Summary
The ACE inhibitor/ARB/ARNI and beta-blocker measures assess selected medication processes. Meeting their numerators does not establish comprehensive HFrEF therapy.
Detail
Reviewed on 2026-11-03. The pinned CMS135FHIR CQL checks an ordered or current ACE inhibitor, ARB, or ARNI. The related CMS144FHIR CQL at package version 1.5.0 checks ordered or current beta-blocker therapy for LVSD. Each has its own eligibility, exclusions, and exceptions. Neither numerator requires an MRA or an SGLT2 inhibitor.
The ACC 2024 HFrEF consensus summary (March 8, 2024) identifies core therapy including an ARNI, evidence-based beta-blocker, MRA, and SGLT inhibitor, with initiation and titration as tolerated. This is a broader clinical assessment than either medication numerator.
As supporting primary research, EMPEROR-Reduced (2020) found a lower risk of cardiovascular death or heart-failure hospitalization with empagliflozin than placebo in its HFrEF trial population. That result supports considering therapy beyond the two measured processes; it does not establish eligibility or safety for every patient in these packages.
Resolution
Open for clinical review. Describe the specific medication process measured, rather than labeling numerator attainment as complete guideline-directed care. A proposed comprehensive-therapy measure would need separate eligibility, contraindication, tolerance, timing, and testing requirements. This comparison does not change either imported measure or assert that the cited 2024 pathway exhausts subsequent heart-failure guidance.