Measure: CMS145
Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%)
Measure Versions
eMeasure Code |
Measure Year |
Full Version Number |
Title |
CMS145v12 |
2024 |
12.0.000 |
Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <=40%) |
CMS145v11 |
2023 |
11 |
Coronary Artery Disease (CAD): Beta-Blocker Therapy – Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF ? 40%) |
CMS145v10 |
2022 |
10.1.000 |
Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%) |
CMS145v9 |
2021 |
9.2.000 |
Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%) |
CMS145v8 |
2020 |
8.2.000 |
Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%) |
CMS145v7 |
2019 |
7.2.000 |
Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%) |
CMS145v6 |
2018 |
6.0.000 |
Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%) |
CMS145v5 |
2017 |
5.2.000 |
Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%) |
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
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 two or more visits 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.
Patient Group Definitions
Group |
Description |
Instructions Links |
Initial Population | All patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12-month period | Webchart Instructions |
Denominator | Equals Initial Population who also have prior (within the past 3 years) MI or a current or prior LVEF <40% | Webchart Instructions |
Denominator Exclusions | None | |
Numerator | Patients who were prescribed beta-blocker therapy | Webchart Instructions |
Numerator Exclusions | Not Applicable | Webchart Instructions |
Denominator Exceptions | Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., 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 health care system). | Webchart Instructions |
Details
Full eMeasure Code |
eMeasure Identifier |
Measure Year |
Version |
NQF # |
GUID |
CMS145v8 |
145 |
2020 |
8.2.000 |
0070e |
80744ae2-de81-4b16-a71d-69522eb865c5 |
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 with left ventricular systolic dysfunction (LVEF <40%)
- Population 2: Patients with a prior (within the past 3 years) myocardial infarction
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
For patients with coronary artery disease (CAD), beta-blockers are recommended for 3 years after myocardial infarction or acute coronary syndrome. Beta-blockers, particularly carvedilol, metoprolol succinate, or bisoprolol which have been shown to reduce risk of death, are recommended indefinitely for patients with CAD and LV systolic dysfunction. These agents have proven efficacy in reducing angina onset and improving the ischemic threshold during exercise. In patients who have suffered an MI, beta-blockers significantly reduce deaths and recurrent MIs (ACCF/AHA/ACP/AATS/PCNA/SCAI/STS, 2012).
Nonadherence to cardioprotective medications is prevalent among outpatients with CAD and can be associated with a broad range of adverse outcomes, including all-cause and cardiovascular mortality, cardiovascular hospitalizations, and the need for revascularization procedures (ACC/AHA, 2002).
This measure is intended to promote beta-blocker usage in select patients with CAD.
Clinical Recommendation Statement
Beta-blocker therapy should be started and continued for 3 years in all patients with normal LV function after MI or ACS (Class I, Level of Evidence: B) (ACCF/AHA/ACP/AATS/PCNA/SCAI/STS, 2012).
Beta-blocker therapy should be used in all patients with LV systolic dysfunction (EF <= 40%) with heart failure or prior MI, unless contraindicated. (Use should be limited to carvedilol, metoprolol succinate, or bisoprolol, which have been shown to reduce risk of death.) (Class I, Level of Evidence: A) (ACCF/AHA/ACP/AATS/PCNA/SCAI/STS, 2012).
Definition
Prescribed may include 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.
Prior Myocardial Infarction (MI) for denominator 2 is limited to those occurring within the past 3 years.
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 |
Coronary Artery Disease No MI |
2.16.840.1.113883.3.526.3.369 |
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 |
Diagnosis |
Myocardial Infarction |
2.16.840.1.113883.3.526.3.403 |
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 |
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 |
2.16.840.1.113883.3.526.3.1174 |
Medication, Active |
Beta Blocker Therapy for LVSD |
2.16.840.1.113883.3.526.3.1184 |
Medication, Not Ordered |
Beta Blocker Therapy |
2.16.840.1.113883.3.526.3.1174 |
Medication, Not Ordered |
Beta Blocker Therapy for LVSD |
2.16.840.1.113883.3.526.3.1184 |
Medication, Order |
Beta Blocker Therapy |
2.16.840.1.113883.3.526.3.1174 |
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 |
Procedure, Performed |
Cardiac Surgery |
2.16.840.1.113883.3.526.3.371 |
References
Fihn, S. D., Gardin, J. M., Abrams, J., et al. (2012). 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Journal of the American College of Cardiology, 60(24), e44-e164.
Gibbons, R. J., Abrams, J., Chatterjee, K., et al. (2002). ACC/AHA 2002 guideline update for the management of patients with chronic stable angina: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for the Management of Patients with Chronic Stable Angina). Circulation, 107(1), 149-158. Retrieved from http://circ.ahajournals.org/content/107/1/149
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Copyright
Copyright 2019 American College of Cardiology, American Heart Association and American Medical Association. All Rights Reserved.
Source:
https://ecqi.healthit.gov/ecqm/measures/cms145v8