Heart Failure (HF): Angiotensin Converting Enzyme (ACE) Inhibitor or

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1 Heart Failure (HF): Angitensin Cnverting Enzyme (ACE) Inhibitr r Angitensin Receptr Blcker (ARB) Therapy fr Left Ventricular Systlic Dysfunctin (LVSD) (NQF 0081) EMeasure Name Heart Failure (HF): Angitensin Cnverting Enzyme (ACE) Inhibitr r Angitensin Receptr Blcker (ARB) Therapy fr Left Ventricular Systlic Dysfunctin (LVSD) EMeasure Id Pending Versin Number 1 Set Id Pending Available Date N infrmatin Measurement Perid January 1, 20xx thrugh December 31, 20xx Measure Steward Endrsed by Descriptin Measure scring Measure type Ratinale Clinical Recmmendatin Statement References American Medical Assciatin Physician Cnsrtium fr Perfrmance Imprvement Natinal Quality Frum Percentage f patients aged 18 years and lder with a diagnsis f heart failure and LVSD (LVEF < 40%) wh were prescribed ACE inhibitr r ARB therapy. Prprtin Prcess In the absence f cntraindicatins, ACE Inhibitrs r ARBs are recmmended fr all patients with symptms f heart failure and reduced left ventricular systlic functin, as measured by left ventricular ejectin fractin (LVEF). Bth drugs have been shwn t decrease mrtality and hspitalizatins. Heart Failure: Angitensin Cnverting Enzyme (ACE) Inhibitr r Angitensin Receptr Blcker (ARB) Therapy fr Left Ventricular Systlic Dysfunctin (LVSD). Angitensin cnverting enzyme inhibitrs are recmmended fr all patients with current r prir symptms f HF and reduced LVEF, unless cntraindicated. (Class I Recmmendatin, Level f Evidence: A)(ACC/AHA) Angitensin II receptr blckers apprved fr the treatment f HF are recmmended in patients with current r prir symptms f HF and reduced LVEF wh are ACEI intlerant. (Class I Recmmendatin, Level f Evidence: A) (ACC/AHA) Angitensin II receptr blckers are reasnable t use as alternatives t ACEIs as first line therapy fr patients with mild t mderate HF and reduced LVEF, especially fr patients already taking ARBs fr ther indicatins (Class IIa Recmmendatin, Level f Evidence: A) (ACC/AHA). Definitins

2 Table f Cntents Ppulatin criteria Data criteria (QDS Data Elements) Summary calculatin Please refer t the spreadsheet fr this measure fr detail regarding data criteria and cde lists. Ppulatin criteria Initial Patient Ppulatin = Denminatr = Numeratr = Exclusins = Patient characteristic: birth date (age) >=18 years; Diagnsis active: heart failure ; OR: >=2 cunt(s) f: OR: Encunter: encunter utpatient ; OR: Encunter: encunter nursing facility ; OR: >=1 cunt(s) f: Encunter: encunter inpatient discharge ; All patients in the initial patient ppulatin; OR: Diagnstic study result: LVF assessment, result <40%; OR: Diagnstic study result: ejectin fractin, result <40%; OR: Medicatin rder: ACE inhibitr r ARB ; OR: Medicatin active: ACE inhibitr r ARB ; OR: Medicatin allergy: ACE inhibitr r ARB ; OR: Medicatin adverse event: ACE inhibitr r ARB ; OR: Medicatin intlerance: ACE inhibitr r ARB ; OR: Diagnsis active: pregnancy ; OR: Diagnsis active: deficiencies f circulating enzymes ; OR: Diagnsis active: disease f artic and mitral valves ; OR: Diagnsis active: nn rheumatic mitral (valve) disease ; OR: Diagnsis active: chrnic kidney disease with r withut hypertensin ; OR: Diagnsis active: hypertensive renal disease with renal failure ; OR: Diagnsis active: athersclersis f renal artery ; OR: Diagnsis active: renal failure and ESRD ; OR: Diagnsis active: acute renal failure ; OR: Diagnsis active: atresia and stensis f arta ; OR: Medicatin nt dne: medical reasn ; OR: Medicatin nt dne: patient reasn fr ACE inhibitr r ARB decline ;

3 OR: Medicatin nt dne: patient reasn ; OR: Medicatin nt dne: system reasn ; Data Criteria (QDS Data Elements) Initial Patient Ppulatin = Denminatr = Numeratr = Exclusins = "Patient characteristic: birth date using birth date cde list befre the measurement perid ; Diagnsis active: heart failure using heart failure cde list gruping befre r simultaneusly t Encunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Encunter: encunter utpatient using encunter utpatient cde list during the measurement perid ; Encunter: encunter nursing facility using encunter nursing facility cde list during the measurement perid ; Encunter: encunter inpatient discharge using encunter inpatient discharge cde list during the measurement perid ; All patients in the initial patient ppulatin; Diagnstic study result: LVF assessment using LVF assessment cde list befre Encunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Diagnstic study result: ejectin fractin using ejectin fractin cde list befre Encunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Medicatin rder: ACE inhibitr r ARB using ACE inhibitr r ARB cde list during the measurement perid ; Medicatin active: ACE inhibitr r ARB using ACE inhibitr r ARB cde list during the measurement perid ; Medicatin allergy: ACE inhibitr r ARB using ACE Inhibitr r ARB cde list befre r simultaneusly t Encunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Medicatin adverse event: ACE inhibitr r ARB using ACE Inhibitr r ARB cde list befre r simultaneusly t Encunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Medicatin intlerance: ACE inhibitr r ARB using ACE Inhibitr r ARB cde list befre r simultaneusly t Encunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Diagnsis active: pregnancy using pregnancy cde list gruping during Encunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Diagnsis active: deficiencies f circulating enzymes using deficiencies f circulating enzymes cde list gruping befre r simultaneusly t Encunter: encunter

4 utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Diagnsis active: disease f artic and mitral valves using disease f artic and mitral valves cde list befre r simultaneusly t Encunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Diagnsis active: nn rheumatic mitral (valve) disease using nnrheumatic mitral (valve) disease cde list befre r simultaneusly t Encunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Diagnsis active: chrnic kidney disease with and withut hypertensin using chrnic kidney disease with and withut hypertensin cde list befre r simultaneusly t Encunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Diagnsis active: hypertensive renal disease with renal failure using hypertensive renal disease with renal failure cde list befre r simultaneusly t Encunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Diagnsis active: athersclersis f renal artery using athersclersis f renal artery cde list cde list gruping befre r simultaneusly t Encunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Diagnsis active: renal failure and ESRD using renal failure and ESRD cde list befre r simultaneusly t Encunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Diagnsis active: acute renal failure using acute renal failure cde list befre r simultaneusly t Encunter: utpatient OR Encunter: nursing facility OR Encunter: inpatient discharge ; Diagnsis active: atresia and stensis f arta using atresia and stensis f arta cde list gruping befre r simultaneusly t Encunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Medicatin nt dne: medical reasn using medical reasn cde list fr Medicatin rder: ACE inhibitr r ARB OR Medicatin active: ACE inhibitr r ARB ; Medicatin nt dne: patient reasn fr ACE inhibitr r ARB decline using patient reasn fr ACE inhibitr r ARB decline cde list fr Medicatin rder: ACE inhibitr r ARB OR Medicatin active: ACE inhibitr r ARB ; Medicatin nt dne: patient reasn using patient reasn cde list fr Medicatin rder: ACE inhibitr r ARB OR Medicatin active: ACE inhibitr r ARB ; Medicatin nt dne: system reasn using system reasn cde list fr Medicatin rder: ACE inhibitr r ARB OR Medicatin active: anti platelet therapy ; Summary Calculatin Calculatin is generic t all measures: Calculate the final denminatr by adding all that meet denminatr criteria. Subtract frm the final denminatr all that d nt meet numeratr criteria yet als meet exclusin criteria. Nte sme measures d nt have exclusin criteria. The perfrmance calculatin is the number meeting numeratr criteria divided by the final denminatr.

5 Fr measures with multiple patient ppulatins, repeat this prcess fr each patient ppulatin and reprt each result separately. Fr measures with multiple numeratrs, calculate each numeratr separately within each ppulatin using the paired exclusin. Measure set CLINICAL QUALITY MEASURE SET