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The Importance of EHR Quality Measures & Heart Failure


Maria has a long history of cardiac problems, including 2 heart attacks in 4 years. She feels short of breath and very anxious. Her daughter takes her to the emergency room where she is diagnosed with congestive heart failure. After being discharged from the hospital Maria visits her primary care physician, who reviews her prescription regimen1

Which Heart Failure Quality Measures Count for Stage 1 2013 Meaningful Use?

  • Heart Failure (HF): ACEI/ARB Therapy (NQF# 0081)
  • Heart Failure (HF): Beta-blocker Therapy (NQF# 0083)
  • Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation* (NQF# 0084)
    • *Note: As of November 29, 2011, CMS has recommended against reporting this measure due to availability of alternative anti-coagulant treatments.

Which Heart Failure Quality Measures Count for Stage 1 & 2 2014 Meaningful Use?

Measuring & Improving Heart Failure Care: A Real Impact on Your Patients

  • An epidemiologic model of coronary heart disease in Ontario estimated that coronary heart disease mortality could be reduced by almost 20% (representing approximately 2000 avoidable deaths per year) by focusing efforts on a relatively small number of quality indicators. The majority of this reduction would occur in stable ambulatory patients with either chronic angina or heart failure.2
    • Prescribing ACE Inhibitors to 90% of all eligible patients with community heart failure reduced mortality 2% when compared with prescribing ACE Inhibitors to 70% of all eligible patients.
    • Prescribing β-Blockers to 90% of all eligible patients with community heart failure reduced mortality 4% when compared with prescribing β-Blockers to 67% of all eligible patients.
  • In general, Warfarin therapy yields an annual relative risk reduction of approximately 60% in patients with atrial fibrillation.3
    • If Warfarin therapy yields an absolute risk reduction of about 6% per year (reduced from a 10% baseline risk) in high-risk patients with untreated atrial fibrillation, one stroke would be prevented for every 17 patients who received Warfarin therapy for 1 year.
  • Of a subgroup of patients in an atrial fibrillation study who had > 1 additional risk factor for stroke and no strong contraindications to anticoagulation, only 40% of them were prescribed Warfarin therapy.4

Conclusion

Implementing the appropriate quality measures in Maria's treatment can substantially reduce her risk of stroke or death, allowing her to look forward to more quality time with her daughter in the years ahead.

Clinical Quality Measure Information

Heart Failure (HF): ACEI/ARB Therapy

NQF# Description Numerator Denominator Exclusions
0081 Percentage of patients with HF who also have left ventricular systolic dysfunction (LVSD) who were prescribed ACE inhibitor or ARB therapy. Patients prescribed:
  • Angiotensin Converting Enzyme Inhibitor, or
  • Angiotensin Receptor Blocker therapy
All Heart Failure Patients with:
  • Age > 18 years
  • LVEF < 40%, or
  • moderately or severely depressed left ventricular systolic function
Documentation of:
  • Allergy or intolerance
  • Pregnancy
  • Other medical contraindication
  • Patient or System reason(s)

Heart Failure (HF): Beta Blocker Therapy

NQF# Description Numerator Denominator Exclusions
0083 Percentage of patients with HF who also have LVSD who were prescribed beta-blocker therapy. All patients:
  • Prescribed beta blocker therapy
All Heart Failure patients with:
  • LVEF < 40%, or
  • with moderately or severely depressed left ventricular systolic function &
  • Age > 18 years
Documentation of:
  • Bradycardia < 50 bpm (without beta-blocker therapy) on 2 consecutive readings
  • History of Class IV heart failure
  • History of 2nd or 3rd degree AV block without permanent pacemaker
  • Other medical contraindication
  • Patient or System reason(s)

Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation

NQF# Description Numerator Denominator Exclusions
0084 Percentage of patients with HF who also have paroxysmal or chronic atrial fibrillation who were prescribed warfarin therapy. All patients:
  • Prescribed Warfarin therapy
All patients with:
  • Paroxysmal or chronic atrial fibrillation, &
  • Aged > 18 years
Documentation of:
  • Allergy/intolerance
  • Risk of bleeding or bleeding disorder
  • Other medical contraindication
  • Patient or System reason(s)

About National Quality Forum (NQF) Endorsement

Each of the Clinical Quality Measures has an NQF number, indicating that it has received endorsement from the National Quality Forum (NQF), a nonprofit organization with the mission to improve the quality of American healthcare. NQF uses a formal Consensus Development Process (CDP) to evaluate and endorse consensus standards, including performance measures. This process includes gathering input on performance measures from a wide variety of stakeholders including consumer organizations and health care providers.5

  1. Based on Dear Nurses Congestive Heart Failure Study. Available at: http://www.dearnurses.com/congestive_heart_failure_chf_case_study Exit Disclaimer [www.dearnurses.com]. Accessed: November 10, 2011.
  2. Wijeysundera, H., Mitsakakis, N., Witteman, W., Paulden, M., van der Velde, G., Tu, J., Lee, D., Goodman, S., Petrella, R., O'Flaherty, M., Capewell, S., Krahn, M. "Achieving Quality Indicator Benchmarks and Potential Impact on Coronary Heart Disease Mortality". Canadian Journal of Cardiology. Xxx (2011): xxx-xx. Available online 14 September 2011. (http://www.sciencedirect.com/science/article/pii/S0828282X11003606) Exit Disclaimer [www.sciencedirect.com]
  3. Garcia, D. "Benefits and risks of oral anticoagulation for stroke prevention in nonvalvular atrial fibrillation". Thrombosis Research. Xxx (2011): xxx-xx. Available online 21 October 2011. (http://www.sciencedirect.com/science/article/pii/S004938481100510X) Exit Disclaimer [www.sciencedirect.com]
  4. Hickey, K. "Anticoagulation management in clinical practice: Preventing stroke in patients with atrial fibrillation". Heart & Lung: The Journal of Acute and Critical Care. Xxx (2011): xxx-xx. Available online 1 November 2011.(http://www.sciencedirect.com/science/article/pii/S0147956311003712) Exit Disclaimer [www.sciencedirect.com]
  5. http://www.qualityforum.org Exit Disclaimer [www.qualityforum.org]. Accessed January 31, 2012

Produced by Meaningful Use Quality Workgroup - February 14, 2013

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