Congestive Heart Failure Incidence and Prognosis: Case Identification Using Central Adjudication Versus Hospital Discharge Diagnoses

Schellenbaum, Gina D.; Heckbert, Susan R.; Smith, Nicholas L.; Rea, Thomas D.; Lumley, Thomas; Kitzman, Dalane W.; Roger, Véronique L.; Taylor, Herman A.; Psaty, Bruce M.

doi:10.1016/j.annepidem.2005.02.012

Cited by 53 publications

(52 citation statements)

References 23 publications

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“…Methods for determining HF presence varied across studies, especially when chart review was used as the reference standard. Seven studies accepted HF diagnosis documented in the chart (12,(16)(17)(18)(19)(20)(21) and four studies used documented HF diagnosis or a combination of clinical judgement based on information in the chart (eg, test results, diagnostics) (22)(23)(24)(25). Eight studies (15,(25)(26)(27)(28)(29)(30)(31) ascertained HF presence based on diagnostic criteria used by scoring systems from Framingham, Carlson, Boston, the National Health and Nutrition Examination Survey (NHANES), the New York Heart Association (NYHA) or the European Society of Cardiology (ESC).…”

Section: Literature Reviewmentioning

confidence: 99%

Administrative data have high variation in validity for recording heart failure

Quach

Blais

Quan

2010

Canadian Journal of Cardiology

126

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H eart failure (HF) has been widely studied because of its high mortality and morbidity rates (1-4). Studies on HF have relied on multiple data sources such as surveys, disease registries, hospital charts and administrative data. Of these sources, administrative data have been increasingly used for health services utilization and outcome evaluation.Administrative data result from implementing health care delivery, enrolling members into health insurance plans and reimbursing health care providers for services (5). The types of administrative data depend on the health care system and the funding structure. For example, Canada has a nationally funded health care system that collects hospital discharge data at a national level, while insurance registry, physician services and emergency room visit information is collected at a provincial level. Although these data are not intended for research, they are widely used in surveillance and outcome studies. Therefore, the validity of the research results rely on the quality of the data. Data quality is critical for interpreting variation across studies from different geographical areas.The purpose of the present study was to systematically review the literature pertaining to the validity of administrative data for recording HF and apply the International Classification of Diseases (ICD) HF definitions to Canadian hospital discharge abstract data to explore the prevalence of HF across ICD code definitions. METHODSLiterature review Search strategy: Only English language articles that compared the validity of ICD codes in administrative databases (eg, physician claims data, hospital discharge) with a reference standard (eg, chart review, registry, survey, case notes) were included. The literature search focused on articles published from 1990 to 2008. To identify peerreviewed journal articles, both the Ovid MEDLINE database and EMBASE were searched. Because validation studies were not indexed consistently with standard MeSH terms, the following key search terms were used: 'admin data', 'administrative data', 'population surveillance', 'heart failure', 'congestive heart failure', 'hospital data', 'physician claims', 'claims', 'hospital discharge', 'validation' and 'registries'. Next, Boolean operators were used to join search terms within the database search engines to locate articles. The reference lists from these articles were scanned to identify any additional articles that met heAlth outcomes/public policy ©2010 Pulsus Group Inc. All rights reserved Twenty-one studies validated hospital discharge abstract data; three studies validated physician claims and two studies validated ambulatory care data. Eighteen studies reported sensitivity (range 29% to 89%). Specificity and negative predictive value were greater than 70% across 17 studies. Nineteen studies reported positive predictive values (range 12% to 100%). Ten studies reported kappa values (range 0.39 to 0.84).

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Section: Literature Reviewmentioning

confidence: 99%

Administrative data have high variation in validity for recording heart failure

Quach

Blais

Quan

2010

Canadian Journal of Cardiology

126

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“…CV events were adjudicated using hospital discharge summaries, diagnostic test reports, surgery and radiology findings, and consultation reports (23). HF, which may be systolic or diastolic, was defined using an algorithm that included a physician diagnosis of HF, documentation of symptoms and physical signs of HF, evidence of pulmonary edema, and specific medical treatment for HF (24). Echocardiography results, when available, were also considered during adjudication.…”

Section: Ascertainment Of Eventsmentioning

confidence: 99%

Kidney Function, Electrocardiographic Findings, and Cardiovascular Events among Older Adults

Kestenbaum¹,

Rudser²,

Shlipak³

et al. 2007

Clinical Journal of the American Society of Nephrology

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Chronic kidney disease (CKD) is associated with cardiovascular (CV) disease and mortality. It is not known whether cardiac rhythm disturbances are more prevalent among individuals with CKD or whether resting electrocardiogram findings predict future CV events in the CKD setting. Data were obtained from the Cardiovascular Health Study, a community-based study of adults aged >65 yr. After exclusions for prevalent heart disease, atrial fibrillation, implantable pacemaker, or antiarrhythmic medication use, 3238 participants were analyzed. CKD was defined by an estimated GFR <60 ml/min per 1.73 m 2 . Outcomes were adjudicated incident heart failure (HF), incident coronary heart disease (CHD), and mortality. Participants with CKD had longer PR and corrected QT intervals compared with those without CKD; however, differences in electrocardiographic markers were explained by traditional CV risk factors and CV medication use. After adjustment for known risk factors, each 10-ms increase in the QRS interval was associated with a 15% greater risk for incident HF (95% confidence interval [CI] 1.04 to 1.27), a 13% greater risk for CHD (95% CI 1.04 to 1.24), and a 17% greater risk for mortality (95% CI 1.09, 1.25) among CKD participants. Each 5% increase in QTI was associated with a 42% (95% CI 1.23 to 1.65), 22% (95% CI 1.07 to 1.40), and 10% (95% CI 0.98 to 1.22) greater risk for HF, CHD, and mortality, respectively. Associations seemed stronger for participants with CKD; however, no significant interactions were detected. Resting electrocardiographic abnormalities are common in CKD and independently predict future clinical CV events in this setting.

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“…Notwithstanding these shortcomings, the study highlights the importance of central adjudication of HF cases for epidemiologic studies. In summary, there is no current "gold standard" for identifying incident HF cases with minimum misclassification bias, central adjudication by a committee is essential for assessing HF in epidemiological studies (37)(38)(39)(40).…”

Section: Heart Failure Assessment In Primary Data Collectionmentioning

confidence: 99%

“…However, hospital discharge data are influenced by reimbursement codes as well as inconsistencies in coding practices (41 (38). In summary, there is no current "gold standard" for identifying incident HF cases with minimum misclassification 9 bias, central adjudication by a committee is essential for population studies because this method has a relatively higher specificity (37)(38)(39)(40)42). …”

Section: Heart Failure Assessment In Secondary Data Collection -Hospimentioning

confidence: 99%

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Vitamin D plus calcium supplementation among postmenopausal women : effect on risk of heart failure in the Women's Health Initiative.

Donneyong¹

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Congestive Heart Failure Incidence and Prognosis: Case Identification Using Central Adjudication Versus Hospital Discharge Diagnoses

Cited by 53 publications

References 23 publications

Administrative data have high variation in validity for recording heart failure

Administrative data have high variation in validity for recording heart failure

Kidney Function, Electrocardiographic Findings, and Cardiovascular Events among Older Adults

Vitamin D plus calcium supplementation among postmenopausal women : effect on risk of heart failure in the Women's Health Initiative.

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