TJC2024A Note for "Hospital Outpatient Mineralocorticoid Receptor Antagonists (MRA)"

• Topic Version for Release TJC2024A: 54
• Topic has changed since last release: Compare versions

Rationale

The update to mineralocorticoid receptor antagonist (MRA) will provide abstractor clarification and alignment with 2022 Clinical Practice Guidelines which recommend prescribing MRAs across the spectrum of Applications/LocalApps.HFrEF, inclusive of a wide range of etiologies and disease severities.

Description

Performance Measure Name
Change from:
Hospital Outpatient Aldosterone Receptor Antagonists
To:
Hospital Outpatient Mineralocorticoid Receptor Antagonists (MRA)

Description
Change from:
Patients with a diagnosis of heart failure, a New York Heart Association (NYHA) class III-IV, and heart failure with a left ventricular ejection fraction (LVSD) ≤35% or a narrative description of left ventricular systolic (LVS) function consistent with moderate or severe systolic dysfunction who are prescribed an aldosterone receptor antagonist.
To:
Patients with a diagnosis of heart failure, a New York Heart Association (NYHA) class II-IV, and heart failure with a left ventricular ejection fraction (LVSD) ≤40% or a narrative description of left ventricular systolic (LVS) function consistent with moderate or severe systolic dysfunction who are prescribed a mineralocorticoid receptor antagonist (MRA).

Rationale
Change to:
The 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure states a benefit of prescribing Mineralocorticoid Receptor Antagonists across the spectrum of Applications/LocalApps.HFrEF, inclusive of a wide range of etiologies and disease severities. An MRA (spironolactone or eplerenone) is recommended in patients with Applications/LocalApps.HFrEF and NYHA class II to IV symptoms to reduce morbidity and mortality, if eGFR is >30 mL/min/1.73 m2 and serum potassium is <5.0 mEq/L. Hyperkalemia is a major risk of MRA therapy; therefore, careful monitoring of potassium, renal function, and diuretic dosing should be performed at initiation and closely monitored thereafter (Heidenreich et al., 2022).

Numerator Statement
Change from:
Patients who are prescribed an aldosterone receptor antagonist (i.e. Aldactone, Aldactazide [Hydrochlorothiazide + Spironolactone], Eplerenone, Inspra, Spironolactone) when seen in the outpatient setting.
To:
Patients who are prescribed a mineralocorticoid receptor antagonist (MRA) (i.e. Aldactone, Aldactazide [Hydrochlorothiazide + Spironolactone], Eplerenone, Inspra, Spironolactone) when seen in the outpatient setting.

Numerator Data Elements
Change from:

• Aldosterone Receptor Antagonist Prescribed in the Outpatient Setting
  

To:

• Mineralocorticoid Receptor Antagonist (MRA) Prescribed in the Outpatient Setting
  

Denominator Statement
Change from:
Heart failure patients with a NYHA class III-IV and current or prior documentation of left ventricular ejection fraction (LVSD) ≤35%.
To:
Heart failure patients with a NYHA class II-IV and current or prior documentation of left ventricular ejection fraction (LVSD) ≤40%.

Denominator Included Populations
Change third and fourth bullet from:

• Documentation of LVSD ≤35%
  
• New York Heart Association (NYHA) Functional Classification III-IV
  

To:

• Documentation of LVSD ≤40%
  
• New York Heart Association (NYHA) Functional Classification II-IV
  

Denominator Excluded Populations
Change last bullet from:

• Patients with a documented Reason for No Aldosterone Receptor Antagonist Prescribed for LVSD in the Outpatient Setting
  

To:

• Patients with a documented Reason for No Mineralocorticoid Receptor Antagonist (MRA) Prescribed in the Outpatient Setting
  

Denominator Data Elements
Change from:

• Reason for No Aldosterone Receptor Antagonist Prescribed in the Outpatient Setting
  

To:

• Reason for No Mineralocorticoid Receptor Antagonist (MRA) Prescribed in the Outpatient Setting
  

Selected References
Add:

• Heidenreich, P., Bozkurt, B., Aguilar, D., Allen, L., Byun, J., Colvin, M., Deswal, A., Drazner, M., Dunlay, S., Evers, L., Fang, J., Fedson, S., Fonarow, G., Hayek, S., Hernandez, A., Khazanie, P., Kittleson, M., Lee, C., Link, M., Milano, C., Nnacheta, L., Sandhu, A., Stevenson, L., Vardeny, O., Vest, A., & Yancy, C. 2022 AHA/ACC2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e895-e1032
  

Algorithm
Denominator
Change from: Heart failure patients with a NYHA class III-IV and current or prior documentation of left ventricular ejection fraction (LVSD) ≤35%.
To: Heart failure patients with a NYHA class II-IV and current or prior documentation of left ventricular ejection fraction (LVSD) ≤40%.

Check Box LVSD
Change from:
If LVSD quals 2, 3 or 5, the case will proceed to a Measure Category Assignment of B.
If LVSD quals 1 or 4, continue processing and proceed to New York Heart Association (NYHA) Classification .
To:
If LVSD quals 5, the case will proceed to a Measure Category Assignment of B.
If LVSD quals 1,2,3 or 4, continue processing and proceed to New York Heart Association (NYHA) Classification .

Check Box New York Heart Association (NYHA) Classification
Change from:
If New York Heart Association (NYHA) Classification quals 1,2 or 5, the case will proceed to 2nd New York Heart Association (NYHA) Classification
If New York Heart Association (NYHA) Classification quals 3 or 4, continue processing and proceed to Mineralocorticoid Receptor Antagonist Prescribed for LVSD in the Outpatient Setting.
To:
If New York Heart Association (NYHA) Classification quals 1 or 5, the case will proceed to 2nd New York Heart Association (NYHA) Classification
If New York Heart Association (NYHA) Classification quals 2, 3 or 4, continue processing and proceed to Mineralocorticoid Receptor Antagonist Prescribed for LVSD in the Outpatient Setting.
2nd Check Box New York Heart Association (NYHA) Classification

Change from:
If New York Heart Association (NYHA) Classification quals 1 or 2, the case will proceed to a Measure Category Assignment of B.
If New York Heart Association (NYHA) Classification quals 5, the case will proceed to a Measure Category Assignment of D.
To:
If New York Heart Association (NYHA) Classification quals 1, the case will proceed to a Measure Category Assignment of B.
If New York Heart Association (NYHA) Classification quals 5, the case will proceed to a Measure Category Assignment of D.

Notes