CMS 135 - Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)

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Covered by this topic

Overview

CMS135v8 (2020)

CMS135v9 (2021)

CMS135v10 (2022)

Identifiers

CMS eCQM IDNQF eCQM IDNQFMIPS Quality ID
CMS135v100081e0081005

*MIE only supports data collection and reporting using eCQM specifications

Definitions

DescriptionPercentage 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 ACE inhibitor or ARB or ARNI therapy either within a 12-month period when seen in the outpatient setting OR at each hospital discharge
Initial Patient PopulationAll patients aged 18 years and older with a diagnosis of heart failure
DenominatorEquals Initial Population with a current or prior LVEF < 40%
Denominator Exclusions–
NumeratorPatients who were prescribed ACE inhibitor or ARB or ARNI therapy either within a 12-month period when seen in the outpatient setting OR at each hospital discharge
Numerator Exclusions–
Denominator Exceptions
  • Documentation of medical reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., hypotensive patients who are at immediate risk of cardiogenic shock, hospitalized patients who have experienced marked azotemia, allergy, intolerance, other medical reasons).
  • Documentation of patient reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., patient declined, other patient reasons).
  • Documentation of system reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., other system reasons).

Additional Information

Measure TypeProcess measure
Measure ScoringProportion measure
Rate AggregationPopulation 1: Patients who were prescribed ACE inhibitor or ARB or ARNI therapy within a 12-month period when seen in the outpatient setting
Population 2: Patients who were prescribed ACE inhibitor or ARB or ARNI therapy at each hospital discharge

Performance Rate = (Numerator 1 + Numerator 2)/ [(Denominator 1 - Denominator Exceptions 1) + (Denominator 2 - Denominator Exceptions 2)]
GranularityPatient
Improvement NotationHigher score indicates better quality
DomainEffective Clinical Care

Clinical Instructions

New UI Visit Encounter (valid RC202109+)

Original Visit Encounter

Track all patients aged 18+ prescribed an ACE inhibitor or ARB therapy within a 12-month period of the diagnosis of heart failure with a current or prior left ventricular ejection fraction (LVEF) < 40%.

  1. Ensure patient has one of the following diagnoses:
    1. Moderate left ventricular systolic dysfunction (disorder) - SNOMED 981000124106
    2. Severe left ventricular systolic dysfunction (disorder) - SNOMED 991000124109
  2. Numerator will be populated with patients prescribed an ACE inhibitor or ARB therapy within the measurement period.

Evidence

Initial Patient Population

NameValue Set
Diagnosis: Heart Failure2.16.840.1.113883.3.526.3.376
Encounter, Performed: Care Services in Long-Term Residential Facility2.16.840.1.113883.3.464.1003.101.12.1014
Encounter, Performed: Discharge Services - Hospital Inpatient2.16.840.1.113883.3.464.1003.101.12.1007
Encounter, Performed: Home Healthcare Services2.16.840.1.113883.3.464.1003.101.12.1016
Encounter, Performed: Nursing Facility Visit2.16.840.1.113883.3.464.1003.101.12.1012
Encounter, Performed: Office Visit2.16.840.1.113883.3.464.1003.101.12.1001
Encounter, Performed: Outpatient Consultation2.16.840.1.113883.3.464.1003.101.12.1008
Encounter, Performed: Patient Provider Interaction2.16.840.1.113883.3.526.3.1012

Denominator

NameValue Set
Diagnosis: Moderate or Severe LVSD2.16.840.1.113883.3.526.3.1090
Diagnostic Study, Performed: Ejection Fraction2.16.840.1.113883.3.526.3.1134

Numerator

NameValue Set
Medication, Active: ACE Inhibitor or ARB or ARNI2.16.840.1.113883.3.526.3.1139

Denominator Exceptions

NameValue Set
Allergy/Intolerance: ACE Inhibitor or ARB Ingredient2.16.840.1.113883.3.526.3.1489
Allergy/Intolerance: sacubitrilRXNORM Code 1656328
Allergy/Intolerance: Substance with angiotensin II receptor antagonist mechanism of action (substance)SNOMEDCT Code 372913009
Allergy/Intolerance: Substance with angiotensin-converting enzyme inhibitor mechanism of action (substance)SNOMEDCT Code 372733002
Allergy/Intolerance: Substance with neprilysin inhibitor mechanism of action (substance)SNOMEDCT Code 786886009
Diagnosis: Allergy to ACE Inhibitor or ARB2.16.840.1.113883.3.526.3.1211
Diagnosis: Intolerance to ACE Inhibitor or ARB2.16.840.1.113883.3.526.3.1212
Diagnosis: Pregnancy2.16.840.1.113883.3.526.3.378
Diagnosis: Renal Failure Due to ACE Inhibitor2.16.840.1.113883.3.526.3.1151

Source(s)

eCQI CMS135

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