Functional Status Assessments for Congestive Heart Failure

Percentage of patients 65 years of age and older with congestive  heart failure who completed initial and follow-up patient-reported functional status assessments

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Patients living with CHF often have poor functional status and health-related quality of life, which declines as the disease progresses (Allen et al. 2012). In addition, their care is often complicated by multiple comorbidities. To assist in managing these complex patients, the American College of Cardiology Foundation and American Heart Association recommend collecting initial and repeat assessments of a patients' function and ability to complete desired activities of daily living (Hunt et al. 2009). The American Heart Association has also released scientific statements emphasizing the collection of patient-reported health status (for example, functional limitations, symptom burden, quality of life) from CHF patients as an important means of establishing a dynamic conversation between patient and provider regarding care goals and the patient's priorities (Allen et al. 2012; Rumsfeld et al. 2013).

American College of Cardiology Foundation/American Heart Association (2013): Every patient with HF should have a clear, detailed, and evidence-based plan of care that ensures the achievement of GDMT (guideline-directed medical therapy) goals, effective management of comorbid conditions, timely follow-up with the health care team, appropriate dietary and physical activities, and compliance with secondary prevention guidelines for cardiovascular disease. This plan of care should be updated regularly and made readily available to all members of each patient's health care team.
(Class of recommendation: I; Level of evidence: C) 
Level C: Only consensus opinion of experts, case studies, or standard of care 
Class I: Procedure/treatment should be performed/administered

A higher score indicates better quality

Allen, L.A., L.W. Stevenson, K.L. Grady, et al. "Decision Making in Advanced Heart Failure: A Scientific Statement from the American Heart Association." Circulation, vol. 125, 2012, pp. 1928-1952. doi: 10.1161/CIR.0b013e31824f2173.

Hunt, S.A., W.T. Abraham, et al. "2009 Focused Update Incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults." Circulation, vol. 119, 2009, pp. e391-e479. doi: 10.1161/CIRCULATIONAHA.109.192065.

Rumsfeld, J.S., K.P. Alexander, D.C. Goff, et al. "Cardiovascular Health: The Importance of Measuring Patient-Reported Health Status: A Scientific Statement from the American Heart Association." Circulation, vol. 127, no. 22, 2013, pp. 2233-2249. doi: 10.1161/CIR.0b013e3182949a2e.

American College of Cardiology Foundation/American Heart Association. "Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines." Circulation, vol. 128, 2013, pp. e240-e327. doi: 10.1161/CIR.0b013e31829e8776.

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Initial encounter: The first encounter during the first 185 days of the measurement year. 

Follow-up encounter: The last encounter that is at least 30 days but no more than 180 days after the initial encounter.

A Functional Status Assessment (FSA) is based on administration of a validated instrument to eligible patients that asks patients to answer questions related to various domains including: pain, physical function, emotional well-being, health-related quality of life, symptom acuity.

The same FSA instrument must be used for the initial and follow-up assessment.

TBD

Patients 65 years of age and older who had two outpatient encounters during the measurement year and a diagnosis of congestive heart failure

Equals Initial Population

Patients with severe cognitive impairment or patients with a diagnosis of cancer

Patients with patient reported functional status assessment results (eg, VR-12; VR-36; MLHF-Q; KCCQ; PROMIS-10 Global Health, PROMIS-29) present in the EHR within two weeks before or during the initial encounter and the follow-up encounter during the measurement year

Not Applicable

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For every patient evaluated by this measure also identify payer, race, ethnicity and sex

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