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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
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 "Count >=2 of Encounter, Performed" is to establish that the eligible professional has an existing relationship with the patient.

Patient Group Definitions

Group Description Instructions Links
Initial PopulationAll patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12 month periodWebchart Instructions
DenominatorEquals Initial Population who also have prior (within the past 3 years) MI or a current or prior LVEF <40%Webchart Instructions
Denominator ExclusionsNone
NumeratorPatients who were prescribed beta-blocker therapyWebchart Instructions
Numerator ExclusionsNot ApplicableWebchart Instructions
Denominator ExceptionsDocumentation of medical reason(s) for not prescribing beta-blocker therapy (eg, allergy, intolerance, other medical reasons) Documentation of patient reason(s) for not prescribing beta-blocker therapy (eg, patient declined, other patient reasons) Documentation of system reason(s) for not prescribing beta-blocker therapy (eg, other reasons attributable to the health care system)Webchart Instructions

Details

Full eMeasure Code eMeasure Identifier Measure Year Version NQF # GUID
CMS145v5 145 2017 5.2.000 Not Applicable 80744ae2-de81-4b16-a71d-69522eb865c5
Steward Developer Endorsed By
American Medical Association (AMA) PCPI(R) Foundation (PCPI[R])
Scoring Method Measure Type Stratification Risk Adjustment
Proportion PROCESS None None

Rate Aggregation

Denominator 1: Patients with left ventricular systolic dysfunction (LVEF <40%)
Denominator 2: Patients with a prior (resolved) (within the past 3 years) myocardial infarction

Improvement Notation

Higher score indicates better quality

Rationale

Nonadherence to cardioprotective medications is prevalent among outpatients with coronary artery disease 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. A patient with a diagnosis of coronary artery disease seen within a 12 month period and LVEF <40% should be taking either bisoprolol, carvedilol, or sustained release metoprolol succinate. While all beta-blockers appear to be of equal efficacy in patients with chronic stable coronary artery disease, these three medications have specifically shown to reduce mortality in patients with reduced LVEF.

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
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 Moderate or Severe 2.16.840.1.113883.3.526.3.1092
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 Face-to-Face Interaction 2.16.840.1.113883.3.464.1003.101.12.1048
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, Allergy Beta Blocker Therapy Ingredient 2.16.840.1.113883.3.526.3.1493
Medication, Intolerance Beta Blocker Therapy 2.16.840.1.113883.3.526.3.1174
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
Medication, Order Medical Reason 2.16.840.1.113883.3.526.3.1007
Medication, Order Patient Reason 2.16.840.1.113883.3.526.3.1008
Medication, Order System Reason 2.16.840.1.113883.3.526.3.1009
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 SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB III, Kligfield PD, Krumholz HM, Kwong RYK, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR Jr, Smith SC Jr, Spertus JA, Williams SV. 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. J Am Coll Cardiol 2012;60:e44-164.

Disclaimer

The Measures are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, eg, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the PCPI(R) Foundation (PCPI[R]), the American Medical Association (AMA), American College of Cardiology (ACC) or the American Heart Association (AHA). Neither the AMA, nor ACC, nor AHA, nor the AMA-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI), now known as the PCPI, nor their members shall be responsible for any use of the Measures. AMA and PCPI encourage use of the Measures by other health care professionals, where appropriate. THE MEASURES 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 AMA, ACC, AHA, the PCPI and its members and former members of the AMA-PCPI 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 2004-2015 American Medical Association. LOINC(R) is copyright 2004-2015 Regenstrief Institute, Inc. This material contains SNOMED CLINICAL TERMS (SNOMED CT[R]) copyright 2004-2015 International Health Terminology Standards Development Organisation (IHTSDO). ICD-10 is copyright 2015 World Health Organization. All Rights Reserved. Due to technical limitations, registered trademarks are indicated by (R) or [R].

Copyright

Copyright 2015 American College of Cardiology, American Heart Association and American Medical Association. All Rights Reserved.

Source: https://ecqi.healthit.gov/ecqm/measures/cms145v5