Measure Description: Percentage of patients age ≥18 y with a diagnosis of heart failure for whom the quantitative result of prior (any time in the past) LVEF assessment, using any imaging modality, is available in the medical record
Numerator	Patients for whom the quantitative* results of prior (any time in the past) LVEF assessment, using any imaging modality, is available in the medical record (includes note documentation) *Single value or numerical range
Denominator	All patients age ≥18 y with a diagnosis of heart failure
Denominator Exclusions	Heart transplant LVAD
Denominator Exceptions	Documentation of medical reason(s) for not evaluating LVEF (e.g., comfort care only) Documentation of patient reason(s) for not evaluating LVEF (e.g., patient 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
Evaluation of LVEF in patients with heart failure provides important information that is required to appropriately direct treatment. Several pharmacological therapies have demonstrated efficacy in slowing disease progression and improving survival in patients with left ventricular systolic dysfunction (3). Although most patients have an LVEF recorded, this remains a performance measure because knowledge of LVEF is required to determine eligibility for appropriate heart failure care. Patients post-heart transplant or with an LVAD are excluded, because these patients were excluded from clinical treatment trials for low LVEF heart failure.
Clinical Recommendation(s)
2013 ACCF/AHA heart failure clinical practice guideline (7) 1. A 2-dimensional echocardiogram with Doppler should be performed during initial evaluation of patients presenting with HF to assess ventricular function, size, wall thickness, wall motion, and valve function. (Class 1, Level of Evidence: C) 2. Repeat measurement of EF and measurement of the severity of structural remodeling are useful to provide information in patients with HF who have had a significant change in clinical status; who have experienced or recovered from a clinical event; or who have received treatment, including GDMT, that might have had a significant effect on cardiac function; or who may be candidates for device therapy. (Class 1, Level of Evidence: C) 3. Radionuclide ventriculography or magnetic resonance imaging can be useful to assess LVEF and volume when echocardiography is inadequate. (Class 2a, Level of Evidence: C)

ACCF indicates American College of Cardiology Foundation; AHA, American Heart Association; EF, ejection fraction; EHR, electronic health record; GDMT, guideline-directed medical therapy; HF, heart failure; LVAD, left ventricular assist device; LVEF, left ventricular ejection fraction; and PM, performance measure.