• Left ventricular systolic function (LVSF) assessment at anytime prior to arrival or during this hospitalization
• A plan for LVSF assessment after discharge
• A reason documented by a physician/APN/PA for not assessing LVSF

• There is no time limitation on pre-arrival LVSF assessments: LVSF assessments done anytime prior to hospital arrival are acceptable.
• In the absence of explicit documentation that an LVSF assessment was done, it should be inferred that an assessment was done if:
  • An echocardiogram, appropriate nuclear medicine test, or a cardiac catheterization with a left ventriculogram was done during this hospital stay (Note: In the absence of noted LVSF findings, give credit for test unless there’s a notation re inability to assess LVSF - e.g., "Rapid A-fib. Unable to assess LV function." - select "Reason"), or
  • There is documentation one of the above diagnostic tests was performed anytime prior to arrival (e.g., “Echo done last March”), or
  • There is documentation of LVSF, either as an ejection fraction or a narrative qualitative description (e.g., “Pt. admitted with severe LV dysfunction”).
• In determining whether there is a reason documented by physician/APN/PA for not assessing LVSF, reasons must be explicitly documented (e.g., “ESRD, life expectancy < 1 month, will not measure EF,” echo done but no LVSF findings noted AND physician notes “Technically difficult study. LVSF could not be measured.”) or clearly implied (e.g., “Patient refusing echo,”“Limited life expectancy, will not do any further evaluation,” “EF measurement not indicated”). If reasons are not mentioned in the context of LVSF assessments, do not make inferences (e.g., Do not assume that the physician/APN/PA is not assessing LVSF because the patient is already on ACEI therapy or is of advanced age). If the physician/APN/PA documents that he is deferring LVSF assessment to another physician/APN/PA, this should NOT count as a reason for not assessing LVSF during hospital stay (nor a reason for not planning an assessment after discharge) unless the reason/problem underlying the deferral is also noted (e.g., Select "No" if “Consulting cardiologist to evaluate pt. for echo” or "Pt. to follow up with physician/APN/PA re measuring EF as outpatient").
• In determining whether there is a plan to assess LVSF after discharge, the plan must be documented as definitive (e.g., “Will measure EF after discharge”). Documentation which indicates only that an LVSF assessment after discharge will be considered (e.g., “May do echo in 1 month”) is not sufficient.

• Consultation notes
• Emergency department record
• History and physical
• Progress notes
• Physician orders
• Discharge summary
• Diagnostic test reports
• Operative notes
• Procedure notes
• Discharge instruction sheet
• Discharge planning notes

Excluded Data Sources:
Any documentation dated/timed after discharge, except discharge summary and operative/procedure/diagnostic test reports (from procedure done during hospital stay)