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

Overview

CMS135v8 (2020)

CMS135v9 (2021)

CMS135v10 (2022)

Identifiers

CMS eCQM ID	NQF eCQM ID	NQF	MIPS Quality ID
CMS135v10	0081e	0081	005

*MIE only supports data collection and reporting using eCQM specifications

Definitions

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 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 Population	All patients aged 18 years and older with a diagnosis of heart failure
Denominator	Equals Initial Population with a current or prior LVEF < 40%
Denominator Exclusions	–
Numerator	Patients 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 Type	Process measure
Measure Scoring	Proportion measure
Rate Aggregation	Population 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)]
Granularity	Patient
Improvement Notation	Higher score indicates better quality
Domain	Effective 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%.

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
Numerator will be populated with patients prescribed an ACE inhibitor or ARB therapy within the measurement period.

Evidence

Initial Patient Population

Name	Value Set
Diagnosis: Heart Failure	2.16.840.1.113883.3.526.3.376
Encounter, Performed: Care Services in Long-Term Residential Facility	2.16.840.1.113883.3.464.1003.101.12.1014
Encounter, Performed: Discharge Services - Hospital Inpatient	2.16.840.1.113883.3.464.1003.101.12.1007
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

Denominator

Name	Value Set
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

Numerator

Name	Value Set
Medication, Active: ACE Inhibitor or ARB or ARNI	2.16.840.1.113883.3.526.3.1139

Denominator Exceptions

Name	Value Set
Allergy/Intolerance: ACE Inhibitor or ARB Ingredient	2.16.840.1.113883.3.526.3.1489
Allergy/Intolerance: sacubitril	RXNORM 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 ARB	2.16.840.1.113883.3.526.3.1211
Diagnosis: Intolerance to ACE Inhibitor or ARB	2.16.840.1.113883.3.526.3.1212
Diagnosis: Pregnancy	2.16.840.1.113883.3.526.3.378
Diagnosis: Renal Failure Due to ACE Inhibitor	2.16.840.1.113883.3.526.3.1151

Source(s)

eCQI CMS135