ACE and hydrops fetalis: The VA HF quality measure known as Congestive Heart Failure Inpatient Measure 19 (CHI19) describes how often guideline-concordant medical therapy, in the form of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-receptor blocker (ARB) use, is provided for patients with left ventricular ejection fraction (LVEF) of <40% at the time of discharge, unless there are contraindications.