exists ( ["Allergy/Intolerance": "ACE Inhibitor or ARB Ingredient"] union ["Allergy/Intolerance": "Substance with angiotensin-converting enzyme inhibitor mechanism of action (substance)"] union ["Allergy/Intolerance": "Substance with angiotensin II receptor antagonist mechanism of action (substance)"] union ["Allergy/Intolerance": "Substance with neprilysin inhibitor mechanism of action (substance)"] union ["Allergy/Intolerance": "sacubitril"] ) ACEIOrARBOrARNIAllergyIntolerance with "Heart Failure Inpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFInpatientEncounter such that ACEIOrARBOrARNIAllergyIntolerance.prevalencePeriod overlaps after ModerateOrSevereLVSDHFInpatientEncounter.relevantPeriod
exists ( ["Allergy/Intolerance": "ACE Inhibitor or ARB Ingredient"] union ["Allergy/Intolerance": "Substance with angiotensin-converting enzyme inhibitor mechanism of action (substance)"] union ["Allergy/Intolerance": "Substance with angiotensin II receptor antagonist mechanism of action (substance)"] union ["Allergy/Intolerance": "Substance with neprilysin inhibitor mechanism of action (substance)"] union ["Allergy/Intolerance": "sacubitril"] ) ACEIOrARBOrARNIAllergyIntolerance with "Heart Failure Outpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter such that ACEIOrARBOrARNIAllergyIntolerance.prevalencePeriod overlaps after ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod
exists ( ["Diagnosis": "Allergy to ACE Inhibitor or ARB"] union ["Diagnosis": "Intolerance to ACE Inhibitor or ARB"] ) ACEIOrARBAllergyOrIntoleranceDiagnosis with "Heart Failure Inpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFInpatientEncounter such that ACEIOrARBAllergyOrIntoleranceDiagnosis.prevalencePeriod overlaps after ModerateOrSevereLVSDHFInpatientEncounter.relevantPeriod
exists ( ["Diagnosis": "Allergy to ACE Inhibitor or ARB"] union ["Diagnosis": "Intolerance to ACE Inhibitor or ARB"] ) ACEIOrARBAllergyOrIntoleranceDiagnosis with "Heart Failure Outpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter such that ACEIOrARBAllergyOrIntoleranceDiagnosis.prevalencePeriod overlaps after ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod
exists ["Diagnosis": "Pregnancy"] Pregnancy with "Heart Failure Inpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFInpatientEncounter such that Pregnancy.prevalencePeriod starts 9 months or less before or on start ModerateOrSevereLVSDHFInpatientEncounter.relevantPeriod
exists ["Diagnosis": "Pregnancy"] Pregnancy with "Heart Failure Outpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter such that Pregnancy.prevalencePeriod starts 9 months or less before or on start ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod
exists ["Diagnosis": "Renal Failure Due to ACE Inhibitor"] RenalFailureDueToACEI with "Heart Failure Inpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFInpatientEncounter such that RenalFailureDueToACEI.prevalencePeriod overlaps ModerateOrSevereLVSDHFInpatientEncounter.relevantPeriod
exists ["Diagnosis": "Renal Failure Due to ACE Inhibitor"] RenalFailureDueToACEI with "Heart Failure Outpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter such that RenalFailureDueToACEI.prevalencePeriod overlaps ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod
exists ["Medication, Not Discharged": "ACE Inhibitor or ARB or ARNI"] NoACEIOrARBOrARNIAtDischarge with "Heart Failure Inpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFInpatientEncounter such that NoACEIOrARBOrARNIAtDischarge.authorDatetime during ModerateOrSevereLVSDHFInpatientEncounter.relevantPeriod where ( NoACEIOrARBOrARNIAtDischarge.negationRationale in "Medical Reason" or NoACEIOrARBOrARNIAtDischarge.negationRationale in "Patient Reason" or NoACEIOrARBOrARNIAtDischarge.negationRationale in "Patient Reason for ACE Inhibitor or ARB Decline" or NoACEIOrARBOrARNIAtDischarge.negationRationale in "System Reason" )
exists ["Medication, Not Ordered": "ACE Inhibitor or ARB or ARNI"] NoACEIOrARBOrARNIOrdered with "Heart Failure Outpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter such that NoACEIOrARBOrARNIOrdered.authorDatetime during ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod where ( NoACEIOrARBOrARNIOrdered.negationRationale in "Medical Reason" or NoACEIOrARBOrARNIOrdered.negationRationale in "Patient Reason" or NoACEIOrARBOrARNIOrdered.negationRationale in "Patient Reason for ACE Inhibitor or ARB Decline" or NoACEIOrARBOrARNIOrdered.negationRationale in "System Reason" )
["Encounter, Performed": "Discharge Services - Hospital Inpatient"] InpatientDischarge with ["Diagnosis": "Heart Failure"] HeartFailure such that HeartFailure.prevalencePeriod overlaps InpatientDischarge.relevantPeriod where InpatientDischarge.relevantPeriod during "Measurement Period"
"Heart Failure Inpatient Encounter" HFInpatientEncounter with "Moderate or Severe LVSD Findings" LVSDFindings such that Coalesce(LVSDFindings.prevalencePeriod, Global."NormalizeInterval"(LVSDFindings.relevantDatetime, LVSDFindings.relevantPeriod))starts before end of HFInpatientEncounter.relevantPeriod
( ["Encounter, Performed": "Care Services in Long-Term Residential Facility"] union ["Encounter, Performed": "Home Healthcare Services"] union ["Encounter, Performed": "Nursing Facility Visit"] union ["Encounter, Performed": "Office Visit"] union ["Encounter, Performed": "Outpatient Consultation"] ) QualifyingEncounter with ["Diagnosis": "Heart Failure"] HeartFailure such that HeartFailure.prevalencePeriod overlaps QualifyingEncounter.relevantPeriod where QualifyingEncounter.relevantPeriod during "Measurement Period"
"Heart Failure Outpatient Encounter" HFOutpatientEncounter with "Moderate or Severe LVSD Findings" LVSDFindings such that Coalesce(LVSDFindings.prevalencePeriod, Global."NormalizeInterval"(LVSDFindings.relevantDatetime, LVSDFindings.relevantPeriod))starts before end of HFOutpatientEncounter.relevantPeriod
exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 18 ) and Count("Qualifying Encounter During Measurement Period")>= 2 and exists "Heart Failure Outpatient Encounter"
exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 18 ) and exists "Heart Failure Inpatient Encounter"
exists ["Medication, Active": "ACE Inhibitor or ARB or ARNI"] ActiveACEIOrARBOrARNI with "Heart Failure Outpatient Encounter with Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter such that ActiveACEIOrARBOrARNI.relevantPeriod overlaps after ModerateOrSevereLVSDHFOutpatientEncounter.relevantPeriod
( ["Diagnostic Study, Performed": "Ejection Fraction"] EjectionFraction where EjectionFraction.result < 40 '%' ) union ["Diagnosis": "Moderate or Severe LVSD"] union ( ["Diagnosis": "Left ventricular systolic dysfunction (disorder)"] LVSD where LVSD.severity in "Moderate or Severe" )
"Has ACEI or ARB or ARNI Ordered Outpatient" or "Is Currently Taking ACEI or ARB or ARNI Outpatient"
"Has ACEI or ARB or ARNI at Inpatient Discharge"
( ["Encounter, Performed": "Office Visit"] union ["Encounter, Performed": "Outpatient Consultation"] union ["Encounter, Performed": "Nursing Facility Visit"] union ["Encounter, Performed": "Care Services in Long-Term Residential Facility"] union ["Encounter, Performed": "Home Healthcare Services"] union ["Encounter, Performed": "Patient Provider Interaction"] ) ValidEncounter where ValidEncounter.relevantPeriod during "Measurement Period"
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
years between ToDate(BirthDateTime)and ToDate(AsOf)
if pointInTime is not null then Interval[pointInTime, pointInTime] else if period is not null then period else null as Interval<DateTime>
DateTime(year from Value, month from Value, day from Value, 0, 0, 0, 0, timezoneoffset from Value)
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
Measure Set |
None |
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