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 or already taking beta-blocker therapy during the measurement period
Guidance
This eCQM is to be reported as patient-based. To satisfy this measure, it must be reported for all heart failure patients at least once during the measurement period.
A range value should satisfy the logic requirement for 'Ejection Fraction' as long as the ranged observation value clearly meets the less than or equal to 40% threshold noted in the denominator logic. A range that is greater than 40% would not meet the measure requirement.
In order for the Ejection Fraction result pathway to be recognized as below 40%, the result must be reported as a number with unit of %. A text string of "below 40%" or "ejection fraction between 35 and 40%" will not be recognized through electronic data capture. Although, this criteria can also be met using the Diagnosis pathway if specified as "Moderate or Severe."
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 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 5.6. 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 two qualifying encounters during the measurement period and a diagnosis of heart failure | Webchart Instructions |
| Denominator | Equals Initial Population with a current or prior LVEF <= 40% | Webchart Instructions |
| Denominator Exclusions | Patients with a history of heart transplant or with a Left Ventricular Assist Device (LVAD) prior to the end of the outpatient encounter with Moderate or Severe LVSD | Webchart Instructions |
| Numerator | Patients who were prescribed or already taking beta-blocker therapy during the measurement period | Webchart Instructions |
| Numerator Exclusions | Not Applicable | Webchart Instructions |
| Denominator Exceptions | Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., arrhythmia, asthma, bradycardia, hypotension, patients with atrioventricular block without cardiac pacer, observation of consecutive heart rates <50, allergy, intolerance, other medical reasons).
Documentation of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient declined, other patient reasons). | Webchart Instructions |
Details
| Full eMeasure Code |
eMeasure Identifier |
Measure Year |
Version |
NQF # |
GUID |
| CMS144v12 |
|
2024 |
12.0.000 |
0083e |
8439f671-2932-4d4c-88ca-ea5faeacc89a |
| Steward |
Developer |
Endorsed By |
| American Medical Association (AMA) |
American Heart Association |
National Quality Forum |
| Scoring Method |
Measure Type |
Stratification |
Risk Adjustment |
| Proportion |
PROCESS |
None |
None |
Rate Aggregation
None
Improvement Notation
Higher score indicates better quality
Rationale
Beta blockers improve survival and reduce hospitalization for patients with stable heart failure and reduced LVEF (HFrEF). Treatment should be initiated as soon as a patient is diagnosed with reduced LVEF and does not have prohibitively low systemic blood pressure, fluid overload, or recent treatment with an intravenous positive inotropic agent. Beta blockers have also been shown to lessen the symptoms of heart failure, improve the clinical status of patients, and reduce future clinical deterioration. Despite these benefits, use of beta blockers in eligible patients remains suboptimal.
Clinical Recommendation Statement
In patients with HFrEF, with current or previous symptoms, use of 1 of the 3 beta blockers proven to reduce mortality (e.g., bisoprolol, carvedilol, sustained-release metoprolol succinate) is recommended to reduce mortality and hospitalizations (Class I, Level of Evidence A) (ACC/AHA/HFSA, 2022).
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) Target 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 25-50 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)
Definition
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.
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 |
Heart Transplant Related Diagnoses |
2.16.840.1.113762.1.4.1178.56 |
| 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 Assist Device Related Diagnoses |
2.16.840.1.113762.1.4.1178.58 |
| 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 |
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 |
| Procedure, Performed |
Cardiac Pacer |
2.16.840.1.113762.1.4.1178.53 |
| Procedure, Performed |
Heart Transplant |
2.16.840.1.113762.1.4.1178.33 |
| Procedure, Performed |
Left Ventricular Assist Device Placement |
2.16.840.1.113762.1.4.1178.61 |
References
CITATIONHeidenreich, P.A., Bozkurt, B, Aguilar, D., ... Allen, L. A. (2022). 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 145(18), e895-e1032. doi: 10.1161/CIR.0000000000001063
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.
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Copyright 2023 American College of Cardiology and American Heart Association. All Rights Reserved.
Source:
https://ecqi.healthit.gov/ecqm/measures/cmsv1