• Institute for Clinical Systems Improvement (ICSI). Heart failure in adults. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2007 Aug. 119 p. [217 references]

Does not apply to this measure

This measure is used to assess the percentage of adult patients with a primary diagnosis of heart failure who have left ventricular systolic dysfunction (LVSD) and who do not have a contraindication to taking beta-blockers, who are prescribed beta-blocker therapy at hospital discharge.

The priority aim addressed by this measure is to optimize the pharmacologic treatment of patients with heart failure.

Heart failure; left ventricular systolic dysfunction (LVSD); beta-blocker

Number of adult patients with a primary diagnosis of heart failure with left ventricular systolic dysfunction (LVSD) and without contraindications to beta-blockers (see the related "Denominator Inclusions/Exclusions" field in the Complete Summary)

Number of adult patients with a primary diagnosis of heart failure with left ventricular systolic dysfunction (LVSD) who are prescribed beta-blocker therapy at hospital discharge

• A clinical practice guideline or other peer-reviewed synthesis of the clinical evidence

Unspecified

Current routine use

Internal quality improvement

Hospitals

Physicians

Group Clinical Practices

Age greater than or equal to 18 years

Either male or female

Unspecified

Heart failure is a major health problem in the United States, and the incidence of the disease is projected to increase. It was the most frequent diagnosis of Medicare patients discharged from the hospital in 2001. There are an estimated 5 million individuals currently diagnosed with heart failure, 550,000 new cases diagnosed annually, and 1 million people hospitalized annually (including readmission rates of 30 to 60%).

• Institute for Clinical Systems Improvement (ICSI). Heart failure in adults. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2007 Aug. 119 p. [217 references]

Unspecified

There are over 260,000 annual deaths from heart failure. From 1979 to 2000 heart failure death rates have increased 148% and hospital discharges have increased 165%. The prognosis of patients with a new diagnosis of heart failure is poor. Senni et al. (1998) noted survival to be 86% at 3 months, 76% at one year, and only 35% at 5 years.

See the "Incidence/Prevalence" field.

Unspecified

Living with Illness

Effectiveness

Users of care only

Adult patients with a primary diagnosis of heart failure who have left ventricular systolic dysfunction (LVSD)*.

The time of assessment is at hospital discharge. Monthly data will be submitted quarterly.

The minimum sample size is 20 patients per month.

*Left ventricular systolic dysfunction is defined quantitatively, as left ventricular ejection fraction less than 40%, and qualitatively, as moderately or severely depressed left ventricular systolic function.

Patients associated with provider

Inclusions
Number of adult patients with a primary diagnosis of heart failure* with left ventricular systolic dysfunction (LVSD)** and without contraindications to beta-blockers

*International Classification of Diseases, Ninth Revision (ICD-9) codes: 428.0, 428.1, 428.20, 428.21, 428.22, 428.23, 428.40, 428.41, 428.42, 428.43, 428.9 (Refer to the table, "Descriptions of ICD-9 Codes," in the original measure documentation for code descriptions.)

**LVSD is defined quantitatively, as left ventricular ejection fraction less than 40%, and qualitatively, as moderately or severely depressed left ventricular systolic function.

Exclusions

• Patients less than 18 years of age
• Patients with contraindications or other reasons* for the provider to not prescribe beta-blocker therapy at discharge
• Patients transferred to another hospital
• Patients who died
• Patients who left against medical advice
• Patients discharged to hospice

*Potential contraindications or other reasons for not prescribing a beta-blocker include:

• Allergy to beta-blocker
• Bradycardia less than 50 beats per minute (bpm) without beta-blocker therapy
• Advanced heart block (greater than 1^st degree atrioventricular [AV] block) unless treated by pacemaker
• Severe bronchospasms/chronic obstructive pulmonary disease (COPD)/asthma/reactive airway disease
• Patient reasons (refusal, financial hardship, side-effects, etc.)

All cases in the denominator are equally eligible to appear in the numerator

Clinical Condition
Institutionalization

Time window is a single point in time

Inclusions
Number of adult patients with a primary diagnosis of heart failure with left ventricular systolic dysfunction (LVSD) who are prescribed a beta-blocker therapy at hospital discharge

Exclusions
Unspecified

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

Institutionalization

Administrative data
Medical record

Individual Case

Unspecified

Rate

Better quality is associated with a higher score

Unspecified

Internal time comparison

Unspecified

Percentage of adult patients with a primary diagnosis of heart failure who have LVSD and who do not have a contraindication to taking beta-blockers, who are prescribed beta-blocker therapy at hospital discharge.

Institute for Clinical Systems Improvement

The following Minnesota health plans provide direct financial support: Blue Cross and Blue Shield of Minnesota, HealthPartners, Medica, Metropolitan Health Plan, PreferredOne, and UCare Minnesota. In-kind support is provided by the Institute for Clinical Systems Improvement's (ICSI) members.

Work Group Members: Stephen Kopecky, MD (Work Group Leader) (Mayo Clinic) (Cardiology); Rufino Festin, MD (Park Nicollet Health Services) (Cardiology); Peter Smars, MD (Mayo Clinic) (Emergency Medicine); Mohammad T. Fareed, MD (Avera Health) (Family practice); Ashok Ojha, MD (Hutchinson Medical Center) (Internal Medicine); Mary Jo Macklem, RN (Park Nicollet Health Services) (Nursing); Joshua E. Breeding, PharmD, BCPS (Fairview University Medical Center) (Pharmacy); Robert Straka, PharmD (University of Minnesota Physicians) (Pharmacy); Angela Turner, Pa-C (Park Nicollet Health Services) (Physician Assistant); Penny Fredrickson (Institute for Clinical Systems Improvement) (Measurement Advisor); Ann-Marie Evenson, BS, RHIT (Institute for Clinical Systems Improvement) (Facilitator)

Measure was not adapted from another source.

2006 Aug

2007 Aug

This is the current release of the measure.

This measure updates a previous version: Institute for Clinical Systems Improvement (ICSI). Heart failure in adults. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2006 Aug. 116 p.

• Institute for Clinical Systems Improvement (ICSI). Heart failure in adults. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2007 Aug. 119 p. [217 references]

This NQMC summary was completed by ECRI on November 14, 2006. This NQMC summary was updated by ECRI Institute on December 16, 2007.

This NQMC summary (abstracted Institute for Clinical Systems Improvement [ICSI] Measure) is based on the original measure, which is subject to the measure developer's copyright restrictions.

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