• 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 heart failure patients who have ever had left ventricular systolic dysfunction (LVSD) and were prescribed or were on beta-blocker therapy within the last 12 months of the clinic visit or who have a contraindication to taking beta-blockers.

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 therapy

Number of adult heart failure patients who have ever had left ventricular systolic dysfunction (LVSD) and had a clinic visit in the month in question (see the related "Denominator Inclusions/Exclusions" field in the Complete Summary)

Number of adult heart failure patients who have ever had left ventricular systolic dysfunction (LVSD) and who were prescribed or were on beta-blocker therapy within the last 12 months of the clinic visit (see the related "Numerator Inclusions/Exclusions" field in the Complete Summary)

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

Unspecified

Current routine use

Internal quality improvement

Physician Group Practices/Clinics

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 heart failure patients who have ever had left ventricular systolic dysfunction (LVSD)* and who had a clinic visit during the month in question

Data for the month in question cover the prior 12 months. Monthly data will be submitted quarterly.

The minimum sample size is 20 patients per month.

*LVSD 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 heart failure* patients who have ever had left ventricular systolic dysfunction (LVSD)** and had a clinic visit*** during the month in question

*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.

***The clinic visit is defined as an office visit with a physician, nurse practitioner or physician assistant. Education office visits may include a visit with a nurse.

Exclusions
Exclude visits for the purpose of testing or device checks only.

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

Clinical Condition
Encounter

Time window is a single point in time

Inclusions
Number of adult heart failure patients who have ever had left ventricular systolic dysfunction (LVSD) and who were prescribed or were on beta-blocker therapy within the last 12 months of the clinic visit

Examples:

• A patient who has ever had LVSD and has contraindications to beta-blockers would be included in the numerator.
• A patient who has ever had LVSD and refuses to take beta-blockers would be included in the numerator.

Exclusions

• Patients less than 18 years of age
• Patients with potential contraindications or other reasons* for the provider to not prescribe beta-blocker therapy
• Hospice patients

Example:

A patient who has ever had LVSD, is not on beta-blockers and does not have contraindications would NOT be included in the numerator.

*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 one first-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.)

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

Fixed time period

Administrative data
Medical record

Individual Case

Unspecified

Rate

Better quality is associated with a higher score

Unspecified

Internal time comparison

Unspecified

Percentage of adult heart failure patients who have ever had LVSD and were prescribed or were on beta-blocker therapy within the last 12 months of the clinic visit or who have a contraindication to taking beta-blockers (primary care and outpatient cardiology).

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.

2007 Aug

This is the current release of the measure.

• 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 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.

The abstracted ICSI Measures contained in this Web site may be downloaded by any individual or organization. If the abstracted ICSI Measures are downloaded by an individual, the individual may not distribute copies to third parties.

If the abstracted ICSI Measures are downloaded by an organization, copies may be distributed to the organization's employees but may not be distributed outside of the organization without the prior written consent of the Institute for Clinical Systems Improvement, Inc.

All other copyright rights in the abstracted ICSI Measures are reserved by the Institute for Clinical Systems Improvement, Inc. The Institute for Clinical Systems Improvement, Inc. assumes no liability for any adaptations or revisions or modifications made to the abstracts of the ICSI Measures.