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2003 National Healthcare Quality Report

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National Healthcare Quality Report 2003.

Percent of heart failure patients with left ventricular systolic dysfunction prescribed ACE inhibitor at discharge.

Measure Source

Centers for Medicare and Medicaid Services, Health Care Quality Improvement Program (HCQIP) Quality Indicator.

Tables

1.43a Percent of heart failure patients with left ventricular systolic dysfunction prescribed ACE inhibitor at discharge, United States, 2000 - 2001.

1.43b Percent of heart failure patients with left ventricular systolic dysfunction prescribed ACE inhibitor at discharge, by state, 2000 – 2001.

Data Source

Centers for Medicare and Medicaid Services, Medicare Quality Improvement Organization Program. Data are from a systematic random sample of up to 800 inpatient records per state.

Denominator

Medicare live discharges meeting both of the following criteria:

Principal diagnosis of heart failure (ICD-9 codes 402.01, 402.11, 402.91, 404.01, 404.11, 404.91, 428.x).

Documented left ventricular function evaluation not consistent with left ventricular systolic dysfunction (ejection fraction less than 40% or equivalent narrative description).

Numerator

Subset of denominator who meet at least one of the following three conditions:

On angiotensin converting enzyme inhibitor (ACEI) at discharge.

Chart documentation of one or more of the following contraindications to ACEI use: moderate or severe aortic stenosis; or bilateral renal artery stenosis; or history of angioedema, hives or severe rash with ACEI use.

Physician documentation of any specific reason why ACEI is not used.

Comments

Excludes patients transferred to another acute care hospital; patients who expired; patients who left against medical advice; patients on dialysis; patients on angiotensin-receptor blocker (ARB), but not ACEI at discharge; patients participating in a clinical trial testing alternatives to ACEIs as first-line heart failure therapy. This measure is also a Joint Commission on Accreditation of Healthcare Organizations core measure.

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