Case Definitions for Acute Myocardial Infarction in Administrative Databases and Their Impact on In‐Hospital Mortality Rates

Metcalfe, Amy; Neudam, Annabelle; Forde, Samantha; Liu, Mingfu; Drösler, Saskia E.; Quan, Hude; Jetté, Nathalie

doi:10.1111/j.1475-6773.2012.01440.x

Cited by 97 publications

(83 citation statements)

References 95 publications

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“…Dates of all admissions during the study period with discharge diagnoses of MI (ICD-9 code, 410.xx), heart failure (428.xx), coronary artery disease/coronary atherosclerosis (414.xx), and stroke (434.xx, 435.xx, or 436.xx) were recorded. Each of these ICD-9 codes is highly specific for its respective diagnosis (24,28). Patients with outpatient visits before the index admission with primary diagnosis ICD-9 codes of 401.xx or 250.xx were coded as having hypertension and diabetes, respectively.…”

Section: Variablesmentioning

confidence: 99%

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Association between AKI and Long-Term Renal and Cardiovascular Outcomes in United States Veterans

Chawla

Amdur

Shaw

et al. 2014

Clinical Journal of the American Society of Nephrology

271

228

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Background and objectives AKI is associated with major adverse kidney events (MAKE): death, new dialysis, and worsened renal function. CKD (arising from worsened renal function) is associated with a higher risk of major adverse cardiac events (MACE): myocardial infarction (MI), stroke, and heart failure. Therefore, the study hypothesis was that veterans who develop AKI during hospitalization for an MI would be at higher risk of subsequent MACE and MAKE.Design, setting, participants, & measurements Patients in the Veterans Affairs (VA) database who had a discharge diagnosis with International Classification of Diseases, Ninth Revision, code of 584.xx (AKI) or 410.xx (MI) and were admitted to a VA facility from October 1999 through December 2005 were selected for analysis. Three groups of patients were created on the basis of the index admission diagnosis and serum creatinine values: AKI, MI, or MI with AKI. Patients with mean baseline estimated GFR,45 ml/min per 1.73 m 2 were excluded. The primary outcomes assessed were mortality, MAKE, and MACE during the study period (maximum of 6 years). The combination of MAKE and MACE-major adverse renocardiovascular events (MARCE)-was also assessed.Results A total of 36,980 patients were available for analysis. Mean age6SD was 66.8611.4 years. The most deaths occurred in the MI+AKI group (57.5%), and the fewest (32.3%) occurred in patients with an uncomplicated MI admission. In both the unadjusted and adjusted time-to-event analyses, patients with AKI and AKI+MI had worse MARCE outcomes than those who had MI alone (adjusted hazard ratios, 1.37 [95% confidence interval, 1.32 to 1.42] and 1.92 [1.86 to 1.99], respectively).Conclusions Veterans who develop AKI in the setting of MI have worse long-term outcomes than those with AKI or MI alone. Veterans with AKI alone have worse outcomes than those diagnosed with an MI in the absence of AKI.

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Section: Variablesmentioning

confidence: 99%

“…Each of these ICD-9 codes is highly specific for its respective diagnoses (23)(24)(25). The first such admission during this period was defined as the index admission.…”

Section: Patientsmentioning

confidence: 99%

Association between AKI and Long-Term Renal and Cardiovascular Outcomes in United States Veterans

Chawla

Amdur

Shaw

et al. 2014

Clinical Journal of the American Society of Nephrology

271

228

View full text Add to dashboard Cite

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“…The secondary outcomes were hospitalization for AMI, hospitalization for stroke, hospitalization for unstable angina, coronary revascularization, and a composite of all outcomes together, including hHF, during the follow-up period (8)(9)(10). The secondary outcomes were separately measured and analyzed as time-to-event variables, with times to each event being measured independently from one another, regardless of the occurrence of other events.…”

Section: Measurement Of Study Outcomesmentioning

confidence: 99%

Association Between Hospitalization for Heart Failure and Dipeptidyl Peptidase 4 Inhibitors in Patients With Type 2 Diabetes: An Observational Study

Johnston

Ghannam

et al. 2016

Diabetes Care

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OBJECTIVETo examine, among patients with type 2 diabetes, the association between hospitalization for heart failure (hHF) and treatment with dipeptidyl peptidase 4 inhibitors (DPP-4is) versus sulfonylureas (SUs), and treatment with saxagliptin versus sitagliptin. RESEARCH DESIGN AND METHODSThis was a retrospective, observational study using a U.S. insurance claims database. Patients initiated treatment between 1 August 2010 and 30 August 2013, and had no use of the comparator treatments in the prior 12 months (baseline). Each comparison consisted of patients matched 1:1 on a propensity score. Time to each outcome was compared between matched groups using Cox models. Analyses were stratified by the presence of baseline cardiovascular disease (CVD). Secondary analyses examined associations between comparator treatments and other selected cardiovascular events. RESULTSAfter matching, the study included 218,556 patients in comparisons of DPP-4i and SU, and 112,888 in comparisons of saxagliptin and sitagliptin. The hazard ratios (HRs) of hHF were as follows: DPP-4i versus SU (reference): HR 0.95 (95% CI 0.78-1.15), P = 0.580 for patients with baseline CVD; HR 0.59 (95% CI 0.38-0.89), P = 0.013 for patients without baseline CVD; saxagliptin versus sitagliptin (reference): HR 0.95 (95% CI 0.70-1.28), P = 0.712 for patients with baseline CVD; HR 0.99 (95% CI 0.56-1.75), P = 0.972 for patients without baseline CVD. Comparisons of the individual secondary and composite cardiovascular outcomes followed a similar pattern. CONCLUSIONSIn patients with type 2 diabetes, there was no association between hHF, or other selected cardiovascular outcomes, and treatment with a DPP-4i relative to SU or treatment with saxagliptin relative to sitagliptin.

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“…40 Chronic kidney disease was defined as a calculated eGFR,60 ml/min per 1.73 m 2 from the index baseline creatinine value. Comorbid conditions and inpatient diagnoses were also defined using ICD-9 diagnosis codes [41][42][43][44][45][46][47][48] (Supplemental Appendix).…”

Section: Index and Recurrent Aki Definitionsmentioning

confidence: 99%

Predictors of Recurrent AKI

Siew

Parr

Abdel-Kader

et al. 2016

Journal of the American Society of Nephrology

131

114

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Recurrent AKI is common among patients after hospitalized AKI and is associated with progressive CKD. In this study, we identified clinical risk factors for recurrent AKI present during index AKI hospitalizations that occurred between 2003 and 2010 using a regional Veterans Administration database in the United States. AKI was defined as a 0.3 mg/dl or 50% increase from a baseline creatinine measure. The primary outcome was hospitalization with recurrent AKI within 12 months of discharge from the index hospitalization. Time to recurrent AKI was examined using Cox regression analysis, and sensitivity analyses were performed using a competing risk approach. Among 11,683 qualifying AKI hospitalizations, 2954 patients (25%) were hospitalized with recurrent AKI within 12 months of discharge. Median time to recurrent AKI within 12 months was 64 (interquartile range 19-167) days. In addition to known demographic and comorbid risk factors for AKI, patients with longer AKI duration and those whose discharge diagnosis at index AKI hospitalization included congestive heart failure (primary diagnosis), decompensated advanced liver disease, cancer with or without chemotherapy, acute coronary syndrome, or volume depletion, were at highest risk for being hospitalized with recurrent AKI. Risk factors identified were similar when a competing risk model for death was applied. In conclusion, several inpatient conditions associated with AKI may increase the risk for recurrent AKI. These findings should facilitate risk stratification, guide appropriate patient referral after AKI, and help generate potential risk reduction strategies. Efforts to identify modifiable factors to prevent recurrent AKI in these patients are warranted.

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Case Definitions for Acute Myocardial Infarction in Administrative Databases and Their Impact on In‐Hospital Mortality Rates

Abstract: We recommend that ICD-9-CM 410 or ICD-10 I21-I22 in the primary diagnosis coding field should be used to define AMI. The use of a consistent validated case definition would improve comparability across studies.

Cited by 97 publications

References 95 publications

Association between AKI and Long-Term Renal and Cardiovascular Outcomes in United States Veterans

Association between AKI and Long-Term Renal and Cardiovascular Outcomes in United States Veterans

Association Between Hospitalization for Heart Failure and Dipeptidyl Peptidase 4 Inhibitors in Patients With Type 2 Diabetes: An Observational Study

Predictors of Recurrent AKI

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