Inclusions
Number of adult patients with a primary diagnosis of heart failure* with left ventricular systolic dysfunction (LVSD)** and without contraindications to both angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs)
*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 potential contraindications or other reasons* for the provider to not prescribe an ACEI at discharge
- Patients with potential contraindications or other reasons* for the provider to not prescribe an ARB 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 an ACEI and a potential contraindication or other reason for not prescribing an ARB at discharge include:
- ACEI and ARB allergy
- Moderate or severe aortic stenosis
- Physician, nurse practitioner, or physician assistant documentation of reasons for not prescribing both an ACEI and ARB at discharge
- ACEI allergy and physician, nurse practitioner, or physician assistant documentation for not prescribing an ARB at discharge
- ARB allergy and physician, nurse practitioner, or physician assistant documentation for not prescribing an ACEI at discharge
- Patient had a left ventricular assistive device (LVAD) or heart transplant procedure during hospitalization
- Patient reasons (refusal, financial hardship, side-effects, etc.)
- Pregnancy
- Hyperkalemia (ARB)
- Renal insufficiency (ACEI) or renal dysfunction (ARB)