Questions and Answers
This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.
Please go to www.ahrq.gov for current information.
Question
How are heart failure patients with AMI handled in the CMS/JCAHO beta-blocker measures?
Answer
In the 'Beta Blocker on Arrival' measure (AMI-6), patients with documented heart failure on arrival or within 24 hours of arrival are automatically excluded from the measure, regardless of whether they received a beta blocker, via any route. Terminology considered synonymous with heart failure is extensive (see 'Contraindication to Beta Blocker on Arrival' definition for more details):
- biventricular failure
- cardiac decompensation
- cardiac failure
- congestive heart failure (CHF)
- edema described as alveolar, diffuse interstitial, diffuse interstitial pulmonary,
interstitial, pulmonary, or pulmonary interstitial
- edema of the lungs
- edema not described as pulmonary in nature, if referenced as chest x-ray
finding (e.g., "CXR shows mild edema")
- fluid overload
- heart failure described as left, right, or unspecified
- perihilar congestion
- pulmonary congestion
- pump failure
- vascular congestion
- venous congestion
- ventricular failure
- volume overload
- wet lungs
Please note that chest x-ray reports are excluded sources in data collection—but MD/NP/PA references to chest x-ray findings are acceptable.
AMI patients with heart failure are not automatically excluded from the Beta Blocker at Discharge measure (AMI-5). If an MD/NP/PA documents that he/she did not prescribe beta blockers at discharge because of the patient's heart failure, the case will be excluded.
Question
Will the CMS/JCAHO measure be changed as a result of the findings from the COMMIT/CCS-2 study?
Answer
We are aware of this study and CMS, JCAHO, ACC, AHA and AHRQ are working together
to address these findings. For details, go to the CMS,
JCAHO, ACC, AHA and AHRQ Practice Advisory.
American College of Cardiology Foundation
American Health Association
Agency for Healthcare Research and Quality
Centers for Medicare & Medicaid Services
Joint Commission of Healthcare Organizations
April 2005
5600 Fishers Lane Rockville, MD 20857