Coding Algorithms for Defining Comorbidities in ICD-9-CM and ICD-10 Administrative Data

Quan, Hude; Sundararajan, Vijaya; Halfon, Patricia; Fong, Andrew; Burnand, Bernard; Luthi, Jean‐Christophe; Saunders, L. Duncan; Beck, Cynthia A.; Feasby, Thomas E.; Ghali, William A.

doi:10.1097/01.mlr.0000182534.19832.83

Cited by 8,657 publications

(6,542 citation statements)

References 13 publications

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“…HDLD use was defined as a peak diuretic dose of >160 mg of IV furosemide equivalents 18. The Elixhauser Comorbidity Index, a marker of in‐hospital mortality, was determined based on ICD‐9 and ICD‐10 diagnostic codes for 30 comorbid conditions 19. All‐cause mortality was determined using the National Death Index 20.…”

Section: Methodsmentioning

confidence: 99%

Outcomes Associated With a Strategy of Adjuvant Metolazone or High‐Dose Loop Diuretics in Acute Decompensated Heart Failure: A Propensity Analysis

Brisco‐Bacik

Maaten

Houser

et al. 2018

JAHA

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BackgroundIn acute decompensated heart failure, guidelines recommend increasing loop diuretic dose or adding a thiazide diuretic when diuresis is inadequate. We set out to determine the adverse events associated with a diuretic strategy relying on metolazone or high‐dose loop diuretics.Methods and ResultsPatients admitted to 3 hospitals using a common electronic medical record with a heart failure discharge diagnosis who received intravenous loop diuretics were studied in a propensity‐adjusted analysis of all‐cause mortality. Secondary outcomes included hyponatremia (sodium <135 mEq/L), hypokalemia (potassium <3.5 mEq/L) and worsening renal function (a ≥20% decrease in estimated glomerular filtration rate). Of 13 898 admissions, 1048 (7.5%) used adjuvant metolazone. Metolazone was strongly associated with hyponatremia, hypokalemia, and worsening renal function (P<0.0001 for all) with minimal effect attenuation following covariate and propensity adjustment. Metolazone remained associated with increased mortality after multivariate and propensity adjustment (hazard ratio=1.20, 95% confidence interval 1.04–1.39, P=0.01). High‐dose loop diuretics were associated with hypokalemia and hyponatremia (P<0.002) but only worsening renal function retained significance (P<0.001) after propensity adjustment. High‐dose loop diuretics were not associated with reduced survival after multivariate and propensity adjustment (hazard ratio=0.97 per 100 mg of IV furosemide, 95% confidence interval 0.90–1.06, P=0.52).ConclusionsDuring acute decompensated heart failure, metolazone was independently associated with hypokalemia, hyponatremia, worsening renal function and increased mortality after controlling for the propensity to receive metolazone and baseline characteristics. However, under the same experimental conditions, high‐dose loop diuretics were not associated with hypokalemia, hyponatremia, or reduced survival. The current findings suggest that until randomized control trial data prove otherwise, uptitration of loop diuretics may be a preferred strategy over routine early addition of thiazide type diuretics when diuresis is inadequate.

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Section: Methodsmentioning

confidence: 99%

Outcomes Associated With a Strategy of Adjuvant Metolazone or High‐Dose Loop Diuretics in Acute Decompensated Heart Failure: A Propensity Analysis

Brisco‐Bacik

Maaten

Houser

et al. 2018

JAHA

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“…Comorbidities were identified from the CorHealth Ontario registry and supplemented with data from DAD, SDS, and OHIP using International Classification of Diseases––10th Revision (ICD‐10) codes19 within 5 years before CABG and using validated algorithms (eg, chronic obstructive pulmonary disease [COPD], asthma, hypertension, diabetes mellitus) 15, 17, 20, 21. We estimated socioeconomic status based on patients’ neighborhood median income in the Canadian census and determined their residence (rural versus urban) using Statistics Canada definitions 22.…”

Section: Methodsmentioning

confidence: 99%

Prevalence and Long‐Term Survival After Coronary Artery Bypass Grafting in Women and Men With Heart Failure and Preserved Versus Reduced Ejection Fraction

Sun

Eddeen

2018

JAHA

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BackgroundHeart failure (HF) with reduced ejection fraction (rEF) is a widely regarded prognosticator after coronary artery bypass grafting. HF with preserved ejection fraction (pEF) accounts for up to half of all HF cases and is associated with considerable morbidity and mortality in hospitalized cohorts. However, HFpEF outcomes have not been elucidated in cardiac surgical patients. We investigated the prevalence and outcomes of HFpEF and HFrEF in women and men following coronary artery bypass grafting.Methods and ResultsWe conducted a retrospective cohort study in Ontario, Canada, between October 1, 2008, and March 31, 2015, using Cardiac Care Network and Canadian Institute of Health Information data. HF is captured through a validated population‐based database of all Ontarians with physician‐diagnosed HF. We defined pEF as ejection fraction ≥50% and rEF as ejection fraction <50%. The primary outcome was all‐cause mortality. Analyses were stratified by sex. Mortality rates were calculated using Kaplan–Meier method. The relative hazard of death was assessed using multivariable Cox proportional hazard models. Of 40 083 patients (20.6% women), 55.5% had pEF without HF, 25.7% had rEF without HF, 6.9% had HFpEF, and 12.0% had HFrEF. Age‐standardized HFpEF mortality rates at 4±2 years of follow‐up were similar in women and men. HFrEF standardized HFpEF mortality rates were higher in women than men.ConclusionsWe found a higher prevalence and poorer prognosis of HFpEF in women. A history of HF was a more important prognosticator than ejection fraction. Preoperative screening and extended postoperative follow‐up should be focused on women and men with HF rather than on rEF alone.

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“…Patients who died during the hospitalization during which the VCF was placed were also noted. Comorbid conditions observed in the pre‐index period consisted of Charlson comorbidities along with a Charlson Comorbidity Index, which represents the overall “comorbidity burden” widely used for risk adjustment 22, 23…”

Section: Methodsmentioning

confidence: 99%

Vena Cava Filter Retrieval Rates and Factors Associated With Retrieval in a Large US Cohort

Brown

Raissi

Han

et al. 2017

JAHA

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BackgroundRetrieval of vena cava filters (VCFs) is important for safety as complications increase with longer dwell times. This study assessed VCF retrieval rates and factors associated with retrieval in a national cohort.Methods and Results VCFs were identified by procedural codes from an administrative claims database. Patients were identified who had a VCF placement during a hospitalization from a national commercial administrative claims database. Indications for VCF placement were identified as pulmonary embolism with or without deep vein thrombosis, deep vein thrombosis only, or prophylactic. Patient demographic and clinical characteristics were included in proportional hazard regression models to find associations with early (90‐day) and 1‐year VCF retrieval. Initiation of anticoagulation and the correlation between time‐to‐retrieval and time‐to‐initiation of anticoagulation were observed. Of 54 766 patients receiving a VCF, 36.9% had pulmonary embolism, 43.9% had deep vein thrombosis only, and 19.2% had no apparent venous thromboembolism present. Over the 1 year of follow‐up, the cumulative incidence of VCF retrieval was 18.4%. Retrieval increased over time from a low of 14.0% in 2010 up to ≈24% in 2014. In adjusted time‐to‐event models, increasing age, differing regions, and some comorbidities were associated with poorer retrieval rates. Initiation of anticoagulation was poorly correlated with retrieval, with anticoagulation preceding retrieval by a median of 51 days while those without retrieval had a median of 278 days of exposure to anticoagulation.Conclusions VCF retrieval increased over the study period but remained suboptimal and was weakly correlated with anticoagulation initiation.

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Coding Algorithms for Defining Comorbidities in ICD-9-CM and ICD-10 Administrative Data

Abstract: These newly developed ICD-10 and ICD-9-CM comorbidity coding algorithms produce similar estimates of comorbidity prevalence in administrative data, and may outperform existing ICD-9-CM coding algorithms.

Cited by 8,657 publications

References 13 publications

Outcomes Associated With a Strategy of Adjuvant Metolazone or High‐Dose Loop Diuretics in Acute Decompensated Heart Failure: A Propensity Analysis

Outcomes Associated With a Strategy of Adjuvant Metolazone or High‐Dose Loop Diuretics in Acute Decompensated Heart Failure: A Propensity Analysis

Prevalence and Long‐Term Survival After Coronary Artery Bypass Grafting in Women and Men With Heart Failure and Preserved Versus Reduced Ejection Fraction

Vena Cava Filter Retrieval Rates and Factors Associated With Retrieval in a Large US Cohort

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