Echocardiogram Stewardship in Heart Failure
Reduces unnecessary repeat echocardiogram testing in stable heart failure patients. Routine echocardiograms in clinically stable patients without new symptoms or clinical changes do not alter management or improve outcomes.
Measure Rationale
Routine surveillance echocardiography in stable heart failure patients is common but rarely changes clinical management. Studies demonstrate that echocardiograms performed in the absence of clinical triggers—new symptoms, clinical deterioration, or planned intervention—seldom result in treatment modifications. These tests increase healthcare costs, contribute to imaging suite congestion, and expose patients to unnecessary healthcare encounters.
Measure Specification
All patients aged 18 years and older with an established diagnosis of heart failure who received a transthoracic echocardiogram during the performance period.
Denominator Note:
Heart failure is identified through diagnosis codes including HFrEF, HFpEF, and HFmrEF.
Patients with the following conditions: • Type 1 diabetes mellitus • Diabetic ketoacidosis
Documented Medical Reason for Exclusion
Performance Met:
Echocardiogram was performed based on a clinically appropriate indication, such as new or worsening symptoms, change in clinical status, planned cardiac intervention, or reassessment of ejection fraction for device therapy evaluation.
Performance Not Met:
Echocardiogram was performed in the absence of a clinical indication, including no new or worsening symptoms, no recent change in clinical status, and no planned intervention.
Documented medical reasons for exclusion, which include any of the following conditions diagnosed within the 12 months prior to the encounter or at any time during the performance period: • Urinary tract infection • Foot ulcer • Foot infection • Fungal infection
Clinical Recommendation Statement
The AHA/ACC Guidelines for the Management of Heart Failure recommend against routine periodic echocardiography in stable patients without a change in clinical status or planned intervention. The Choosing Wisely campaign identifies routine echocardiograms in stable heart failure as low-value care.
References
- 1.
Heidenreich PA, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. Circulation. 2022.
- 2.
American Board of Internal Medicine Foundation. Choosing Wisely: Cardiology Recommendations.
Use this measure in your practice
This measure is available through VBCA's CMS-approved QCDR. First and second-year measures receive automatic MIPS points regardless of performance.