LVSD < 40%

Specifications Manual for Joint Commission National Quality Measures (v2016B1)

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Release Notes:
Data Element
Version 2016B1

Data Element Name:

LVSD < 40%

Collected For:

ACHF-01, ACHFOP-01, ACHFOP-02, ACHFOP-03,

Definition:

Left ventricular systolic dysfunction (LVSD) documented in medical record. LVSD is defined as a left ventricular ejection fraction less than 40% or a narrative description consistent with moderate or severe systolic dysfunction.

LVSD is an impairment of left ventricular performance. An ejection fraction (EF) is an index of left ventricular systolic function (LVSF) and reflects the proportion of blood ejected during each ventricular contraction compared with the total ventricular filling volume.

Suggested Data Collection Question:

Is the left ventricular systolic function (LVSF) documented as an ejection fraction (EF) less than 40% or a narrative description consistent with moderate or severe systolic dysfunction?

Format:

Length:	1
Type:	Alphanumeric
Occurs:	1

Allowable Values:

Y (Yes) LVSF is documented as an ejection fraction (EF) less than 40% or a narrative description consistent with moderate or severe systolic dysfunction.

N (No) LVSF is not documented as an ejection fraction (EF) less than 40% or a narrative description consistent with moderate or severe systolic dysfunction, or unable to determine from medical record documentation.

Notes for Abstraction:

Results from in-hospital LVSF assessments filed into the chart after discharge should still be used.

A. Methodology:

Final findings take priority over preliminary findings. Applies to test reports and findings noted outside of reports. If not labeled "preliminary," assume it is final.
Conclusion section of report takes priority over other sections. Consider the "Impression," "Interpretation," and "Final Diagnosis" sections as equivalent with the "Conclusion" section.
Apply Section B Conflicting Documentation priority order in ANY step in Methodology section when there are two or more different descriptions of Ejection Fraction/LVSF.
Disregard the following terminology when reviewing the record for documentation of LVSF/LVSD. If documented, continue reviewing for LVSF/LVSD inclusions outlined in the Inclusion lists, as directed in the abstraction guidelines below.
- Diastolic dysfunction, failure, function, or impairment
- Ventricular dysfunction not described as left ventricular or systolic
- Ventricular failure not described as left ventricular or systolic
- Ventricular function not described as left ventricular or systolic
  E.g., Impression section of echo report states only "diastolic dysfunction." Findings section states "EF 35%." Disregard "diastolic dysfunction" in the Impression section and answer "Yes" due to EF 35%.

If one or more in-hospital tests performed:
1. Use report from most recent test* (test done closest to discharge).
2. If no report or no Ejection Fraction/LVSF findings noted in report, use other sources (e.g., progress notes) that clearly reference the most recent test*.
3. If no Ejection Fraction/LVSF results from the most recent test are documented anywhere, use the report from the second most recent test*.
4. If no Ejection Fraction/LVSF findings from second most recent test are documented anywhere, use other sources (e.g., progress notes) that clearly reference the second most recent test*. Continue working backwards (if greater than 2 tests) and use Ejection Fraction/LVSF from the most recent test* that has Ejection Fraction/LVSF findings, using the report over non-report sources as above.
5. If no Ejection Fraction/LVSF results from any in-hospital test are documented anywhere, skip to step 2a below.

*If you cannot determine between two in-hospital tests which was performed closest to the time of discharge, use BOTH tests:

Use reports. Reports take priority over non-report sources.
If no reports or no Ejection Fraction/LVSF findings on reports from any test, use other sources (e.g., progress notes) that clearly reference the tests.
If no Ejection Fraction/LVSF results from either in-hospital test documented anywhere, go to step 2a below.

If in-hospital test not done, no Ejection Fraction/LVSF results from any in-hospital test documented, OR documentation is not clear that one was done (e.g., echo ordered but no documentation that it was done):
1. Assume notations of Ejection Fraction/LVSF with no timeframe ("floating" Ejection Fractions/LVSFs) are from assessments done prior to arrival.
2. If timeframe known for ALL pre-arrival Ejection Fractions/LVSFs (no "floaters"):
  - Use results from the pre-arrival test known to be most recent (closest to hospital arrival). Use report over other sources, and Conclusion (Impression, etc.) over other sections of report, as above.
3. If one or more "floaters":
  - Compile all Ejection Fractions/LVSFs and eliminate those that you can determine are not the most recent, resulting in a list of Ejection Fraction/LVSF "Possibles."
  - If Ejection Fraction/LVSF from one test in the "Possibles" list is referenced both in a report and in another source, use the report, and use the Conclusion (Impression, etc.) over other sections of the report, as above, to determine which Ejection Fraction/LVSF from this test to add to the list of "Possibles."
  - Select final Ejection Fraction/LVSF from list of "Possibles" based on the Conflicting Documentation rules below.

B. Conflicting Documentation:
Apply the following priority order in cases of conflicting documentation within ANY ONE STEP in Methodology above, where there are two or more different descriptions of Ejection Fraction/LVSF:

Use lowest calculated ejection fraction. Presume calculated unless described as estimated (e.g., "Ejection fraction 30%").
- If calculated ejection fraction less than 40% select "Yes." If calculated ejection fraction greater than or equal to 40%, select "No."
Use lowest estimated ejection fraction. E.g., "Ejection fraction about 40%," "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%."
- If estimated ejection fraction less than 40%, select "Yes." If estimated ejection fraction greater than or equal to 40%, select "No."
Use worst narrative description with severity specified.
- Select "Yes" if description is synonymous with term from Inclusion list A.
- Select "No" if description with severity specified is NOT synonymous with term from Inclusion List A (e.g., normal, mild, preserved).
Use narrative description without severity specified. Select "Yes" if description is synonymous with term from Inclusion list B. Otherwise, select "No."

Suggested Data Sources:

Consultation notes
History and physical
Progress notes
Discharge summary
Procedure notes
Outpatient medical record

Additional Notes:

Guidelines for Abstraction:

Inclusion

Exclusion

Inclusion list A: Moderate/severe LVSD

Biventricular dysfunction described as marked, moderate, moderate-severe, severe, significant, substantial, or very severe
Biventricular heart failure described as moderate or severe
Ejection fraction or left ventricular ejection fraction (LVEF) described as low, poor, or very low
Endstage cardiomyopathy
Hypokinesis described as diffuse, generalized, or global AND marked, moderate, moderate-severe, severe, significant, substantial, or very severe
Left ventricular (LV) akinesis described as marked, moderate, moderate-severe, severe, significant, substantial, or very severe
Left ventricular (LV) hypokinesis described as marked, moderate, moderate-severe, severe, significant, substantial, or very severe in one or more segments of left ventricle
Left ventricular dysfunction (LVD), left ventricular systolic dysfunction (LVSD), or systolic dysfunction described as marked, moderate, moderate-severe, severe, significant, substantial, or very severe
Left ventricular function (LVF), left ventricular systolic function (LVSF), or systolic function described as low, poor, or very low
Systolic failure described as marked, moderate, moderate-severe, severe, significant, substantial, or very severe AND not described as right ventricular

Inclusion list B: LVSD Severity not specified

Biventricular dysfunction where severity is not specified
Ejection fraction or left ventricular ejection fraction (LVEF) described as abnormal, compromised, decreased, depressed, diminished, impaired, or reduced
Hypokinesis described as diffuse, generalized, or global where severity is not specified
Left ventricular (LV) hypokinesis described as involving the entire left ventricle
Left ventricular dysfunction (LVD), left ventricular systolic dysfunction (LVSD), or systolic dysfunction where severity is not specified
Left ventricular function (LVF), left ventricular systolic function (LVSF), or systolic function described as abnormal, compromised, decreased, depressed, diminished, impaired, or reduced
Systolic failure where severity is not specified AND not described as right ventricular

Moderate or severe systolic dysfunction

Any term in Inclusion list A or B described using one of the negative modifiers or qualifiers listed in Appendix H, Table 2.6, Qualifiers and Modifiers Table
Any term in Inclusion list A or B described as mild-moderate

LVSD < 40%

Specifications Manual for Joint Commission National Quality Measures (v2016B1)
Discharges 01-01-17 (1Q17) through 06-30-17 (2Q17)