Performance Measurement Network

Question: When mutiple ejection fractions (EF) are documented in the medical record, which value should we use?

If there are multiple EF values present in the medical record, which value should be used for LVSD < 35%?

Answer:

According to the abstraction guidelines for "LVSD < 35%", the worst (lowest) EF documented should be used (see abstraction guidelines below). For "LVSD < 40%", the same applies. The cut-off point (<35% or <40%) is the only difference. In cases where the patient received CRT, this is probably going to be a EF value obtained pre-implantation. Also, remember that either an EF value or description of EF < 35 % (See inclusion/exclusion terms for the data element definition) is acceptable.

Conflicting Documentation: Apply the following where there are two or more different descriptions of Ejection Fraction/LVSF: 1. Use lowest calculated ejection fraction. Presume calculated unless described as estimated (e.g., “Ejection fraction 30%”). 2. If calculated ejection fraction less than 35% select “Yes”. If calculated ejection fraction greater than 35%, select “No”. 3. Use lowest estimated ejection fraction. E.g., “Ejection fraction about 30%,” “Ejection fraction approximately 30%,” “Ejection fraction appears to be 35%,” “Visually ejection fraction is 45%,” “Ejection fraction 35-40%” (use mid-point), “Ejection fraction less than 40%.” 4. If estimated ejection fraction less than 35%, select “Yes”. If estimated ejection fraction greater than or equal to 35%, select “No”. a. Use worst narrative description with severity specified. b. Select “Yes” if description is synonymous with term from Inclusion list A. c. Select “No” if description with severity specified is NOT synonymous with term from Inclusion List A (e.g., normal, mild, preserved). 5. Use narrative description without severity specified. Select “Yes” if description is synonymous with term from Inclusion list B. Otherwise, select “No”.

Question Details
Focus area(s): Chart Abstracted Measure Specifications – Clinical
Related documents: ACHF,
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