Measure Information Form

Measure Set: Advanced Certification Heart Failure Outpatient (ACHFOP)

Set Measure ID: ACHFOP-03

Performance Measure Name: Hospital Outpatient Aldosterone Receptor Antagonists

Description: 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.

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 mortality. 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 with 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.

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

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

Included Populations: Not applicable
Excluded Populations: None
Data Elements:

Aldosterone Receptor Antagonist Prescribed in the Outpatient Setting

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

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 ≤35%

New York Heart Association (NYHA) Functional Classification III-IV

Excluded Populations:

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 Aldosterone Receptor Antagonist Prescribed for LVSD in the Outpatient Setting

Data Elements:

Birthdate

Clinical Trial

Discharge Code

E/M Code

ICD-10-CM Principal Diagnosis Code

ICD-10-PCS Other Procedure Codes

ICD-10-PCS Principal Procedure Code

ICD-10-PCS Principal Procedure Date

LVSD

New York Heart Association (NYHA) Classification

Outpatient Encounter Date

Reason for No Aldosterone Receptor Antagonist Prescribed in the Outpatient Setting

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:

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, 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, 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:

Specifications Manual for Joint Commission National Quality Measures (v2020A1)
Discharges 01-01-20 (1Q20) through 6-30-20 (2Q20)

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