Release Ntes: Measure Infrmatin Frm Versin 2.0 **NQF-ENDORSED VOLUNTRY CONSENSUS STNDRDS FOR HOSPITL CRE** Measure Set: Heart Failure (HF) Set Measure ID#: Measure Infrmatin Frm Perfrmance Measure Name: CEI r R fr LVSD Descriptin: Heart failure patients with left ventricular systlic dysfunctin (LVSD) and withut bth angitensin cnverting enzyme inhibitr (CEI) and angitensin receptr blcker (R) cntraindicatins wh are prescribed an CEI r R at hspital discharge. Fr purpses f this measure, LVSD is defined as chart dcumentatin f a left ventricular ejectin fractin (LVEF) less than 40% r a narrative descriptin f left ventricular systlic (LVS) functin cnsistent with mderate r severe systlic dysfunctin. Ratinale: CEI therapy reduces mrtality and mrbidity in patients with heart failure and left ventricular systlic dysfunctin (The SOLVD Investigatrs, 1991 and CONSENSUS Trial Study Grup, 1987) and are effective in a wide range f patients (Masudi, 2004). Recent clinical trials have als established R therapy as an acceptable alternative t CEI, especially in patients wh are CEI intlerant (Granger, 2003 and Pfeffer, 2003). Natinal guidelines strngly recmmend CEIs fr patients hspitalized with heart failure (Hunt, 2005 and HFS, 1999). Guideline cmmittees have als supprted the inclusin f Rs in perfrmance measures fr heart failure (Executive Cuncil f the Heart Failure Sciety f merica, 2004). Despite these recmmendatins, CEIs and Rs remain underutilized in eligible lder patients hspitalized with heart failure (Jencks, 2000 and Masudi, 2004). Type f Measure: Prcess Imprvement Nted s: n increase in the rate Numeratr Statement: Heart failure patients wh are prescribed an CEI r R at hspital discharge Included Ppulatins: Nt pplicable Excluded Ppulatins: Nne Data Elements: CEI Prescribed at Discharge R Prescribed at Discharge -1
Denminatr Statement: Heart failure patients with LVSD and withut bth CEI and R cntraindicatins Included Ppulatins: Discharges with: n ICD-9-CM Principal Diagnsis Cde fr heart failure as defined in ppendix, Table 2.1 ND Chart dcumentatin f a LVEF less than 40% r a narrative descriptin f LVS functin cnsistent with mderate r severe systlic dysfunctin Excluded Ppulatins: Patients less than 18 years f age Patients transferred t anther acute care hspital r federal hspital Patients wh expired Patients wh left against medical advice Patients discharged t hspice Patients with cmfrt measures nly dcumented by a physician, nurse practitiner, r physician assistant Patients with OTH a ptential cntraindicatin/reasn fr nt prescribing an CEI at discharge ND a ptential cntraindicatin/reasn fr nt prescribing an R at discharge, as evidenced by ne r mre f the fllwing: CEI allergy ND R allergy Mderate r severe artic stensis Physician, nurse practitiner, r physician assistant dcumentatin f OTH a reasn fr nt prescribing an CEI at discharge ND a reasn fr nt prescribing an R at discharge Reasn dcumented by physician, nurse practitiner, r physician assistant fr nt prescribing an R at discharge ND an CEI allergy Reasn dcumented by physician, nurse practitiner, r physician assistant fr nt prescribing an CEI at discharge ND an R allergy Patients wh had a left ventricular assistive device (LVD) r heart transplant prcedure during hspital stay (ICD-9-CM prcedure cde fr LVD and heart transplant as defined in ppendix, Table 2.2) Data Elements: dmissin Date irthdate Cmfrt Measures Only Cntraindicatin t th CEI and R at Discharge Discharge Status ICD-9-CM Other Prcedure Cdes ICD-9-CM Principal Diagnsis Cde ICD-9-CM Principal Prcedure Cde LVSD -2
Risk djustment: N Data Cllectin pprach: Retrspective data surces fr required data elements include administrative data and medical recrds. Data ccuracy: Variatin may exist in the assignment f ICD-9-CM cdes; therefre, cding practices may require evaluatin t ensure cnsistency. Measure nalysis Suggestins: Nne Sampling: Yes, fr additinal infrmatin see the Sampling Sectin. Data Reprted s: ggregate rate generated frm cunt data reprted as a prprtin Selected References: nw RO, ennett S, Casey DE, Ganiats TG, Hlatky M, Knstam M, Lambrew CT, Nrmand ST, Piña IL, Radfrd MJ, Smith L, Stevensn L. CC/H Clinical Perfrmance Measures fr dults With Chrnic Heart Failure: a reprt f the merican Cllege f Cardilgy/merican Heart ssciatin Task Frce n Perfrmance Measures (Writing Cmmittee t Develp Heart Failure Clinical Perfrmance Measures). J m Cll Cardil 2005;46:1144 78. vailable at http://www.acc.rg and http://www.americanheart.rg. Effects f enalapril n mrtality in severe cngestive heart failure. Results f the Cperative Nrth Scandinavian Enalapril Survival Study (CONSENSUS). The CONSENSUS Trial Study Grup. N Engl J Med. 1987;316:1429-1435. Executive Cuncil f the Heart Failure Sciety f merica. Implicatins f recent clinical trials fr heart failure perfrmance measures. HFS Psitin Statement. J Card Fail. 2004;10:4-5. Granger C, McMurray JJ, Yusuf S et al. Effects f candesartan in patients with chrnic heart failure and reduced left-ventricular systlic functin intlerant t angitensincnverting-enzyme inhibitrs: the CHRM-lternative trial. Lancet. 2003;362:772-776. Heart Failure Sciety f merica (HFS) practice guidelines. HFS guidelines fr management f patients with heart failure caused by left ventricular systlic dysfunctinpharmaclgical appraches. J Card Fail. 1999 Dec;5(4):357-82. Hunt S. CC/H 2005 guideline update fr the diagnsis and management f chrnic heart failure in the adult: a reprt f the merican Cllege f Cardilgy/merican Heart ssciatin Task Frce n Practice Guidelines (Writing Cmmittee t Update the 2001 Guidelines fr the Evaluatin and Management f Heart Failure). J m Cll Cardil 2005; 46(6):e1-82. Jencks SJ, Cuerdn T, urwen DR, Fleming, Huck PM, Kussmaul E, Nilasena DS, Ordin DL, rday DR. Quality f medical care delivered t Medicare beneficiaries: a prfile at state and natinal levels. JM. 2000;284:1670-1676. Masudi F, Rathre SS, Wang Y et al. Natinal patterns f use and effectiveness f angitensin-cnverting enzyme inhibitrs in lder patients with heart failure and left ventricular systlic dysfunctin. Circulatin. 2004;110:724-731. -3
Pfeffer M, McMurray JJ, Velazquez EJ et al. Valsartan, captpril, r bth in mycardial infarctin cmplicated by heart failure, left ventricular dysfunctin, r bth. N Engl J Med. 2003;349:1893-1906. The SOLVD Investigatrs. Effect f enalapril n survival in patients with reduced left ventricular ejectin fractins and cngestive heart failure. N Engl J Med, 325:293-302, 1991. -4
: CEI r R fr LVSD Numeratr: Heart failure patients wh are prescribed an CEI r R at hspital discharge. Denminatr: Heart failure patients with LVSD and withut bth CEI and R cntraindicatins. Start Variable Key: Patient ge ICD-9-CM Principal Diagnsis Cde Nt n Table 2.1 On Table 2.1 ICD-9-CM ll Invalid Principal r Other t least ne n Table 2.2 Prcedure Cdes ll Missing r Nne n Table 2.2 dmissin Date Valid irthdate Valid Patient ge(in years) = dmissin Date minus irthdate Nte: The algrithm t calculate age must use the mnth and day prtin f admissin date and birthdate t yield the mst accurate age. age is < 0 days (negative value) Patient ge age is > r = 0 days and < 18 years age is > r = 18 years Cmfrt Measures Only = Y (Initial ppulatin, cmmn t all measures in the HF set) = N H -5
H Discharge Status = 02, 07, 20, 41, 43, 50 r 51 = 01, 03, 04, 05, 06, 61, 62, 63, 64, 65, 66 LVSD = N = Y Missing r Invalid Measure Ppulatin Data Missing / Invalid Cntraindicatin t th CEI and R at Discharge =Y Nt In Measure Ppulatin Z =N Z CEI Prescribed at Discharge =Y =N, Missing/Invalid Missing / Invalid R Prescribed at Discharge = Y E In Numeratr Ppulatin = N C Missing r Invalid Numeratr Data Missing /Invalid CEI Prescribed at Discharge =N Measure Ppulatin DIn Z Stp -6