Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)FHIR - dQM QICore Content Implementation Guide v2025.0.0

dQM QICore Content Implementation Guide, published by cqframework. This guide is not an authorized publication; it is the continuous build for version 2025.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/dqm-content-qicore-2025/ and changes regularly. See the Directory of published versions

Measure: Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)FHIR

Official URL: https://madie.cms.gov/Measure/CMS144FHIRHFBetaBlockerForLVSD		Version: 1.0.000
Active as of 2025-08-22	Responsible: American Heart Association	Computable Name: CMS144FHIRHFBetaBlockerForLVSD
Other Identifiers: Short Name: CMS144FHIR (use: usual, ), UUID:73947208-412c-4295-bf7f-43bc907569d3 (use: official, ), UUID:94b4a85e-8f32-4155-b1d3-20d139c2e1a7 (use: official, ), Endorser: 0083e (use: official, ), Publisher: 144FHIR (use: official, )
Copyright/Legal: Copyright 2024 American College of Cardiology and American Heart Association. All Rights Reserved.

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

Metadata

Title Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)FHIR

Version 1.0.000

Short Name CMS144FHIR

GUID (Version Independent) urn:uuid:73947208-412c-4295-bf7f-43bc907569d3

GUID (Version Specific) urn:uuid:94b4a85e-8f32-4155-b1d3-20d139c2e1a7

CMS Identifier 144FHIR

CMS Consensus Based Entity Identifier 0083e

Effective Period 2026-01-01 through 2026-12-31

Steward (Publisher) American Heart Association

Developer American Heart Association

Developer American Medical Association (AMA)

Description

Disclaimer

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

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.

Clinical Recommendation Statement

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
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

Citation

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

Definition

Moderate or Severe LVSD:

LVEF <=40% corresponds to qualitative documentation of moderate dysfunction or severe dysfunction (LVSD). The LVSD may be determined by quantitative or qualitative assessment, which may be current or historical. Examples of a quantitative or qualitative assessment may include an echocardiogram:

that provides a numerical value of LVSD or
that uses descriptive terms such as moderately or severely depressed left ventricular systolic function. Any current or prior ejection fraction study documenting LVSD can be used to identify patients.

Guidance (Usage)

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).

Measure Group (Rate) (ID: Group_1)

Basis boolean

Scoring [http://terminology.hl7.org/CodeSystem/measure-scoring#proportion: 'Proportion']

Type [http://terminology.hl7.org/CodeSystem/measure-type#process: 'Process']

Improvement Notation [http://terminology.hl7.org/CodeSystem/measure-improvement-notation#increase: 'Increased score indicates improvement']

Initial Population

ID: InitialPopulation_1
Description:

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

Logic Definition: Initial Population

Denominator

ID: Denominator_1
Description:

Equals Initial Population with a current or prior LVEF <= 40%

Logic Definition: Denominator

Denominator Exclusion

ID: DenominatorExclusion_1
Description:

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

Logic Definition: Denominator Exclusions

Numerator

ID: Numerator_1
Description:

Patients who were prescribed or already taking beta-blocker therapy during the measurement period

Logic Definition: Numerator

Denominator Exception

ID: DenominatorException_1
Description:

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).

Logic Definition: Denominator Exceptions

Supplemental Data Guidance

For every patient evaluated by this measure also identify payer, race, ethnicity and sex

Supplemental Data Elements

Supplemental Data Element ID: sde-ethnicity
Usage Code: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]
Description: SDE Ethnicity
Logic Definition: SDE Ethnicity

Supplemental Data Element ID: sde-payer
Usage Code: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]
Description: SDE Payer
Logic Definition: SDE Payer

Supplemental Data Element ID: sde-race
Usage Code: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]
Description: SDE Race
Logic Definition: SDE Race

Supplemental Data Element ID: sde-sex
Usage Code: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]
Description: SDE Sex
Logic Definition: SDE Sex

Measure Logic

Primary Library https://madie.cms.gov/Library/CMS144FHIRHFBetaBlockerForLVSD

Contents Population Criteria
Logic Definitions
Terminology
Dependencies
Data Requirements

Population Criteria

Measure Group (Rate) (ID: Group_1)

Initial Population

define "Initial Population":
  AHA."Is Adult With Two Qualifying Outpatient Encounters and One Heart Failure Outpatient Encounter During the Measurement Period"

Denominator

define "Denominator":
  "Initial Population"
    and exists AHA."Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD"

Denominator Exclusion

define "Denominator Exclusions":
  AHA."Has Heart Transplant"
    or AHA."Has Heart Transplant Complications"
    or AHA."Has Left Ventricular Assist Device"
    or AHA."Has Left Ventricular Assist Device Complications"

Numerator

define "Numerator":
  "Has Beta Blocker Therapy for LVSD Ordered"
    or "Is Currently Taking Beta Blocker Therapy for LVSD"

Denominator Exception

define "Denominator Exceptions":
  "Has Consecutive Heart Rates Less than 50"
    or "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"
    or "Has Arrhythmia Diagnosis"
    or "Has Hypotension Diagnosis"
    or "Has Asthma Diagnosis"
    or "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy"
    or "Has Bradycardia Diagnosis"
    or "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient"
    or "Atrioventricular Block without Cardiac Pacer"

Logic Definitions

Logic Definition Library Name: SupplementalDataElements

define "SDE Sex":
  case
    when Patient.sex = '248153007' then "Male (finding)"
    when Patient.sex = '248152002' then "Female (finding)"
    else null
  end

Logic Definition Library Name: SupplementalDataElements

define "SDE Payer":
  [Coverage: type in "Payer Type"] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }

Logic Definition Library Name: SupplementalDataElements

define "SDE Ethnicity":
  Patient.ethnicity E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }

Logic Definition Library Name: SupplementalDataElements

define "SDE Race":
  Patient.race R
    return Tuple {
      codes: R.ombCategory union R.detailed,
      display: R.text
    }

Logic Definition Library Name: QICoreCommon

/*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting 
interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.
*/
define fluent function prevalenceInterval(condition Choice<"ConditionEncounterDiagnosis", "ConditionProblemsHealthConcerns">):
if condition.clinicalStatus ~ "active"
  or condition.clinicalStatus ~ "recurrence"
  or condition.clinicalStatus ~ "relapse" then
  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
    (end of condition.abatementInterval()) abatementDate
    return if abatementDate is null then
      Interval[start of condition.onset.toInterval(), abatementDate)
    else
      Interval[start of condition.onset.toInterval(), abatementDate]

Logic Definition Library Name: QICoreCommon

/*
@description: Returns an interval representing the normalized abatement of a given Condition.
@comment: If the abatement element of the Condition is represented as a DateTime, the result
is an interval beginning and ending on that DateTime.
If the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The
result is an interval from the date the patient turned that age to immediately before one year later.
If the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during
which the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately
before one year later than the date the patient turned the ending age of the quantity interval.
*/
define fluent function abatementInterval(condition Choice<"ConditionEncounterDiagnosis", "ConditionProblemsHealthConcerns">):
	if condition.abatement is DateTime then
	  Interval[condition.abatement as DateTime, condition.abatement as DateTime]
	else if condition.abatement is Quantity then
		Interval[Patient.birthDate + (condition.abatement as Quantity),
			Patient.birthDate + (condition.abatement as Quantity) + 1 year)
	else if condition.abatement is Interval<Quantity> then
	  Interval[Patient.birthDate + (condition.abatement.low as Quantity),
		  Patient.birthDate + (condition.abatement.high as Quantity) + 1 year)
	else if condition.abatement is Interval<DateTime> then
	  Interval[condition.abatement.low, condition.abatement.high)
	else null as Interval<DateTime>

Logic Definition Library Name: QICoreCommon

/*
@description: Returns true if the given reference is to the given resource
@comment: Returns true if the `id` element of the given resource exactly equals the tail of the given reference.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(reference Reference, resource Resource):
  resource.id = Last(Split(reference.reference, '/'))

Logic Definition Library Name: QICoreCommon

/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types
to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
representations for timing-valued elements in QICore, allowing this function to be used across any resource.
The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.
The intent of this function is to provide a clear and concise mechanism to treat single
elements that have multiple possible representations as intervals so that logic doesn't have to account
for the variability. More complex calculations (such as medication request period or dispense period
calculation) need specific guidance and consideration. That guidance may make use of this function, but
the focus of this function is on single element calculations where the semantics are unambiguous.
If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.
If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
If the input is a DateTime Interval, the result is the input.
If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
If the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval
*/
define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):
  case
	  when choice is DateTime then
    	Interval[choice as DateTime, choice as DateTime]
		when choice is Interval<DateTime> then
  		choice as Interval<DateTime>
		when choice is Quantity then
		  Interval[Patient.birthDate + (choice as Quantity),
			  Patient.birthDate + (choice as Quantity) + 1 year)
		when choice is Interval<Quantity> then
		  Interval[Patient.birthDate + (choice.low as Quantity),
			  Patient.birthDate + (choice.high as Quantity) + 1 year)
		when choice is Timing then
      Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>
		else
			null as Interval<DateTime>
	end

Logic Definition Library Name: FHIRHelpers

define function ToString(value uri): value.value

Logic Definition Library Name: FHIRHelpers

/*
@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)
value to a CQL DateTime Interval
@comment: If the start value of the given period is unspecified, the starting
boundary of the resulting interval will be open (meaning the start of the interval
is unknown, as opposed to interpreted as the beginning of time).
*/
define function ToInterval(period FHIR.Period):
    if period is null then
        null
    else
        if period."start" is null then
            Interval(period."start".value, period."end".value]
        else
            Interval[period."start".value, period."end".value]

Logic Definition Library Name: FHIRHelpers

/*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
    if coding is null then
        null
    else
        System.Code {
          code: coding.code.value,
          system: coding.system.value,
          version: coding.version.value,
          display: coding.display.value
        }

Logic Definition Library Name: FHIRHelpers

/*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
    if concept is null then
        null
    else
        System.Concept {
            codes: concept.coding C return ToCode(C),
            display: concept.text.value
        }

Logic Definition Library Name: AHAOverall

define "Outpatient Encounter":
  ( [Encounter: "Care Services in Long Term Residential Facility"]
      union [Encounter: "Home Healthcare Services"]
      union [Encounter: "Nursing Facility Visit"]
      union [Encounter: "Office Visit"]
      union [Encounter: "Outpatient Consultation"]
  )

Logic Definition Library Name: AHAOverall

/*
@description: Returns certain finished encounter types that overlap a Heart Failure condition and are during the measurement period: 
                * care services in long term residential facility (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014)
                * home healthcare services (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016)
                * nursing facility visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012)
                * office visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001)
                * outpatient consultation (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008)
*/
define "Heart Failure Outpatient Encounter":
  "Outpatient Encounter" QualifyingEncounter
    with ( [ConditionProblemsHealthConcerns: "Heart Failure"]
      union [ConditionEncounterDiagnosis: "Heart Failure"] ) HeartFailure
      such that HeartFailure.prevalenceInterval ( ) overlaps day of QualifyingEncounter.period
        and HeartFailure.isVerified ( )
    where QualifyingEncounter.period during day of "Measurement Period"
      and QualifyingEncounter.isEncounterFinished ( )

Logic Definition Library Name: AHAOverall

/*
@description: Returns a union  of the following:
                * Observations where the final, amended or correction ejection fraction result is <= 40
                * Moderate or Severe LVSD conditions where the diagnosis has been confirmed as active
*/
define "Moderate or Severe LVSD Findings":
  ( [ObservationClinicalResult: "Ejection Fraction"] EjectionFraction
      where EjectionFraction.value as Quantity <= 40 '%'
        and EjectionFraction.status in { 'final', 'amended', 'corrected' }
  )
    union ( ( ( [ConditionProblemsHealthConcerns: "Moderate or Severe LVSD"]
          union [ConditionEncounterDiagnosis: "Moderate or Severe LVSD"]
      )
        union ( ( [ConditionProblemsHealthConcerns: "Left ventricular systolic dysfunction (disorder)"]
            union [ConditionEncounterDiagnosis: "Left ventricular systolic dysfunction (disorder)"] ) LVSDDiagnosis
            where LVSDDiagnosis.severity in "Moderate or Severe"
        ) ) ModerateOrSevereLVSD
        where ModerateOrSevereLVSD.isVerified ( )
    )

Logic Definition Library Name: AHAOverall

/*
@description: Returns heart failure outpatient encounters that start before the end of a moderate or severe LVSD finding
*/
define "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD":
  "Heart Failure Outpatient Encounter" HFOutpatientEncounter
    with "Moderate or Severe LVSD Findings" LVSDFindings
      such that Coalesce(LVSDFindings.prevalenceInterval(), LVSDFindings.effective.toInterval()) starts before end of HFOutpatientEncounter.period

Logic Definition Library Name: AHAOverall

define "Outpatient Encounter or Patient Provider Interaction":
  "Outpatient Encounter"
    union [Encounter: "Patient Provider Interaction"]

Logic Definition Library Name: AHAOverall

/*
@description: Returns certain finished encounter types that occurred during the measurement period: 
                * office visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001)
                * outpatient consultation (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008)
                * nursing facility visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012)
                * care services in long term residential facility (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014)
                * home healthcare services (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016)
                * patient provider interactions (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1012) 
*/
define "Qualifying Outpatient Encounter During Measurement Period":
  "Outpatient Encounter or Patient Provider Interaction" ValidEncounter
    where ValidEncounter.period during day of "Measurement Period"
      and ValidEncounter.isEncounterFinished ( )

Logic Definition Library Name: AHAOverall

/*
@description: Returns true if the patient meets the following criteria:
                * 18 years of age or older,
                * Has two Qualifying Outpatient Encounters During Measurement Period
                * Has a Heart Failure Outpatient Encounter
*/
define "Is Adult With Two Qualifying Outpatient Encounters and One Heart Failure Outpatient Encounter During the Measurement Period":
  AgeInYearsAt(date from start of "Measurement Period") >= 18
    and exists ( "Qualifying Outpatient Encounter During Measurement Period" Encounter1
        with "Qualifying Outpatient Encounter During Measurement Period" Encounter2
          such that Encounter2.id !~ Encounter1.id
    )
    and exists "Heart Failure Outpatient Encounter"

Logic Definition Library Name: AHAOverall

/*
@description: Returns completed heart tansplant procedures that start before the end of a heart failure outpatient encounter with history of moderate or severe LVSD
*/
define "Has Heart Transplant":
  exists ( [Procedure: "Heart Transplant"] HeartTransplant
      with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
        such that HeartTransplant.performed.toInterval ( ) starts before end of ModerateOrSevereLVSDHFOutpatientEncounter.period
      where HeartTransplant.status = 'completed'
  )

Logic Definition Library Name: AHAOverall

/*
@description: Returns true if patient has confirmed heart transplant complications that start before the end of a heart failure outpatient encounter with history of moderate or severe LVSD 
*/
define "Has Heart Transplant Complications":
  exists ( ( [ConditionEncounterDiagnosis: "Heart Transplant Complications"]
      union [ConditionProblemsHealthConcerns: "Heart Transplant Complications"] ) HeartTransplantComplications
      let diagnosisStart: Coalesce(start of HeartTransplantComplications.prevalenceInterval(), HeartTransplantComplications.recordedDate)
      with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
        such that date from diagnosisStart on or before date from end of ModerateOrSevereLVSDHFOutpatientEncounter.period
      where HeartTransplantComplications.isVerified ( )
  )

Logic Definition Library Name: AHAOverall

/*
@description: Returns true if patient has a completed LVAD placement that starts before the end of a heart failure outpatient encounter with history of moderate or severe LVSD
*/
define "Has Left Ventricular Assist Device":
  exists ( [Procedure: "Left Ventricular Assist Device Placement"] LVADPlacement
      with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
        such that LVADPlacement.performed.toInterval ( ) starts before day of end of ModerateOrSevereLVSDHFOutpatientEncounter.period
      where LVADPlacement.status = 'completed'
  )

Logic Definition Library Name: AHAOverall

/*
@description: Returns true if patient has active LVAD complications that start before the end of a heart failure outpatient encounter with history of moderate or severe LVSD
*/
define "Has Left Ventricular Assist Device Complications":
  exists ( ( [ConditionEncounterDiagnosis: "Left Ventricular Assist Device Complications"]
      union [ConditionProblemsHealthConcerns: "Left Ventricular Assist Device Complications"] ) LVADComplications
      let diagnosisStart: Coalesce(start of LVADComplications.prevalenceInterval(), LVADComplications.recordedDate)
      with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
        such that date from diagnosisStart on or before date from end of ModerateOrSevereLVSDHFOutpatientEncounter.period
      where LVADComplications.isVerified ( )
  )

Logic Definition Library Name: AHAOverall

/*
@description: Returns true if the given MedicationRequest is ordered during the heart failure outpatient encounter with history of moderate or severe LVSD at any point
*/
define fluent function isOrderedDuringHeartFailureOutpatientEncounter(MedicationRequest MedicationRequest):
  exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
      where MedicationRequest.authoredOn during day of ModerateOrSevereLVSDHFOutpatientEncounter.period
        and MedicationRequest.status in { 'active', 'completed' }
        and MedicationRequest.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        and not exists ( ["TaskRejected"] TaskReject
            where TaskReject.focus.references ( MedicationRequest )
              and TaskReject.code ~ QICoreCommon."Fulfill"
        )
  )

Logic Definition Library Name: AHAOverall

/*
@description: Returns true if the given Condition has a verification status of "confirmed", "unconfirmed", "provisional", or "differential"
*/
define fluent function isVerified(condition Choice<ConditionEncounterDiagnosis, ConditionProblemsHealthConcerns>):
  condition.verificationStatus is not null implies ( condition.verificationStatus ~ QICoreCommon."confirmed"
      or condition.verificationStatus ~ QICoreCommon."unconfirmed"
      or condition.verificationStatus ~ QICoreCommon."provisional"
      or condition.verificationStatus ~ QICoreCommon."differential"
  )

Logic Definition Library Name: AHAOverall

/*
@description: Returns true if the given Encounter is finished
*/
define fluent function isEncounterFinished(Encounter Encounter):
  Encounter.status = 'finished'

Logic Definition Library Name: AHAOverall

/*
@overloaded
@description: Returns true if the given MedicationRequest overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD
*/
define fluent function overlapsAfterHeartFailureOutpatientEncounter(MedicationRequest MedicationRequest):
  exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
      where First((collapse(MedicationRequest.dosageInstruction.timing.repeat.bounds DoseTime
            return TimingBoundToInterval(MedicationRequest.authoredOn, DoseTime)
        )) DrugPeriods
          sort by start of $this
      ) overlaps after day of ModerateOrSevereLVSDHFOutpatientEncounter.period
        and MedicationRequest.status in { 'active', 'completed' }
        and MedicationRequest.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        and not exists ( ["TaskRejected"] TaskReject
            where TaskReject.focus.references ( MedicationRequest )
              and TaskReject.code ~ QICoreCommon."Fulfill"
        )
  )

Logic Definition Library Name: AHAOverall

define function TimingBoundToInterval(startDate System.DateTime, choice Choice<Quantity, Interval<Quantity>, Interval<DateTime>>):
  case
    when choice is Interval<DateTime> then
        choice as Interval<DateTime>
    when choice is Interval<Quantity> then
        Interval[startDate + (choice.low as Quantity), startDate + (choice.high as Quantity)]
    when choice is Quantity then
        Interval[startDate, startDate + (choice as Quantity))
    else
		null as Interval<DateTime>
	end

Logic Definition Library Name: AHAOverall

/*
@overloaded
@description: Returns true if the given Condition overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD
*/
define fluent function overlapsAfterHeartFailureOutpatientEncounter(Condition Choice<ConditionEncounterDiagnosis, ConditionProblemsHealthConcerns>):
  exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
      where Condition.prevalenceInterval ( ) overlaps after day of ModerateOrSevereLVSDHFOutpatientEncounter.period
        and Condition.isVerified ( )
  )

Logic Definition Library Name: AHAOverall

/*
@overloaded
@description: Returns true if the given AllergyIntolerance overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD
*/
define fluent function overlapsAfterHeartFailureOutpatientEncounter(AllergyIntolerance AllergyIntolerance):
  exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
      where Interval[start of AllergyIntolerance.onset.toInterval ( ), AllergyIntolerance.lastOccurrence]overlaps after day of ModerateOrSevereLVSDHFOutpatientEncounter.period
        and AllergyIntolerance.isVerified ( )
  )

Logic Definition Library Name: AHAOverall

/*
@description: Returns true if the given condition either has no verification status or has a verification status of confirmed, unconfirmed, provisional, or differential
*/
define fluent function isVerified(AllergyIntolerance AllergyIntolerance):
  AllergyIntolerance.verificationStatus is not null implies ( AllergyIntolerance.verificationStatus ~ QICoreCommon."allergy-confirmed"
      or AllergyIntolerance.verificationStatus ~ QICoreCommon."allergy-unconfirmed"
  )