Specifications Manual for Joint Commission National Quality Measures (v2018B1)

Release Notes:
Measure Information Form
Version 2018B1


Measure Information Form

Measure Set: Advanced Certification Heart Failure (ACHF)

Set Measure ID: ACHF-01

Performance Measure Name: Beta-Blocker Therapy (i.e., Bisoprolol, Carvedilol, or Sustained-Release Metoprolol Succinate Prescribed for LVSD at Discharge)

Description: Beta-blocker therapy (i.e., bisoprolol, carvedilol, or sustained-release metoprolol succinate) is prescribed for heart failure patients with LVSD at discharge. 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: Beta-blocker therapy has been recommended for the treatment of patients with heart failure and reduced left ventricular ejection fraction (LVEF) since the 1970's (HFSA, 2010). Several large-scale clinical trials have provided unequivocal evidence of important reductions in both morbidity and mortality. The marked beneficial effects of beta blockade has been well demonstrated in large-scale clinical trials of symptomatic patients with New York Heart Association (NYHA) class II-IV heart failure and reduced LVEF using carvedilol, bisoprolol, and sustained-release metoprolol succinate (Hunt et al., 2009). These beta-blockers, in addition to ACE inhibitors and diuretics, are considered routine therapy for heart failure patients with reduced LVEF. Beta-blocker therapy is well tolerated by the majority of patients, even those with co-morbidities such as, diabetes mellitus, chronic obstructive lung disease, and peripheral vascular disease.

Type Of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Patients who are prescribed bisoprolol, carvedilol, or sustained-release metoprolol succinate for LVSD at hospital discharge.
Included Populations: Not applicable

Excluded Populations: None

Data Elements:

Denominator Statement: Heart failure patients with current or prior documentation of left ventricular ejection fraction (LVSD) < 40%.
Included Populations:
  • Discharges with ICD-10-CM Principal Diagnosis Code for HF as defined in Appendix A, Table 2.1, and
  • Documentation of LVSD < 40%

Excluded Populations:
  • Patients who had a left ventricular assistive device (LVAD) or heart transplant procedure during hospital stay (ICD-10-PCS procedure code for LVAD and heart transplant as defined in Appendix A, Table 2.2)
  • Patients less than 18 years of age
  • Patients who have a Length of Stay greater than 120 days
  • Patients with Comfort Measures Only documented
  • Patients enrolled in a Clinical Trial
  • Patients discharged to another hospital
  • Patients who left against medical advice
  • Patients who expired
  • Patients discharged to home for hospice care
  • Patients discharged to a healthcare facility for hospice care
  • Patients with a documented Reason for No Bisoprolol, Carvedilol, or Sustained-Release Metoprolol Succinate Prescribed for LVSD at Discharge

Data Elements:

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:
  1. American College of Cardiology Foundation, American Heart Association, Physician Consortium for Performance Improvement® (PCPI). Heart Failure Performance Measurement Set. Jan. 2011; 47-56.
  2. American Heart Association. Get With The Guidelines® Outpatient Fact Sheet. 2010.
  3. 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.
  4. Lindenfeld J, Albert NM, Boehmer JP, Collins SP, Ezekowitz JA, Givertz MM, Klapholz M, 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.
  5. 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, McBride PE, 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:

Measure Information Form ACHF-01
Specifications Manual for Joint Commission National Quality Measures (v2018B1)
Discharges 01-01-19 (1Q19) through 06-30-19 (2Q19)