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Study of Cardiovascular Health Outcomes in the Era of Claims Data: The Cardiovascular Health Study.
Tuesday,2016-01-12 12:07 America/Los_Angeles — zdrager
| Title | Study of Cardiovascular Health Outcomes in the Era of Claims Data: The Cardiovascular Health Study. |
| Publication Type | Journal Article |
| Year of Publication | 2016 |
| Authors | Psaty, BM, Delaney, JA, Arnold, AM, Curtis, LH, Fitzpatrick, AL, Heckbert, SR, McKnight, B, Ives, D, Gottdiener, JS, Kuller, LH, Longstreth, WT |
| Journal | Circulation |
| Volume | 133 |
| Issue | 2 |
| Pagination | 156-64 |
| Date Published | 2016 Jan 12 |
| ISSN | 1524-4539 |
| Keywords | Blood Glucose, Cardiovascular Diseases, Female, Follow-Up Studies, Health Surveys, Hospitalization, Hospitals, Veterans, Humans, Insurance Claim Review, International Classification of Diseases, Lipids, Male, Managed Care Programs, Medicare, Risk Factors, Sampling Studies, Treatment Outcome, United States |
| Abstract | <p><b>BACKGROUND: </b>Increasingly, the diagnostic codes from administrative claims data are being used as clinical outcomes.</p><p><b>METHODS AND RESULTS: </b>Data from the Cardiovascular Health Study (CHS) were used to compare event rates and risk factor associations between adjudicated hospitalized cardiovascular events and claims-based methods of defining events. The outcomes of myocardial infarction (MI), stroke, and heart failure were defined in 3 ways: the CHS adjudicated event (CHS[adj]), selected International Classification of Diseases, Ninth Edition diagnostic codes only in the primary position for Medicare claims data from the Center for Medicare & Medicaid Services (CMS[1st]), and the same selected diagnostic codes in any position (CMS[any]). Conventional claims-based methods of defining events had high positive predictive values but low sensitivities. For instance, the positive predictive value of International Classification of Diseases, Ninth Edition code 410.x1 for a new acute MI in the first position was 90.6%, but this code identified only 53.8% of incident MIs. The observed event rates for CMS[1st] were low. For MI, the incidence was 14.9 events per 1000 person-years for CHS[adj] MI, 8.6 for CMS[1st] MI, and 12.2 for CMS[any] MI. In general, cardiovascular disease risk factor associations were similar across the 3 methods of defining events. Indeed, traditional cardiovascular disease risk factors were also associated with all first hospitalizations not resulting from an MI.</p><p><b>CONCLUSIONS: </b>The use of diagnostic codes from claims data as clinical events, especially when restricted to primary diagnoses, leads to an underestimation of event rates. Additionally, claims-based events data represent a composite end point that includes the outcome of interest and selected (misclassified) nonevent hospitalizations.</p> |
| DOI | 10.1161/CIRCULATIONAHA.115.018610 |
| Alternate Journal | Circulation |
| PubMed ID | 26538580 |
| PubMed Central ID | PMC4814341 |
| Grant List | HHSN268200800007C / HL / NHLBI NIH HHS / United States HHSN268200800007C / / PHS HHS / United States HHSN268201200036C / HL / NHLBI NIH HHS / United States HHSN268201200036C / / PHS HHS / United States N01HC55222 / HC / NHLBI NIH HHS / United States N01HC55222 / HL / NHLBI NIH HHS / United States N01HC85079 / HC / NHLBI NIH HHS / United States N01HC85079 / HL / NHLBI NIH HHS / United States N01HC85080 / HC / NHLBI NIH HHS / United States N01HC85080 / HL / NHLBI NIH HHS / United States N01HC85081 / HC / NHLBI NIH HHS / United States N01HC85081 / HL / NHLBI NIH HHS / United States N01HC85082 / HC / NHLBI NIH HHS / United States N01HC85082 / HL / NHLBI NIH HHS / United States N01HC85083 / HC / NHLBI NIH HHS / United States N01HC85083 / HL / NHLBI NIH HHS / United States N01HC85086 / HC / NHLBI NIH HHS / United States N01HC85086 / HL / NHLBI NIH HHS / United States R01 AG023629 / AG / NIA NIH HHS / United States R01AG023629 / AG / NIA NIH HHS / United States U01 HL080295 / HL / NHLBI NIH HHS / United States U01HL080295 / HL / NHLBI NIH HHS / United States |