Percentage of patients, age ≥18 years, evaluated in an outpatient setting who within the previous 12 months, have had a new heart failure with reduced ejection fraction (HFrEF) event or exacerbation, and have not participated in an exercise training program, such as provided in cardiac rehabilitation (CR) programs, for the qualifying event/diagnosis, are to be referred for exercise training.

Number of patients in an outpatient clinical practice who have had a new HFrEF event or exacerbation and have not participated in a supervised exercise training program (e.g., as a CR program) during the previous 12 months, who have been referred to an outpatient CR program. Referral is defined as: 1. Documented communication* between the healthcare provider and the patient to recommend an outpatient CR program AND 2A. Official referral order† is sent to outpatient CR program OR 2B. Documentation of patient refusal to justify why patient information was not sent to the CR program‡ Note: Performance is met if steps 1 AND either 2A (official referral order transmitted) OR 2B (patient refusal documented in the patient's medical record) are completed and documented. *All communications must maintain appropriate confidentiality as outlined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). †All patient information required for enrolment should be transmitted to the CR program. Necessary patient information may be found in the hospital discharge summary. ‡Patients who refuse a CR referral should not have their data transmitted to the receiving CR program against their will.

Number of patients in an outpatient clinical practice who have had HFrEF during the previous 12 months

Denominator Exclusions: Patients age <18 years Patients who leaves clinic visit against medical advice Patients have already participated in or had already completed a CR program prior to clinic visit. Denominator Exceptions: Documentation of a patient-oriented reason that precludes referral to CR (e.g., no traditional CR program available to the patient, within 60 min [travel time] from the patient's home, or patient does not have access to an alternative model of CR delivery that meets all criteria for a CR program) Documentation of a medical reason that precludes referral to CR (e.g., patient deemed by a medical provider to have a medically unstable, life-threatening condition or has other cognitive or physical impairments that preclude CR participation) Documentation of a healthcare system reason that precludes referral to CR (e.g., patient resides in a nursing care or long-term care facility, or patient lacks medical coverage for CR).

Data Sources: Medical record or other database (e.g., administrative, clinical, registry).

Measurement Period: Encounter

Thomas RJ, Balady G, Banka G, Beckie TM, Chiu J, Gokak S, et al. 2018 ACC/AHA Clinical Performance and Quality Measures for Cardiac Rehabilitation: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. Circulation: Cardiovascular Quality and Outcomes. 2018;11(4):e000037.

Appendix A. www.ahajournals.org/doi/10.1161/hcq.0000000000000037