Measure Information Form

Measure Set: Advanced Certification Heart Failure Outpatient(ACHFOP)

Set Measure ID: ACHFOP-03

Performance Measure Name: Hospital Outpatient Aldosterone Receptor Antagonists Prescribed for LVSD

Description: Aldosterone receptor antagonist therapy prescribed for heart failure patients with LVSD. For purposes of this measure, LVSD is defined as chart documentation of a left ventricular ejection fraction (LVEF) less than 40% or a narrative description of left ventricular systolic (LVS) function consistent with moderate or severe systolic dysfunction.

Rationale: Use of aldosterone receptor antagonist in eligible HF patients with LVSD and no documented contraindications, intolerance, or other medical reason(s) is recommended to reduce heart failure hospitalization and moratlity. Both ACEIs and ARBs can lower circulating aldosterone with initial therapy; however, aldosterone suppression may not be sustained over time. Clinical studies have demonstrated that the addition of spironolactone to ACEI therapy for patients wih NYHA class III or IV symptoms and recent hospitalization reduced the risk of death from 46% to 35% (30% relative risk reduction) over two years. Furthermore, a 35% reduction in heart failure hospitalization and improvement in functional class was noted. A more recent trial of a newer aldosterone antagonist, eplerenone, in patients with LVSD < 40% and clinical evidence of heart failure or diabetes mellitus within 14 days of myocardial infarction (MI) also demonstrated a reducation in mortality (13.6% to 11.8% at one year).

Hyperkalemia is a major risk of aldosterone antagonist therapy. Potassium supplements should be discontinued after the initiation of therapy, and patients should be counseled to avoid high-potassium foods.

Type of Measure: Process

Improvement Noted As: Increase in the rate

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records.

Data Accuracy: Variation may exist in the assignment of ICD-10 codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: None.

Sampling: Yes. Please refer to the measure set specific sampling requirements and for additional information see the Population and Sampling Specifications section.

Data Reported As: Aggregate rate generated from count data reported as a proportion.

Selected References:

• American Heart Association. Get With The Guidelines® Outpatient Fact Sheet. 2010.
• Hunt SA, Abraham WT, Chin MH, Felman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW. 2009 Focused update incorporated Into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation. Circulation. 2009;119(14):e391-e479.
• Lindenfeld J, Albert NM, Boehmer JP, Collins SP, Ezekowitz JA, Givertz MM, Klapholz M, Applications/LocalApps.MoserDK, Rogers JG, Starling RC, Stevenson WG, Tang WHW, Teerlink JR, Walsh MN. Executive Summary: HFSA 2010 Comphrensive Heart Failure Practice Guideline. J Card Fail 2010;16:475-539.
• Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, Applications/LocalApps.McBride PE, Applications/LocalApps.McMurray JJV, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WHW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;128:e240–e327.

Measure Algorithm: