<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 coronary artery disease seen within a 12-month period who also have a prior MI or a current or prior left ventricular ejection fraction (LVEF) \<=40% who were prescribed beta-blocker therapy "/> <usage value="Beta-blocker therapy: * For patients with prior MI, beta-blocker therapy includes any agent within the beta-blocker drug class. As of 2015, no recommendations or evidence are cited in current stable ischemic heart disease guidelines for preferential use of specific agents. * For patients with prior LVEF \<=40%, beta-blocker therapy includes the following: 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. 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." If a patient has had a myocardial infarction (MI) within the past 3 years and a current or prior LVEF \<=40% (or moderate or severe LVSD), the patient should only be counted in Population Criteria 1. This eCQM is a patient-based measure. This FHIR-based measure has been derived from the QDM-based measure CMS145v14. 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 2025 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="Fihn, S. D., Gardin, J. M., Abrams, J., Berra, K., Blankenship, J. C., Dallas, A. P., ... Williams, S. V. (2012). 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease. Circulation, 126(25), e354--e471. doi: 10.1161/cir.0b013e318277d6a0 "/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Gibbons, R. J., Abrams, J., Chatterjee, K., Daley, J., Deedwania, P.K, Douglas J.S., ... Smith Jr., S.C. (2002). ACC/AHA 2002 Guideline update for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee to update the 1999 guidelines for the management of patients with chronic stable angina). Circulation, 107(1), 149-158. doi:10.1161/01.CIR.0000047041.66447.29 "/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Virani, S.S., Newby, L.K., Arnold, S.V., Bittner, V., Brewer, L.C., Demeter, S.H., ... Dixon, D.L. (2023). 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the management for patients with chronic coronary disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Practice Guidelines. Circulation, 148, e9-e119. doi: 10.1161/CIR.0000000000001168 "/> </relatedArtifact> <library value="https://madie.cms.gov/Library/CMS145FHIRCADBBlockerTPMIorLVSD"/> <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="For patients with coronary artery disease (CAD), beta-blockers are recommended for 3 years after myocardial infarction or acute coronary syndrome. Beta-blockers, particularly carvedilol, metoprolol succinate, or bisoprolol which have been shown to reduce risk of death, are recommended indefinitely for patients with CAD and LV systolic dysfunction. These agents have proven efficacy in reducing angina onset and improving the ischemic threshold during exercise. In patients who have suffered an MI, beta-blockers significantly reduce deaths and recurrent MIs (Fihn et al., 2012). Nonadherence to cardioprotective medications is prevalent among outpatients with CAD and can be associated with a broad range of adverse outcomes, including all-cause and cardiovascular mortality, cardiovascular hospitalizations, and the need for revascularization procedures (Gibbons et al., 2002). This measure is intended to promote beta-blocker usage in select patients with CAD. "/> <clinicalRecommendationStatement value="Beta-blocker therapy should be started and continued for 3 years in all patients with normal LV function after MI or acute coronary syndrome (ACS) (Class I, Level of Evidence: B) (Fihn et al., 2012). Beta-blocker therapy should be used in all patients with LV systolic dysfunction (EF \<= 40%) with heart failure or prior MI, unless contraindicated. (Use should be limited to carvedilol, metoprolol succinate, or bisoprolol, which have been shown to reduce risk of death.) (Class I, Level of Evidence: A) (Fihn et al., 2012). In patients with chronic coronary disease (CCD) and LVEF ≤40% with or without previous MI, the use of beta-blocker therapy is recommended to reduce the risk of future Major Adverse Cardiac Events (MACE), including cardiovascular death. (Class 1, Level of Evidence: A) (Virani et al., 2023) "/> <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-rateAggregation"> <valueString value="This measure is intended to have one reporting rate, which aggregates the following populations into a single performance rate for reporting purposes: * Population 1: Patients with left ventricular systolic dysfunction (LVEF \<=40%) * Population 2: Patients with a prior (within the past 3 years) myocardial infarction For the purposes of this measure, a single performance rate can be calculated as follows: Performance Rate = (Numerator 1 + Numerator 2)/ \[(Denominator 1 - Denominator Exceptions 1) + (Denominator 2 - Denominator Exceptions 2)\] "/> </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 coronary artery disease "/> <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 who also have prior (within the past 3 years) MI or a current or prior LVEF \<=40% "/> <criteria> <language value="text/cql-identifier"/> <expression value="Denominator 1"/> </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 beta-blocker therapy "/> <criteria> <language value="text/cql-identifier"/> <expression value="Numerator 1"/> </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 1"/> </criteria> </population> </group> <group id="Group_2"> <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-rateAggregation"> <valueString value="This measure is intended to have one reporting rate, which aggregates the following populations into a single performance rate for reporting purposes: * Population 1: Patients with left ventricular systolic dysfunction (LVEF \<=40%) * Population 2: Patients with a prior (within the past 3 years) myocardial infarction For the purposes of this measure, a single performance rate can be calculated as follows: Performance Rate = (Numerator 1 + Numerator 2)/ \[(Denominator 1 - Denominator Exceptions 1) + (Denominator 2 - Denominator Exceptions 2)\] "/> </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_2"> <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 coronary artery disease "/> <criteria> <language value="text/cql-identifier"/> <expression value="Initial Population"/> </criteria> </population> <population id="Denominator_2"> <code> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-population"/> <code value="denominator"/> <display value="Denominator"/> </coding> </code> <description value="Equals Initial Population who also have prior (within the past 3 years) MI or a current or prior LVEF \<=40% "/> <criteria> <language value="text/cql-identifier"/> <expression value="Denominator 2"/> </criteria> </population> <population id="Numerator_2"> <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 beta-blocker therapy "/> <criteria> <language value="text/cql-identifier"/> <expression value="Numerator 2"/> </criteria> </population> <population id="DenominatorException_2"> <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 2"/> </criteria> </population> </group> <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> <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-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-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> </Measure>

Exception generating Narrative: Unable to Parse HTML - node 'td' has unexpected content '=' (last text = 'Moderate or Severe LVSD: LVEF \' at line 394 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 coronary artery disease seen within a 12-month period who also have a prior MI or a current or prior left ventricular ejection fraction (LVEF) \<=40% who were prescribed beta-blocker therapy
"/>
  <usage value="Beta-blocker therapy:

* For patients with prior MI, beta-blocker therapy includes any agent within the beta-blocker drug class. As of 2015, no recommendations or evidence are cited in current stable ischemic heart disease guidelines for preferential use of specific agents.

* For patients with prior LVEF \<=40%, beta-blocker therapy includes the following: 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.

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."

If a patient has had a myocardial infarction (MI) within the past 3 years and a current or prior LVEF \<=40% (or moderate or severe LVSD), the patient should only be counted in Population Criteria 1.

This eCQM is a patient-based measure.

This FHIR-based measure has been derived from the QDM-based measure CMS145v14. 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 2025 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="Fihn, S. D., Gardin, J. M., Abrams, J., Berra, K., Blankenship, J. C., Dallas, A. P., ... Williams, S. V. (2012). 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease. Circulation, 126(25), e354--e471. doi: 10.1161/cir.0b013e318277d6a0
"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="Gibbons, R. J., Abrams, J., Chatterjee, K., Daley, J., Deedwania, P.K, Douglas J.S., ... Smith Jr., S.C. (2002). ACC/AHA 2002 Guideline update for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee to update the 1999 guidelines for the management of patients with chronic stable angina). Circulation, 107(1), 149-158. doi:10.1161/01.CIR.0000047041.66447.29
"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="Virani, S.S., Newby, L.K., Arnold, S.V., Bittner, V., Brewer, L.C., Demeter, S.H., ... Dixon, D.L. (2023). 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the management for patients with chronic coronary disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Practice Guidelines. Circulation, 148, e9-e119. doi: 10.1161/CIR.0000000000001168
"/>
  </relatedArtifact>
  <library value="https://madie.cms.gov/Library/CMS145FHIRCADBBlockerTPMIorLVSD"/>
  <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="For patients with coronary artery disease (CAD), beta-blockers are recommended for 3 years after myocardial infarction or acute coronary syndrome. Beta-blockers, particularly carvedilol, metoprolol succinate, or bisoprolol which have been shown to reduce risk of death, are recommended indefinitely for patients with CAD and LV systolic dysfunction. These agents have proven efficacy in reducing angina onset and improving the ischemic threshold during exercise. In patients who have suffered an MI, beta-blockers significantly reduce deaths and recurrent MIs (Fihn et al., 2012).

Nonadherence to cardioprotective medications is prevalent among outpatients with CAD and can be associated with a broad range of adverse outcomes, including all-cause and cardiovascular mortality, cardiovascular hospitalizations, and the need for revascularization procedures (Gibbons et al., 2002).

This measure is intended to promote beta-blocker usage in select patients with CAD.
"/>
  <clinicalRecommendationStatement value="Beta-blocker therapy should be started and continued for 3 years in all patients with normal LV function after MI or acute coronary syndrome (ACS) (Class I, Level of Evidence: B) (Fihn et al., 2012).

Beta-blocker therapy should be used in all patients with LV systolic dysfunction (EF \<= 40%) with heart failure or prior MI, unless contraindicated. (Use should be limited to carvedilol, metoprolol succinate, or bisoprolol, which have been shown to reduce risk of death.) (Class I, Level of Evidence: A) (Fihn et al., 2012).

In patients with chronic coronary disease (CCD) and LVEF ≤40% with or without previous MI, the use of beta-blocker therapy is recommended to reduce the risk of future Major Adverse Cardiac Events (MACE), including cardiovascular death. (Class 1, Level of Evidence: A) (Virani et al., 2023)
"/>
  <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-rateAggregation">
      <valueString value="This measure is intended to have one reporting rate, which aggregates the following populations into a single performance rate for reporting purposes:

* Population 1: Patients with left ventricular systolic dysfunction (LVEF \<=40%)

* Population 2: Patients with a prior (within the past 3 years) myocardial infarction

For the purposes of this measure, a single performance rate can be calculated as follows: Performance Rate = (Numerator 1 + Numerator 2)/ \[(Denominator 1 - Denominator Exceptions 1) + (Denominator 2 - Denominator Exceptions 2)\]
"/>
    </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 coronary artery disease
"/>
      <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 who also have prior (within the past 3 years) MI or a current or prior LVEF \<=40%
"/>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Denominator 1"/>
      </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 beta-blocker therapy
"/>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Numerator 1"/>
      </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 1"/>
      </criteria>
    </population>
  </group>
  <group id="Group_2">
    <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-rateAggregation">
      <valueString value="This measure is intended to have one reporting rate, which aggregates the following populations into a single performance rate for reporting purposes:

* Population 1: Patients with left ventricular systolic dysfunction (LVEF \<=40%)

* Population 2: Patients with a prior (within the past 3 years) myocardial infarction

For the purposes of this measure, a single performance rate can be calculated as follows: Performance Rate = (Numerator 1 + Numerator 2)/ \[(Denominator 1 - Denominator Exceptions 1) + (Denominator 2 - Denominator Exceptions 2)\]
"/>
    </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_2">
      <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 coronary artery disease
"/>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Initial Population"/>
      </criteria>
    </population>
    <population id="Denominator_2">
      <code>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="denominator"/>
          <display value="Denominator"/>
        </coding>
      </code>
      <description value="Equals Initial Population who also have prior (within the past 3 years) MI or a current or prior LVEF \<=40%
"/>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Denominator 2"/>
      </criteria>
    </population>
    <population id="Numerator_2">
      <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 beta-blocker therapy
"/>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Numerator 2"/>
      </criteria>
    </population>
    <population id="DenominatorException_2">
      <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 2"/>
      </criteria>
    </population>
  </group>
  <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>
  <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-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-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>
</Measure>