<status value="active"/> <experimental value="false"/> <date value="2026-01-16T18:18:13+00:00"/> <publisher value="American Heart Association"/> <contact> <telecom> <system value="url"/> <value value="https://www.heart.org/"/> </telecom> </contact> <description value="Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) \<= 40% who were prescribed or already taking beta-blocker therapy during the measurement period "/> <usage value="This eCQM is to be reported as patient-based. To satisfy this measure, it must be reported for all heart failure patients at least once during the measurement period. A range value should satisfy the logic requirement for 'Ejection Fraction' as long as the ranged observation value clearly meets the less than or equal to 40% threshold noted in the denominator logic. A range that is greater than 40% would not meet the measure requirement. In order for the Ejection Fraction result pathway to be recognized as below 40%, the result must be reported as a number with unit of %. A text string of "below 40%" or "ejection fraction between 35 and 40%" will not be recognized through electronic data capture. Although, this criteria can also be met using the Diagnosis pathway if specified as "Moderate or Severe." Beta-blocker therapy: For patients with prior LVEF \<= 40%, beta-blocker therapy should include bisoprolol, carvedilol, or sustained release metoprolol succinate. The requirement of two or more visits is to establish that the eligible clinician has an existing relationship with the patient. This FHIR-based measure has been derived from the QDM-based measure CMS144v14. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html). "/> <copyright value="Copyright 2024 American College of Cardiology and American Heart Association. All Rights Reserved. "/> <effectivePeriod> <start value="2026-01-01"/> <end value="2026-12-31"/> </effectivePeriod> <author> <name value="American Heart Association"/> <telecom> <system value="url"/> <value value="https://www.heart.org/"/> </telecom> </author> <author> <name value="American Medical Association (AMA)"/> <telecom> <system value="url"/> <value value="https://www.ama-assn.org/"/> </telecom> </author> <relatedArtifact> <type value="citation"/> <citation value="Heidenreich, P.A., Bozkurt, B, Aguilar, D., ... Allen, L. A. (2022). 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 145(18), e895-e1032. doi: 10.1161/CIR.0000000000001063 "/> </relatedArtifact> <library value="https://madie.cms.gov/Library/CMS144FHIRHFBetaBlockerForLVSD"/> <disclaimer value="The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measure require a license agreement between the user and the American College of Cardiology (ACC) or the American Heart Association (AHA). Neither the ACC, nor AHA, nor their members shall be responsible for any use of the Measure. ACC and AHA encourage use of the Measure by other health care professionals, where appropriate. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The ACC and AHA and their members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT\[R\]) or other coding contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2024 American Medical Association. LOINC(R) is copyright 2004-2024 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT\[R\]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2024 World Health Organization. All Rights Reserved. The American Medical Association's and the PCPI(R) Foundation's significant past efforts and contributions to the performance measure are gratefully acknowledged. Due to technical limitations, registered trademarks are indicated by (R) or \[R\]. "/> <rationale value="Beta blockers improve survival and reduce hospitalization for patients with stable heart failure with reduced ejection fraction (HFrEF). Treatment should be initiated as soon as a patient is diagnosed with reduced LVEF and does not have prohibitively low systemic blood pressure, fluid overload, or recent treatment with an intravenous positive inotropic agent. Beta blockers have also been shown to lessen the symptoms of heart failure, improve the clinical status of patients, and reduce future clinical deterioration. Despite these benefits, use of beta blockers in eligible patients remains suboptimal. "/> <clinicalRecommendationStatement value="In patients with HFrEF, with current or previous symptoms, use of 1 of the 3 beta blockers proven to reduce mortality (e.g., bisoprolol, carvedilol, sustained-release metoprolol succinate) is recommended to reduce mortality and hospitalizations (Class I, Level of Evidence A) (Heidenreich, 2022). Drugs Commonly Used for Stage C HFrEF (abbreviated to align with focus of measure to include only Beta-blocker therapy) | Drug | Initial Daily Dose(s) | Target Dose(s) | Mean Doses Achieved in Clinical Trials | |----------------------------------------------------------|-----------------------|----------------|----------------------------------------| | *Beta Blockers* | <br /> | <br /> | <br /> | | Bisoprolol | 1.25 mg once | 10 mg once | 8.6 mg/d | | Carvedilol | 3.125 mg twice | 25-50 mg twice | 37 mg/d | | Carvedilol CR | 10 mg once | 80 mg once | N/A | | Metoprolol succinate extended release (metoprolol CR/XL) | 12.5 to 25 mg once | 200 mg once | 159 mg/d | "/> <group id="Group_1"> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring"> <valueCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-scoring"/> <code value="proportion"/> <display value="Proportion"/> </coding> </valueCodeableConcept> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis"> <valueCode value="boolean"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type"> <valueCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-type"/> <code value="process"/> <display value="Process"/> </coding> </valueCodeableConcept> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation"> <valueCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/> <code value="increase"/> <display value="Increased score indicates improvement"/> </coding> </valueCodeableConcept> </extension> <population id="InitialPopulation_1"> <code> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-population"/> <code value="initial-population"/> <display value="Initial Population"/> </coding> </code> <description value="All patients aged 18 years and older with two qualifying encounters during the measurement period and a diagnosis of heart failure on or before at least one qualifying encounter "/> <criteria> <language value="text/cql-identifier"/> <expression value="Initial Population"/> </criteria> </population> <population id="Denominator_1"> <code> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-population"/> <code value="denominator"/> <display value="Denominator"/> </coding> </code> <description value="Equals Initial Population with a current or prior LVEF \<= 40% "/> <criteria> <language value="text/cql-identifier"/> <expression value="Denominator"/> </criteria> </population> <population id="DenominatorExclusion_1"> <code> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-population"/> <code value="denominator-exclusion"/> <display value="Denominator Exclusion"/> </coding> </code> <description value="Patients with a history of heart transplant or with a Left Ventricular Assist Device (LVAD) prior to the end of the outpatient encounter with Moderate or Severe LVSD "/> <criteria> <language value="text/cql-identifier"/> <expression value="Denominator Exclusions"/> </criteria> </population> <population id="Numerator_1"> <code> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-population"/> <code value="numerator"/> <display value="Numerator"/> </coding> </code> <description value="Patients who were prescribed or already taking beta-blocker therapy during the measurement period "/> <criteria> <language value="text/cql-identifier"/> <expression value="Numerator"/> </criteria> </population> <population id="DenominatorException_1"> <code> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-population"/> <code value="denominator-exception"/> <display value="Denominator Exception"/> </coding> </code> <description value="Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., arrhythmia, asthma, bradycardia, hypotension, patients with atrioventricular block without cardiac pacer, observation of consecutive heart rates \<50, allergy, intolerance, other medical reasons). Documentation of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient declined, other patient reasons). "/> <criteria> <language value="text/cql-identifier"/> <expression value="Denominator Exceptions"/> </criteria> </population> </group> <supplementalData id="sde-ethnicity"> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <description value="SDE Ethnicity "/> <criteria> <language value="text/cql-identifier"/> <expression value="SDE Ethnicity"/> </criteria> </supplementalData> <supplementalData id="sde-payer"> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <description value="SDE Payer "/> <criteria> <language value="text/cql-identifier"/> <expression value="SDE Payer"/> </criteria> </supplementalData> <supplementalData id="sde-race"> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <description value="SDE Race "/> <criteria> <language value="text/cql-identifier"/> <expression value="SDE Race"/> </criteria> </supplementalData> <supplementalData id="sde-sex"> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <description value="SDE Sex "/> <criteria> <language value="text/cql-identifier"/> <expression value="SDE Sex"/> </criteria> </supplementalData> </Measure>

Exception generating Narrative: Unable to Parse HTML - node 'td' has unexpected content '=' (last text = 'Moderate or Severe LVSD: LVEF \' at line 377 column 63


  
    
      
    
    
      
        
          
          
          
        
        
      
    
  
  
    
      
    
    
      
    
  
  
    
      
    
  
  
    
  
  
  
    
    
      
        
        
        
      
    
    
    
  
  
    
    
      
        
        
        
      
    
    
    
  
  
    
    
      
        
        
        
      
    
    
    
  
  
    
    
      
        
        
        
      
    
    
    
    
      
    
  
  
    
    
      
        
        
        
      
    
    
    
    
      
    
  
  
  
  
  <status value="active"/>
  <experimental value="false"/>
  <date value="2026-01-16T18:18:13+00:00"/>
  <publisher value="American Heart Association"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="https://www.heart.org/"/>
    </telecom>
  </contact>
  <description value="Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) \<= 40% who were prescribed or already taking beta-blocker therapy during the measurement period
"/>
  <usage value="This eCQM is to be reported as patient-based. To satisfy this measure, it must be reported for all heart failure patients at least once during the measurement period.

A range value should satisfy the logic requirement for 'Ejection Fraction' as long as the ranged observation value clearly meets the less than or equal to 40% threshold noted in the denominator logic. A range that is greater than 40% would not meet the measure requirement.

In order for the Ejection Fraction result pathway to be recognized as below 40%, the result must be reported as a number with unit of %. A text string of "below 40%" or "ejection fraction between 35 and 40%" will not be recognized through electronic data capture. Although, this criteria can also be met using the Diagnosis pathway if specified as "Moderate or Severe."

Beta-blocker therapy: For patients with prior LVEF \<= 40%, beta-blocker therapy should include bisoprolol, carvedilol, or sustained release metoprolol succinate.

The requirement of two or more visits is to establish that the eligible clinician has an existing relationship with the patient.

This FHIR-based measure has been derived from the QDM-based measure CMS144v14. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).
"/>
  <copyright value="Copyright 2024 American College of Cardiology and American Heart Association. All Rights Reserved.
"/>
  <effectivePeriod>
    <start value="2026-01-01"/>
    <end value="2026-12-31"/>
  </effectivePeriod>
  <author>
    <name value="American Heart Association"/>
    <telecom>
      <system value="url"/>
      <value value="https://www.heart.org/"/>
    </telecom>
  </author>
  <author>
    <name value="American Medical Association (AMA)"/>
    <telecom>
      <system value="url"/>
      <value value="https://www.ama-assn.org/"/>
    </telecom>
  </author>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="Heidenreich, P.A., Bozkurt, B, Aguilar, D., ... Allen, L. A. (2022). 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 145(18), e895-e1032. doi: 10.1161/CIR.0000000000001063
"/>
  </relatedArtifact>
  <library value="https://madie.cms.gov/Library/CMS144FHIRHFBetaBlockerForLVSD"/>
  <disclaimer value="The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications.

The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain.

Commercial uses of the Measure require a license agreement between the user and the American College of Cardiology (ACC) or the American Heart Association (AHA). Neither the ACC, nor AHA, nor their members shall be responsible for any use of the Measure.

ACC and AHA encourage use of the Measure by other health care professionals, where appropriate.

THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.

Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The ACC and AHA and their members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT\[R\]) or other coding contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2024 American Medical Association. LOINC(R) is copyright 2004-2024 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT\[R\]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2024 World Health Organization. All Rights Reserved.

The American Medical Association's and the PCPI(R) Foundation's significant past efforts and contributions to the performance measure are gratefully acknowledged.

Due to technical limitations, registered trademarks are indicated by (R) or \[R\].
"/>
  <rationale value="Beta blockers improve survival and reduce hospitalization for patients with stable heart failure with reduced ejection fraction (HFrEF). Treatment should be initiated as soon as a patient is diagnosed with reduced LVEF and does not have prohibitively low systemic blood pressure, fluid overload, or recent treatment with an intravenous positive inotropic agent. Beta blockers have also been shown to lessen the symptoms of heart failure, improve the clinical status of patients, and reduce future clinical deterioration. Despite these benefits, use of beta blockers in eligible patients remains suboptimal.
"/>
  <clinicalRecommendationStatement value="In patients with HFrEF, with current or previous symptoms, use of 1 of the 3 beta blockers proven to reduce mortality (e.g., bisoprolol, carvedilol, sustained-release metoprolol succinate) is recommended to reduce mortality and hospitalizations (Class I, Level of Evidence A) (Heidenreich, 2022).

Drugs Commonly Used for Stage C HFrEF (abbreviated to align with focus of measure to include only Beta-blocker therapy)

|                           Drug                           | Initial Daily Dose(s) | Target Dose(s) | Mean Doses Achieved in Clinical Trials |
|----------------------------------------------------------|-----------------------|----------------|----------------------------------------|
| *Beta Blockers*                                          | <br />                | <br />         | <br />                                 |
| Bisoprolol                                               | 1.25 mg once          | 10 mg once     | 8.6 mg/d                               |
| Carvedilol                                               | 3.125 mg twice        | 25-50 mg twice | 37 mg/d                                |
| Carvedilol CR                                            | 10 mg once            | 80 mg once     | N/A                                    |
| Metoprolol succinate extended release (metoprolol CR/XL) | 12.5 to 25 mg once    | 200 mg once    | 159 mg/d                               |

"/>
  <group id="Group_1">
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring">
      <valueCodeableConcept>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
          <code value="proportion"/>
          <display value="Proportion"/>
        </coding>
      </valueCodeableConcept>
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    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
      <valueCode value="boolean"/>
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    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type">
      <valueCodeableConcept>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
          <code value="process"/>
          <display value="Process"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation">
      <valueCodeableConcept>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/>
          <code value="increase"/>
          <display value="Increased score indicates improvement"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <population id="InitialPopulation_1">
      <code>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="initial-population"/>
          <display value="Initial Population"/>
        </coding>
      </code>
      <description value="All patients aged 18 years and older with two qualifying encounters during the measurement period and a diagnosis of heart failure on or before at least one qualifying encounter
"/>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Initial Population"/>
      </criteria>
    </population>
    <population id="Denominator_1">
      <code>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="denominator"/>
          <display value="Denominator"/>
        </coding>
      </code>
      <description value="Equals Initial Population with a current or prior LVEF \<= 40%
"/>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Denominator"/>
      </criteria>
    </population>
    <population id="DenominatorExclusion_1">
      <code>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="denominator-exclusion"/>
          <display value="Denominator Exclusion"/>
        </coding>
      </code>
      <description value="Patients with a history of heart transplant or with a Left Ventricular Assist Device (LVAD) prior to the end of the outpatient encounter with Moderate or Severe LVSD
"/>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Denominator Exclusions"/>
      </criteria>
    </population>
    <population id="Numerator_1">
      <code>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="numerator"/>
          <display value="Numerator"/>
        </coding>
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      <description value="Patients who were prescribed or already taking beta-blocker therapy during the measurement period
"/>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Numerator"/>
      </criteria>
    </population>
    <population id="DenominatorException_1">
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          <system value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="denominator-exception"/>
          <display value="Denominator Exception"/>
        </coding>
      </code>
      <description value="Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., arrhythmia, asthma, bradycardia, hypotension, patients with atrioventricular block without cardiac pacer, observation of consecutive heart rates \<50, allergy, intolerance, other medical reasons).

Documentation of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient declined, other patient reasons).
"/>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Denominator Exceptions"/>
      </criteria>
    </population>
  </group>
  <supplementalData id="sde-ethnicity">
    <usage>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="SDE Ethnicity
"/>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Ethnicity"/>
    </criteria>
  </supplementalData>
  <supplementalData id="sde-payer">
    <usage>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="SDE Payer
"/>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Payer"/>
    </criteria>
  </supplementalData>
  <supplementalData id="sde-race">
    <usage>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="SDE Race
"/>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Race"/>
    </criteria>
  </supplementalData>
  <supplementalData id="sde-sex">
    <usage>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="SDE Sex
"/>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Sex"/>
    </criteria>
  </supplementalData>
</Measure>