Identification of Acute Decompensated Heart Failure Hospitalizations Using Administrative Data

Huang, Hans; Turner, Matthew; Raju, Srihari; Reich, Jon; Leatherman, Sarah; Armstrong, Katherine; Woods, Patricia; Ferguson, Ryan; Fiore, Louis D.; Lederle, Frank A.

doi:10.1016/j.amjcard.2017.03.007

Cited by 16 publications

(11 citation statements)

References 18 publications

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“…Others have found variable sensitivity and specificity when relying on diagnosis codes in administrative data sets in adult pulmonary and cardiovascular medicine [23, 24]. Although not directly comparable to our work, their results parallel ours.…”

Section: Discussionsupporting

confidence: 71%

Which ICD-9-CM codes should be used for bronchiolitis research?

Walsh

Rothenberg

2018

BMC Med Res Methodol

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BackgroundBronchiolitis is a common respiratory disorder in children. Although there are specific ICD-9-CM diagnosis codes for bronchiolitis, the illness is often coded using broader diagnosis codes. This creates the potential for subject misclassification if researchers rely on specific diagnosis codes when assembling retrospective cohorts. Here we challenge the common research practice of relying on specific diagnosis codes for bronchiolitis.MethodsWe examined the use of diagnosis codes for the first episode of bronchiolitis, bronchitis, acute asthma, and bronchospasm and wheezing, in children younger than six and 24 months in the State of California Medic-Aid database. We categorized codes as narrow or broad diagnosis codes. We compared patient, geographic, and temporal characteristics of the different diagnoses codes.ResultsWe identified visits from 48,732 children for first episode of wheezing illness. We retained 48,269 who had the diagnosis codes and data of interest. Diagnosis codes for acute asthma were widely used, even in children younger than six months in whom a diagnosis code for bronchiolitis would have been anticipated. The temporal pattern was similar across all diagnoses. Antipyretics were prescribed more often in those with diagnosis codes for bronchiolitis and bronchitis. Other statistically significant differences were too small to usefully distinguish the groups. There was substantial geographic variability in the diagnosis codes selected.ConclusionUsers of Medic-Aid administrative data should generally favor broad rather than narrow definitions of bronchiolitis and should perform sensitivity analysis comparing broad and narrow definitions.Electronic supplementary materialThe online version of this article (10.1186/s12874-018-0589-4) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 71%

Which ICD-9-CM codes should be used for bronchiolitis research?

Walsh

Rothenberg

2018

BMC Med Res Methodol

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“…Non-fatal events were identified using an administrative algorithm incorporating previously validated ICD-9 codes (online supplemental table 2). [24][25][26][27][28][29][30] We queried the VA CDW, requiring a primary or secondary hospital discharge diagnosis for CAD or stroke, including transient ischaemic attack. Since it is a chronic condition, HF was required to be a primary discharge diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Investigating changes in disease activity as a mediator of cardiovascular risk reduction with methotrexate use in rheumatoid arthritis

et al. 2021

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ObjectiveExamine the association of methotrexate (MTX) use with cardiovascular disease (CVD) in rheumatoid arthritis (RA) using marginal structural models (MSM) and determine if CVD risk is mediated through modification of disease activity.MethodsWe identified incident CVD events (coronary artery disease (CAD), stroke, heart failure (HF) hospitalisation, CVD death) within a multicentre, prospective cohort of US Veterans with RA. A 28-joint Disease Activity Score with C-reactive protein (DAS28-CRP) was collected at regular visits and medication exposures were determined by linking to pharmacy dispensing data. MSMs were used to estimate the treatment effect of MTX on risk of incident CVD, accounting for time-varying confounders between receiving MTX and CVD events. A mediation analysis was performed to estimate the indirect effects of methotrexate on CVD risk through modification of RA disease activity.ResultsAmong 2044 RA patients (90% male, mean age 63.9 years, baseline DAS28-CRP 3.6), there were 378 incident CVD events. Using MSM, MTX use was associated with a 24% reduced risk of composite CVD events (HR 0.76, 95% CI 0.58 to 0.99) including a 57% reduction in HF hospitalisations (HR 0.43, 95% CI 0.24 to 0.77). Individual associations with CAD, stroke and CVD death were not statistically significant. In mediation analyses, there was no evidence of indirect effects of MTX on CVD risk through disease activity modification (HR 1.03, 95% CI 0.80 to 1.32).ConclusionsMTX use in RA was associated with a reduced risk of CVD events, particularly HF-related hospitalisations. These associations were not mediated through reductions in RA disease activity, suggesting alternative MTX-related mechanisms may modify CVD risk in this population.

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“…A minimum of 3 LVEF was selected because preliminary analysis showed that LVEF followed a quadratic trend, and a quadratic line needed at least 3 points to fit. HF diagnosis was based on having at least one previously validated inpatient or outpatient International Classification of Diseases Ninth Revision/Tenth Revision (ICD 9/10 ) codes for HF 3–6 (ICD9: 398.91, 401.01, 402.01, 402.11, 402.91, 404.03, 404.11, 404.13, 404.91, 404.93, 428.xx; ICD10: I09.81, I11.0, I13.0, I13.2, I50) at first visit in the electronic health record (baseline) or on follow-up. We also set time zero as the date of HF diagnosis.…”

Section: Methodsmentioning

confidence: 99%

Long-Term Trajectories of Left Ventricular Ejection Fraction in Patients With Chronic Inflammatory Diseases and Heart Failure: An Analysis of Electronic Health Records

Rivera

Sinha

Ahmad

et al. 2021

Circ: Heart Failure

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Background: Immune regulation and inflammation play a role in the pathogenesis and progression of acute and chronic heart failure (HF). Although the clinical course of acute, severe inflammatory cardiomyopathy is well described, the effects of chronic systemic inflammation on cardiovascular function over time are less clear. To investigate this question, we compared trajectories over time in left ventricular ejection fraction for patients with HF with different chronic inflammatory diseases (CIDs): HIV, systemic lupus erythematosus, systemic sclerosis, rheumatoid arthritis, inflammatory bowel disease, and/or psoriasis. Methods: Using a database of patients receiving care in a large metropolitan health care system since January 1, 2000, we analyzed serial, clinically indicated echocardiograms from patients with HF with CIDs and frequency-matched patients with HF without CIDs. We included patients with ≥3 serial echocardiograms (N=974; median 6.1 years between first and most recent echo). We assessed left ventricular ejection fraction trajectories over time using latent trajectory models, then investigated differences in left ventricular ejection fraction trajectories for specific CID subtypes compared with controls. Results: Overall, the majority of patients studied (N=687; 70.5%) had left ventricular ejection fraction trajectories consistent with HF with preserved or midrange EF, whereas 255 (26.2%) had HF with reduced EF and 32 (3.3%) had HF with recovered EF. Compared with non-CID controls with HF, patients with rheumatoid arthritis, inflammatory bowel disease, and systemic lupus erythematosus were significantly more likely than controls to have HF with preserved or midrange EF whereas patients with HIV were significantly more likely to have HF with reduced EF. Conclusions: Among patients with HF with CIDs, distinct left ventricular ejection fraction trajectory patterns associate with different specific individual CIDs. This highlights the heterogeneity of HF subtypes and changes over time across different CIDs.

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Identification of Acute Decompensated Heart Failure Hospitalizations Using Administrative Data

Cited by 16 publications

References 18 publications

Which ICD-9-CM codes should be used for bronchiolitis research?

Which ICD-9-CM codes should be used for bronchiolitis research?

Investigating changes in disease activity as a mediator of cardiovascular risk reduction with methotrexate use in rheumatoid arthritis

Long-Term Trajectories of Left Ventricular Ejection Fraction in Patients With Chronic Inflammatory Diseases and Heart Failure: An Analysis of Electronic Health Records

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