Measure Information Form

*THIS MEASURE IS RETIRED AS OF 1/1/2025 FOR ADVANCED CERTIFICATION HEART FAILURE PROGRAMS* 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) ≤ 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:

ACEI Prescribed for LVSD in the Outpatient Setting

ARB Prescribed for LVSD in the Outpatient Setting

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 enrolled in a Clinical Trial

Patients who had a left ventricular assistive device (LVAD) or heart transplant procedure during the hospital stay or a past medical history of an LVAD or heart transplant (ICD-10-PCS procedure code for LVAD and heart transplant as defined in Appendix A Table 2.2, and ICD-10 diagnosis codes on Table 2.13)

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:

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

Outpatient Encounter Date

Reason for No ACEI and No ARB Prescribed for LVSD in 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:

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:
Graphic depiction of the Measure Algorithm. Refer to the Algorithm Narrative for each detailed step.

ACHFOP–02: Hospital Outpatient ACEI or ARB Prescribed for LVSD Algorithm Narrative

Numerator: Patients who are prescribed an ACEI or ARB for LVSD when seen in the outpatient setting.
Denominator: Heart failure patients with current or prior documentation of left ventricular ejection fraction (LVSD) less than or equal to 40%.

1. Start processing. Run cases that are included in the ACHFOP Outpatient Initial Patient Population and pass the edits defined in the Clinical Data Processing Flow, through this measure.

2. Check Clinical Trial

If Clinical Trial is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
If Clinical Trial equals Y, the case will proceed to a Measure Category Assignment of B and will not be in measure population. Stop processing
If Clinical Trial equals N, continue processing and proceed to LVSD.

3.Check LVSD

If LVSD is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
If LVSD equals 5, the case will proceed to a Measure Category Assignment of B and will not be in measure population. Stop processing
If LVSD equals 1,2,3 or 4, continue processing and proceed to ACEI Prescribed for LVSD in the Outpatient Setting

4.Check ACEI Prescribed for LVSD in the Outpatient Setting

If ACEI Prescribed for LVSD in the Outpatient Setting is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
If ACEI Prescribed for LVSD in the Outpatient Setting equals Y, the case will proceed to a Measure Category Assignment of E and will be in numerator population. Stop processing
If ACEI Prescribed for LVSD in the Outpatient Setting equals N, continue processing and proceed to ARB Prescribed for LVSD in the Outpatient Setting

5. Check ARB Prescribed for LVSD in the Outpatient Setting

If ARB Prescribed for LVSD in the Outpatient Setting is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
If ARB Prescribed for LVSD in the Outpatient Setting equals Y, the case will proceed to a Measure Category Assignment of E and will be in numerator population. Stop processing
If ARB Prescribed for LVSD in the Outpatient Setting equals N, continue processing and proceed to Reason for No ACEI and No ARB Prescribed for LVSD in Outpatient Setting

6. Check Reason for No ACEI and No ARB Prescribed for LVSD in Outpatient Setting

If Reason for No ACEI and No ARB Prescribed for LVSD in Outpatient Setting is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
If Reason for No ACEI and No ARB Prescribed for LVSD in Outpatient Setting equals Y, the case will proceed to a Measure Category Assignment of B and will not be in measure population. Stop processing
If Reason for No ACEI and No ARB Prescribed for LVSD in Outpatient Setting equals N, the case will proceed to a Measure Category Assignment of D and will be in measure population. Stop processing.

Specifications Manual for Joint Commission National Quality Measures (v2025A)
Discharges 01-01-25 (1Q25) through 06-30-25 (2Q25)

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