Measure: CMS144
Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
Measure Versions
eMeasure Code |
Measure Year |
Full Version Number |
Title |
CMS144v12 |
2024 |
12.0.000 |
Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) |
CMS144v11 |
2023 |
11 |
Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) |
CMS144v10 |
2022 |
10.0.000 |
Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) |
CMS144v9 |
2021 |
9.2.000 |
Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) |
CMS144v8 |
2020 |
8.1.000 |
Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) |
CMS144v7 |
2019 |
7.1.000 |
Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) |
CMS144v6 |
2018 |
6.0.000 |
Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) |
CMS144v5 |
2017 |
5.2.000 |
Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) |
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
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.
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.
Beta-blocker therapy:
-For patients with prior LVEF < 40%, beta-blocker therapy should include bisoprolol, carvedilol, or sustained release metoprolol succinate.
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.
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.
Patient Group Definitions
Group |
Description |
Instructions Links |
Initial Population | All patients aged 18 years and older with a diagnosis of heart failure | Webchart Instructions |
Denominator | Equals Initial Population with a current or prior LVEF < 40% | Webchart Instructions |
Denominator Exclusions | None | |
Numerator | Patients who were prescribed beta-blocker therapy either within a 12-month period when seen in the outpatient setting OR at each hospital discharge | Webchart Instructions |
Numerator Exclusions | Not Applicable | Webchart Instructions |
Denominator Exceptions | Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., 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 (e.g., patient declined, other patient reasons).
Documentation of system reason(s) for not prescribing beta-blocker therapy (e.g., other reasons attributable to the healthcare system). | Webchart Instructions |
Details
Full eMeasure Code |
eMeasure Identifier |
Measure Year |
Version |
NQF # |
GUID |
CMS144v9 |
144 |
2021 |
9.2.000 |
0083e |
8439f671-2932-4d4c-88ca-ea5faeacc89a |
Steward |
Developer |
Endorsed By |
American Medical Association (AMA) |
PCPI(R) Foundation (PCPI[R]) |
National Quality Forum |
Scoring Method |
Measure Type |
Stratification |
Risk Adjustment |
Proportion |
PROCESS |
None |
None |
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 beta-blocker therapy within a 12-month period when seen in the outpatient setting
- Population 2: Patients who were prescribed beta-blocker 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)]
Improvement Notation
Higher score indicates better quality
Rationale
Beta-blockers are recommended for all patients with stable heart failure and left ventricular systolic dysfunction, unless contraindicated. Treatment should be initiated as soon as a patient is diagnosed with left ventricular systolic dysfunction and does not have low blood pressure, fluid overload, or recent treatment with an intravenous positive inotropic agent. Beta-blockers have been shown to lessen the symptoms of heart failure, improve the clinical status of patients, reduce future clinical deterioration, and decrease the risk of mortality and the combined risk of mortality and hospitalization.
Clinical Recommendation Statement
Use of 1 of the 3 beta blockers proven to reduce mortality (e.g., bisoprolol, carvedilol, and sustained-release metoprolol succinate) is recommended for all patients with current or prior symptoms of HFrEF [heart failure with reduced ejection fraction], unless contraindicated, to reduce morbidity and mortality (Class I, Level of Evidence: A) (ACCF/AHA, 2013).
Treatment with a beta blocker should be initiated at very low doses [see excerpt from guideline table below] followed by gradual increments in dose if lower doses have been well tolerated... Clinicians should make every effort to achieve the target doses of the beta blockers shown to be effective in major clinical trials. Even if symptoms do not improve, long-term treatment should be maintained to reduce the risk of major clinical events. Abrupt withdrawal of treatment with a beta blocker 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 Beta-blocker therapy)
Drug Initial Daily Dose(s) Maximum Dose(s) Mean Doses Achieved in Clinical Trials
Beta Blockers
Bisoprolol 1.25 mg once 10 mg once 8.6 mg/d
Carvedilol 3.125 mg twice 50 mg twice 37 mg/d
Carvedilol CR 10 mg once 80 mg once N/A
Metoprolol succinate 12.5 to 25 mg once 200 mg once 159 mg/d
extended release
(metoprolol CR/XL)
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).
Initiation of beta-blocker therapy is recommended after optimization of volume status and successful discontinuation of intravenous diuretics, vasodilators, and inotropic agents. Beta-blocker therapy should be initiated at a low dose and only in stable patients. Caution should be used when initiating beta blockers in patients who have required inotropes during their hospital course (Class I, Level of Evidence: B) (ACCF/AHA, 2013).
Definition
Prescribed-Outpatient setting: prescription given to the patient for beta-blocker therapy at one or more visits in the measurement period OR patient already taking beta-blocker therapy as documented in current medication list.
Prescribed-Inpatient setting: prescription given to the patient for beta-blocker therapy at discharge OR beta-blocker 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.
Transmission Format
TBD
Applicable Value Sets
Category |
Value Set |
OID |
Allergy/Intolerance |
Beta Blocker Therapy Ingredient |
2.16.840.1.113883.3.526.3.1493 |
Diagnosis |
Allergy to Beta Blocker Therapy |
2.16.840.1.113883.3.526.3.1177 |
Diagnosis |
Arrhythmia |
2.16.840.1.113883.3.526.3.366 |
Diagnosis |
Asthma |
2.16.840.1.113883.3.526.3.362 |
Diagnosis |
Atrioventricular Block |
2.16.840.1.113883.3.526.3.367 |
Diagnosis |
Bradycardia |
2.16.840.1.113883.3.526.3.412 |
Diagnosis |
Cardiac Pacer in Situ |
2.16.840.1.113883.3.526.3.368 |
Diagnosis |
Heart Failure |
2.16.840.1.113883.3.526.3.376 |
Diagnosis |
Hypotension |
2.16.840.1.113883.3.526.3.370 |
Diagnosis |
Intolerance to Beta Blocker Therapy |
2.16.840.1.113883.3.526.3.1178 |
Diagnosis |
Left Ventricular Systolic Dysfunction |
2.16.840.1.113883.3.526.3.1091 |
Diagnosis |
Moderate or Severe LVSD |
2.16.840.1.113883.3.526.3.1090 |
Diagnostic Study, Performed |
Ejection Fraction |
2.16.840.1.113883.3.526.3.1134 |
Encounter, Performed |
Care Services in Long-Term Residential Facility |
2.16.840.1.113883.3.464.1003.101.12.1014 |
Encounter, Performed |
Discharge Services - Hospital Inpatient |
2.16.840.1.113883.3.464.1003.101.12.1007 |
Encounter, Performed |
Home Healthcare Services |
2.16.840.1.113883.3.464.1003.101.12.1016 |
Encounter, Performed |
Nursing Facility Visit |
2.16.840.1.113883.3.464.1003.101.12.1012 |
Encounter, Performed |
Office Visit |
2.16.840.1.113883.3.464.1003.101.12.1001 |
Encounter, Performed |
Outpatient Consultation |
2.16.840.1.113883.3.464.1003.101.12.1008 |
Encounter, Performed |
Patient Provider Interaction |
2.16.840.1.113883.3.526.3.1012 |
Medication, Active |
Beta Blocker Therapy for LVSD |
2.16.840.1.113883.3.526.3.1184 |
Medication, Not Ordered |
Beta Blocker Therapy for LVSD |
2.16.840.1.113883.3.526.3.1184 |
Medication, Order |
Beta Blocker Therapy for LVSD |
2.16.840.1.113883.3.526.3.1184 |
Patient Characteristic Ethnicity |
Ethnicity |
2.16.840.1.114222.4.11.837 |
Patient Characteristic Payer |
Payer |
2.16.840.1.114222.4.11.3591 |
Patient Characteristic Race |
Race |
2.16.840.1.114222.4.11.836 |
Patient Characteristic Sex |
ONC Administrative Sex |
2.16.840.1.113762.1.4.1 |
Physical Exam, Performed |
Heart Rate |
2.16.840.1.113883.3.526.3.1176 |
References
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
Disclaimer
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Copyright
Copyright 2020 American College of Cardiology, American Heart Association and American Medical Association. All Rights Reserved.
Source:
https://ecqi.healthit.gov/ecqm/measures/cms144v9