Validity of International Classification of Diseases (ICD)-10 Diagnosis Codes for Identification of Acute Heart Failure Hospitalization and Heart Failure with Reduced Versus Preserved Ejection Fraction in a National Medicare Sample.

Autor:	Bates BA; Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ (B.A.B., M.R., P.G., C.V.D., S.S.).; Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (B.A.B., E.A., M.M.N., A.M., E.H., J.R., B.W., A.V., S.S.)., Akhabue E; Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (B.A.B., E.A., M.M.N., A.M., E.H., J.R., B.W., A.V., S.S.)., Nahass MM; Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (B.A.B., E.A., M.M.N., A.M., E.H., J.R., B.W., A.V., S.S.)., Mukherjee A; Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (B.A.B., E.A., M.M.N., A.M., E.H., J.R., B.W., A.V., S.S.)., Hiltner E; Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (B.A.B., E.A., M.M.N., A.M., E.H., J.R., B.W., A.V., S.S.)., Rock J; Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (B.A.B., E.A., M.M.N., A.M., E.H., J.R., B.W., A.V., S.S.)., Wilton B; Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (B.A.B., E.A., M.M.N., A.M., E.H., J.R., B.W., A.V., S.S.)., Mittal G; Rutgers School of Public Health, Rutgers University, Piscataway, NJ (G.M.)., Visaria A; Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (B.A.B., E.A., M.M.N., A.M., E.H., J.R., B.W., A.V., S.S.)., Rua M; Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ (B.A.B., M.R., P.G., C.V.D., S.S.)., Gandhi P; Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ (B.A.B., M.R., P.G., C.V.D., S.S.)., Dave CV; Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ (B.A.B., M.R., P.G., C.V.D., S.S.).; Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ (C.V. D.)., Setoguchi S; Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ (B.A.B., M.R., P.G., C.V.D., S.S.).; Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (B.A.B., E.A., M.M.N., A.M., E.H., J.R., B.W., A.V., S.S.).
Jazyk:	angličtina
Zdroj:	Circulation. Cardiovascular quality and outcomes [Circ Cardiovasc Qual Outcomes] 2023 Feb; Vol. 16 (2), pp. e009078. Date of Electronic Publication: 2023 Jan 23.
DOI:	10.1161/CIRCOUTCOMES.122.009078
Abstrakt:	Background: Heart failure (HF) is a leading cause of hospitalization in older adults. Medicare data have been used to assess HF outcomes. However, the validity of ICD-10 diagnosis codes (used since 2015) to identify acute HF hospitalization or distinguish reduced (heart failure with reduced ejection fraction) versus preserved ejection fraction (HFpEF) is unknown in Medicare data. Methods: Using Medicare data (2015-2017), we randomly sampled 200 HF hospitalizations with ICD-10 diagnosis codes for HF in the first/second claim position in a 1:1:2 ratio for systolic HF (I50.2), diastolic HF (I50.3), and other HF (I50.X). The primary gold standards included recorded HF diagnosis by a treating physician for HF hospitalization, ejection fraction (EF)≤50 for heart failure with reduced ejection fraction, and EF>50 for HFpEF. If the quantitative EF was not present, then qualitative descriptions of EF were used for heart failure with reduced ejection fraction/HFpEF gold standards. Multiple secondary gold standards were also tested. Gold standard data were extracted from medical records using standardized forms and adjudicated by cardiology fellows/staff. We calculated positive predictive values with 95% CIs. Results: The 200-chart validation sample included 50 systolic, 50 diastolic, 47 combined dysfunction, and 53 unspecified HF patients. The positive predictive values of acute HF hospitalization was 98% [95% CI, 95-100] for first-position ICD-10 HF diagnosis and 66% [95% CI, 58-74] for first/second-position diagnosis. Quantitative EF was available for ≥80% of patients with systolic, diastolic, or combined dysfunction ICD-10 codes. The positive predictive value of systolic HF codes was 90% [95% CI, 82-98] for EFs≤50% and 72% [95% CI, 60-85] for EFs≤40%. The positive predictive value was 92% [95% CI, 85-100] for HFpEF for EFs>50%. The ICD-10 codes for combined or unspecified HF poorly predicted heart failure with reduced ejection fraction or HFpEF. Conclusions: ICD-10 principal diagnosis identified acute HF hospitalization with a high positive predictive value. Systolic and diastolic ICD-10 diagnoses reliably identified heart failure with reduced ejection fraction and HFpEF when EF 50% was used as the cutoff.
Databáze:	MEDLINE
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