CMS135v8 – Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)

All patients aged 18 years and older with a diagnosis of heart failure

All patients aged 18 years and older with a diagnosis of heart failure with a current or prior LVEF < 40%

Patients who were prescribed ACE inhibitor or ARB therapy either within a 12-month period when seen in the outpatient setting

All patients aged 18 years and older with a diagnosis of heart failure

All patients aged 18 years and older with a diagnosis of heart failure with a current or prior LVEF < 40%

Patients who were prescribed ACE inhibitor or ARB therapy either within a 12-month period when seen at each hospital discharge

• Documentation of medical reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., hypotensive patients who are at immediate risk of cardiogenic shock, hospitalized patients who have experienced marked azotemia, allergy, intolerance, other medical reasons).
• Documentation of patient reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., patient declined, other patient reasons).
• Documentation of system reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., other system reasons).

For Initial Population 1:

All patients aged 18 years and older with a diagnosis of heart failure.

• To add diagnosis, navigate to Patient > Provider Note > Diagnosis. 
• To record visit, navigate to Patient > Provider Note > eSuperbill or Patient > Clinical > Order& Results > Procedure.

For Denominator 1:

All patients aged 18 years and older with a diagnosis of heart failure with a current or prior LVEF < 40% are included in denominator. To record any of the following condition, navigate to:

• Ejection Fraction with result < 40 ‘%’ (Patient > Clinical > Evaluations)
• Moderate or Severe LVSD (Patient > Provider Note > Diagnosis)
• Left Ventricular Systolic Dysfunction with severity in Moderate or Severe (Patient > Provider Note > Diagnosis)

For Numerator 1:

Patients who were prescribed ACE inhibitor or ARB therapy either within a 12-month period when seen in the outpatient setting are included in numerator. To add a medication, navigate to Patient > Provider Notes > Prescription

Denominator Exceptions:

All patient that full fill the below mentioned criteria are included in denominator.

• Medical Patient or System Reason for Not Ordering ACE Inhibitor or ARB Outpatient (Patient > Provider Notes > Clinical > Medication)
• Patient Declined ACE Inhibitor or ARB Outpatient (Patient > Clinical > Evaluation)
• Allergy or Intolerance to ACE Inhibitor or ARB Ingredient Outpatient (Patient > Clinical > Allergy)
• Diagnosis of Allergy to ACE Inhibitor or ARB Outpatient (Patient > Clinical > Evaluation)
• Diagnosis of Intolerance to ACE Inhibitor or ARB Outpatient (Patient > Clinical > Evaluation)
• Diagnosis of Pregnancy Outpatient (Patient > Provider Notes > Clinical > Diagnosis)
• Diagnosis of Renal Failure Due to ACE Inhibitor Outpatient (Patient > Clinical > Evaluation)