Specifications Manual for Joint Commission National Quality Measures (v2019A)

Release Notes:
Measure Information Form
Version 2019A

Measure Information Form

Measure Set: Advanced Certification Heart Failure Outpatient (ACHFOP)

Set Measure ID: ACHFOP-02

Performance Measure Name: Hospital Outpatient ACEI or ARB Prescribed for LVSD

Description: Heart failure patients with left ventricular systolic dysfunction (LVSD) who are prescribed an ACEI or ARB in the outpatient setting. 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: ACE inhibitors reduce mortality and morbidity in patients with heart failure and left ventricular systolic dysfunction (The SOLVD Investigators, 1991 and CONSENSUS Trial Study Group, 1987) and are effective in a wide range of patients (Masoudi, 2004). Clinical trials have also established ARB therapy as an acceptable alternative to ACEI, especially in patients who are ACEI intolerant (Granger, 2003 and Pfeffer, 2003). National guidelines strongly recommend ACEIs for patients hospitalized with heart failure (Jessup, 2009 and HFSA, 2010). Guideline committees have also supported the inclusion of ARBs in performance measures for heart failure (Executive Council of the Heart Failure Society of America, 2004).

Type Of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Patients who are prescribed an ACEI or ARB for LVSD when seen in the outpatient setting
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:
  • E/M Code for hospital outpatient encounter as defined in Appendix A, Table 2.0
  • An ICD-10-CM Principal Diagnosis Code for HF as defined in Appendix A, Table 2.1, and
  • Documentation of LVSD < 40%

Excluded Populations:
  • Patients renrolled in a Clinical Trial
  • Patients who had a left ventricular assist device (LVAD) or heart transplant procedure (ICD-10-PCS Procedure Code for LVAD or heart transplant as defined in Appendix A, Table 2.2)
  • Patients less than 18 years of age
  • Patients with a documented Reason for No ACEI or ARB Prescribed for LVSD in the Outpatient Setting

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:

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:
  • Bonow RO, Ganiats TG, Beam CT, Blake K, Casey DE, Goodlin SJ, et al. January 2011. American College of Cardiology Foundation/ American Heart Association/ Physician Consortium for Performance Improvement Heart Failure Performance Measurement Set. In American Medical Association. Retrieved February 2011, from http://www.ama-assn.org/ama1/pub/upload/mm/pcpi/hfset-12-5.pdf.
  • Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). The CONSENSUS Trial Study Group. N Engl J Med. 1987;316:1429-1435.
  • Executive Council of the Heart Failure Society of America. Implications of recent clinical trials for heart failure performance measures. HFSA Position Statement. J Card Fail. 2004;10:4-5.
  • Granger CB, McMurray JJ, Yusuf S et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: the CHARM-Alternative trial. Lancet. 2003;362:772-776.
  • Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG, et al, writing on behalf of the 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult Writing Committee. 2009 focused update: ACCF/AHA guidelines for the diagnosis and management of heart failure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2009;53:1343— 82.
  • Lindenfeld J, Albert NM, Boehmer JP, Collins SP, Ezekowitz JA, Givertz MM, et al. Executive Summary: HFSA 2010 Comprehensive Heart Failure Practice Guideline. J Card Fail 2010; 16:475-539.
  • Masoudi FA, Rathore SS, Wang Y et al. National patterns of use and effectiveness of angiotensin-converting enzyme inhibitors in older patients with heart failure and left ventricular systolic dysfunction. Circulation. 2004;110:724-731.
  • Pfeffer MA, McMurray JJ, Velazquez EJ et al. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med. 2003;349:1893-1906.
  • The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med. 1991;325:293-302.
  • 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 ACHFOP-02
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Specifications Manual for Joint Commission National Quality Measures (v2019A)
Discharges 07-01-19 (3Q19) through 12-31-19 (4Q19)

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