Measure Description: Percentage of patients age ≥18 y with a diagnosis of heart failure with current LVEF ≤35%, LBBB, QRS duration ≥150 ms, NYHA class II,III, and IV, despite ACE inhibitor, ARB, or ARNI and beta-blocker therapy for at least 3 mo who have undergone CRT implantation
Numerator	Patients (meeting denominator criteria) who have undergone CRT implantation
Denominator	All patients age ≥18 y with a diagnosis of heart failure with current LVEF ≤35%, LBBB, QRS duration ≥150 ms, NYHA class II, III, and IV, despite ACE inhibitor, ARB, or ARNI and beta-blocker therapy for at least 3 mo
Denominator Exclusions	Heart transplant LVAD
Denominator Exceptions	Documentation of medical reason(s) for not undergoing CRT implantation (e.g., multiple or significant comorbidities, limited life expectancy) Documentation of patient reason(s) for not undergoing CRT implantation (e.g., refusal)
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
CRT has been shown to improve survival and symptoms among symptomatic patients with heart failure and LVEF ≤35%, LBBB, and QRS duration ≥150 ms (7). CRT implantation (not just counseling) is recommended as CRT improves both quantity and quality of life, unlike ICDs, where there is no symptomatic benefit. In the GWTG database from 2014, 26% of eligible patients had CRT in place, implanted, or prescribed (89). Women were less likely to receive CRT, and this disparity increased over time. Black patients were less likely than White patients to have CRT.
Clinical Recommendation(s)
2013 ACCF/AHA heart failure clinical practice guideline (7) 1. CRT is indicated for patients who have LVEF of 35% or less, sinus rhythm, LBBB with a QRS duration of 150 ms or greater, and NYHA class II, III, or ambulatory IV symptoms on GDMT. (Class 1, Level of Evidence: A for NYHA class III/IV (90–93); Level of Evidence: B for NYHA class II (94,95))

ACCF indicates American College of Cardiology Foundation; ACE, angiotensin–converting enzyme; AHA, American Heart Association; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor–neprilysin inhibitor; CRT, cardiac resynchronization therapy; EHR, electronic health record; GWTG, Get With The Guidelines; GDMT, guideline-directed medical therapy; ICD, implantable cardioverter-defibrillator; LBBB, left bundle branch block; LVAD, left ventricular assist device; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association; and PM, performance measure.