Measure Description: Percentage of patient visits for those patients age ≥18 y with a diagnosis of heart failure and with quantitative results of an evaluation of both level of activity and clinical symptoms documented in which patient symptoms have improved or remained consistent with treatment goals, or patient symptoms have worsened since last assessment and have a documented plan of care
Numerator	Patient visits in which patient symptoms have improved or remained consistent with treatment goals since last assessment,* or patient symptoms have worsened since last assessment* and have a documented plan of care† *Examples of quantitative assessment: NYHA class or A valid, reliable, disease-specific instrument (e.g., KCCQ [clinically important deterioration can be classified as a 5-point reduction in the overall summary score] or MLHFQ [clinically important deterioration can be classified as a 10-point increase in the total score]) 6-Minute Walk Test Peak oxygen consumption (VO2) or the slope of minute ventilation to carbon dioxide production (VE/VCO2 slope) †A documented plan of care may include ≥1 of the following: reevaluation of medical therapy including up-titration of medication doses, consideration of electrical device therapy, recommended lifestyle modifications (e.g., salt restriction, exercise training), initiation of palliative care, referral for more advanced therapies (e.g., cardiac transplant, ventricular assist device), or referral to disease management programs.
Denominator	All patient visits for those patients age ≥18 y with a diagnosis of heart failure and with quantitative results of an evaluation of both level of activity and clinical symptoms documented at the time of the encounter and at a prior time point 1 to 12 mo previously.
Denominator Exclusions	Heart transplant LVAD
Denominator Exceptions	None
Measurement Period	12 mo
Sources of Data	EHR data Administrative data/claims (inpatient or outpatient claims) Administrative data/claims expanded (multiple sources) Paper medical record
Attribution	Individual practitioner Facility
Care Setting	Outpatient
Rationale
Heart failure significantly decreases HRQOL, especially in the areas of physical functioning and vitality (21,22). Lack of improvement in HRQOL after discharge from the hospital is a powerful predictor of rehospitalization and mortality (23,24). Women with heart failure have consistently been found to have worse HRQOL than men (22,25). Ethnic differences also have been found, with Mexican Hispanics reporting better HRQOL than other ethnic groups in the United States (26). Other determinants of poor HRQOL include depression, younger age, higher BMI, greater symptom burden, lower systolic blood pressure, sleep apnea, low perceived control, and uncertainty about prognosis (25,27–31). Objective data on symptoms and functional status from at least 2 time points are needed to decide if patients are benefitting from therapy.
Clinical Recommendation(s)
2013 ACCF/AHA heart failure clinical practice guideline (7) 1. Goals of treatment in heart failure are to improve health-related quality of life and symptoms (see Figure 3, 2013 ACCF/AHA guideline) (7).

ACCF indicates American College of Cardiology Foundation; AHA, American Heart Association; BMI, body mass index; EHR, electronic health record; ICC, intraclass correlation coefficient; HRQOL, health-related quality of life; KCCQ, Kansas City Cardiomyopathy Questionnaire; LVAD, left ventricular assist device; MLHFQ, Minnesota Living with Heart Failure Questionnaire; NYHA, New York Heart Association; PM, performance measure; PRO, patient-reported outcome; VE/VCO₂, ventilation and carbon dioxide; and VO₂, oxygen consumption.