Specifications Manual for Joint Commission National Quality Measures (v2020B)
Posted: 2/5/2020
Home » LVSD

Release Notes:
Data Element
Version 2020B

Name:LVSD
Collected For: ACHF-01, ACHFOP-01, ACHFOP-02, ACHFOP-03
Definition:Left ventricular 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.
Question:Is the left ventricular systolic function (LVSF) documented as an ejection fraction (EF) of <40% or ≤35% or a narrative description consistent with moderate or severe systolic dysfunction?
Format:
Length:1
Type:Alphanumeric
Occurs:1
Allowable Values:

1 LVSF is documented as an EF ≤35%.

2 LVSF is documented as an EF equal to 36-39%.

3 LVSF is documented as an EF equal to 40%.

4 Documentation of a narrative description consistent with moderate or severe systolic dysfunction.

5 EF or a narrative description consistent with moderate or severe systolic dysfunction is not documented, or EF ≥ 41% or unable to determine from medical record documentation.
Notes for Abstraction:
  • Utilize documentation from the most recent test/procedure performed (i.e. test or procedure performed closest to discharge).
    • If a test/procedure was not performed to determine EF, other documentation within the medical record may be used (e.g. H&P, progress report, consolation report).
      • Test and procedure report results take priority over non-report sources (e.g. progress notes).
    • Final findings from a test or procedure report take priority over preliminary findings.
      • If documentation is not labeled as a "preliminary result”, assume it is a final result.
      • Conclusion section of a report takes priority over other sections. Consider the “Impression,” “Interpretation,” and “Final Diagnosis” sections as equivalent with the “Conclusion” section.
      • Results from in-hospital test or procedure filed in the medical record after the patient’s discharge can be utilized.
      • If the most recent test/procedure does not include documentation of an EF utilize the second most recent test or procedure (i.e. test/procedure performed closest to discharge), and so on.
      • Documentation from a test/procedure performed prior to arrival for this hospital or outpatient encounter maybe utilized, if no testing/procedures were performed during this encounter. Use results from the pre-arrival test known to be most recent (i.e. closest to hospital or outpatient arrival).
      • If the EF is documented as a range, document lowest value (e.g. EF between 38% and 41%. Assign 38%).
  • Narrative descriptions
    • Use worst narrative description with severity specified.
    • Select 4 if description is synonymous with term from Inclusion list A.
    • Select 5 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 4 if description is synonymous with term from Inclusion list B. Otherwise, select 5.
    • Do not use narrative descriptions that indicates uncertainty about the patient’s EF. E.g. questionable EF of <36%.
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 as mild-moderate

LVSD
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Specifications Manual for Joint Commission National Quality Measures (v2020B)
Discharges 07-01-20 (3Q20) through 12-31-20 (4Q20)

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