Implementation of an established algorithm and modifications for the identification of epilepsy patients in the veterans health administration

Rehman, Rizwana; Everhart, Amanda; Frontera, Alfred T.; Kelly, Pat; López, María Fernanda; Riley, Denise; Sajan, Sheela; Schooff, David M.; Tran, Tung Thanh; Husain, Aatif M.

doi:10.1016/j.eplepsyres.2016.09.012

Cited by 10 publications

(19 citation statements)

References 13 publications

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“…21 Participants were adults in eight studies, 29,33,40,42,46,48,52,53 children in two studies, 27,41 both adults and children in 14 studies, 14,28,[34][35][36][37][38][39]43,[49][50][51]54,55 and unclear age in six studies. [30][31][32]44,45,47 Epilepsy was the target diagnostic condition in all included studies. The majority (19 studies) used hand-searched medical records as the diagnostic gold standard.…”

Section: Search and Study Characteristicsmentioning

confidence: 99%

“…The majority (19 studies) used hand-searched medical records as the diagnostic gold standard. 14,30,32,[37][38][39][40][41][42][43][45][46][47][48][50][51][52][53][54] In the remaining 11 studies, the other gold standards used were the general practitioner (GP: 3 studies), 35,36,49 being on antiepileptic drugs (AEDs: three studies, one of which used rufinamide only), 31,33,44 medical records and/ or parent telephone interview, 27 an epilepsy center patient list, 28 a previous epilepsy prevalence study, 29 another administrative data set, 34 and a specialist epilepsy database. 55 Administrative data sets validated included inpatients, outpatients, pharmacy, accident and emergency, physician claims, and primary care.…”

Section: Search and Study Characteristicsmentioning

confidence: 99%

“…Algorithms included ICD-9, ICD-10 (including two studies that combined ICD-8 and ICD-10 data sets together), 30,52 Read Codes (Version 2), AEDs, hospitalizations, and procedures such as electroencephalography (EEG) or vagus nerve stimulation (VNS). Twenty-eight studies assessed PPV, 14,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][45][46][47][48][49][50][51][52][53][54] of which 14 also assessed sensitivity. 14,28,29,[33][34][35]37,38,40,42,48,51,52,54 Two studies assessed sensitivity alone.…”

Section: Search and Study Characteristicsmentioning

confidence: 99%

“…14,49,54 The remaining 12 studies had ratings of both low and unclear risks across different categories, resulting in overall risks being graded unclear. 28,32,37,[41][42][43][45][46][47]50,52,55 The most common reason for this was lack of clarity about whether or not those reading the reference standard were blinded to the participants' administrative codes.…”

Section: Quality Assessmentmentioning

confidence: 99%

“…Positive predictive value and sensitivity ranged from 32.7%-96.0% and 12.2%-97.3%, respectively, across nine US studies (Appendix S7). 32,36,37,[42][43][44][45][46][47] Risks of bias and applicability concern were unclear in all but two studies, 36,44 where risks were…”

Section: United Statesmentioning

confidence: 99%

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The accuracy of using administrative healthcare data to identify epilepsy cases: A systematic review of validation studies

et al. 2020

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Section: Search and Study Characteristicsmentioning

confidence: 99%

Section: Search and Study Characteristicsmentioning

confidence: 99%

Section: Search and Study Characteristicsmentioning

confidence: 99%

Section: Quality Assessmentmentioning

confidence: 99%

Section: United Statesmentioning

confidence: 99%

See 3 more Smart Citations

The accuracy of using administrative healthcare data to identify epilepsy cases: A systematic review of validation studies

et al. 2020

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Association Between Standardized Mortality Ratio and Utilization of Care in US Veterans With Drug-Resistant Epilepsy Compared With All US Veterans and the US General Population

2022

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ImportanceDrug-resistant epilepsy (DRE) is thought to be associated with increased mortality, but larger population-based studies are lacking. Additionally, the benefit of effective management in DRE lacks evidence.ObjectiveTo examine the association of utilization of care with mortality in US veterans with DRE.Design, Setting, and ParticipantsObservational cohort study conducted between October 1, 2013, and March 31, 2020. Mortality statistics in US veterans with DRE were compared to the US general population and all veterans within the Veterans Health Administration. Epilepsy was defined as use of 1 or more antiseizure medications (ASMs) for 30 days or longer with a seizure diagnosis or 1 inpatient or 2 outpatient encounters with an epilepsy diagnosis. DRE was defined as the use of 2 or more ASMs. Among 9.6 million US veterans, 164 435 (1.7%) had epilepsy, of whom 55 571 (33.8%) had DRE. Epilepsy and DRE were administratively identified based on criteria noted in design. Identified participants were included for analysis.ExposuresVeterans with DRE.Main Outcomes and MeasuresStandardized mortality ratio (SMR).ResultsAmong US veterans with DRE, the mean (SD) age was 58.3 (15.4) years, and 49 430 individuals (88.9%) were male. Of ethnicity data gathered, 3170 individuals (5.7%) were Hispanic or Latino, 50 599 (91.1%) were not Hispanic or Latino, 842 (1.5%) declined to answer, and 960 (1.7%) were recorded as unknown. Of race data gathered, 516 individuals (0.9%) were American Indian or Alaskan Native, 270 (0.5%) were Asian, 11 316 (20.4%) were Black or African American, 587 (1.1%) were of multiple races, 453 (0.8%) were Native Hawaiian or Pacific Islander, 39 543 (71.2%) were White, 1697 (3.1%) declined to answer, and 1189 (2.1%) were recorded as unknown. SMR was 1.50 (95% CI, 1.47-1.53) compared with the US general population and 1.56 (95% CI, 1.53-1.59) compared with all veterans. Utilization rates were 81.1% (n = 45 057) for neurology clinic evaluation, 66.4% (n = 36 905) for magnetic resonance imaging (MRI), and 49.6% (n = 27 546) for electroencephalography (EEG) testing. Only 8350 individuals (15.0%) had comprehensive epilepsy evaluations and 3357 (6.0%) had epilepsy monitoring. Multivariable analysis revealed an association between lower mortality and neurology clinic evaluation, EEG, MRI, epilepsy monitoring, and the use of more than 2 ASMs after adjusting for age and comorbidities.Conclusions and RelevanceMortality rates were significantly higher in US veterans with DRE compared to the general population. Better utilization of comprehensive epilepsy care, diagnostic services, and medications were each associated with reduced mortality. These findings indicate that appropriate management of DRE is critical in this population.

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Angiotensin Receptor Blockers for Hypertension and Risk of Epilepsy

Wen,

Otoo,

Tang

et al. 2024

JAMA Neurol

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ImportanceAnimal and human studies have suggested that the use of angiotensin receptor blockers (ARBs) may be associated with a lower risk of incident epilepsy compared with other antihypertensive medications. However, observational data from the US are lacking.ObjectiveTo evaluate the association between ARB use and epilepsy incidence in subgroups of US patients with hypertension.Design, Setting, and ParticipantsThis retrospective cohort study used data from a national health administrative database from January 2010 to December 2017 with propensity score (PS) matching. The eligible cohort included privately insured individuals aged 18 years or older with diagnosis of primary hypertension and dispensed at least 1 ARB, angiotensin-converting enzyme inhibitor (ACEI), β-blocker, or calcium channel blocker (CCB) from 2010 to 2017. Patients with a diagnosis of epilepsy at or before the index date or dispensed an antiseizure medication 12 months before or 90 days after initiating the study medications were excluded. The data analysis for this project was conducted from April 2022 to April 2024.ExposuresPropensity scores were generated based on baseline covariates and used to match patients who received ARBs with those who received either ACEIs, β-blockers, CCBs, or a combination of these antihypertensive medications.Main Outcomes and MeasuresCox regression analyses were used to evaluate epilepsy incidence during follow-up comparing the ARB cohort with other antihypertensive classes. Subgroup and sensitivity analyses were conducted to examine the association between ARB use and epilepsy incidence in various subgroups.ResultsOf 2 261 964 patients (mean [SD] age, 61.7 [13.9] years; 1 120 630 [49.5%] female) included, 309 978 received ARBs, 807 510 received ACEIs, 695 887 received β-blockers, and 448 589 received CCBs. Demographic and clinical characteristics differed across the 4 comparison groups prior to PS matching. Compared with ARB users, patients receiving ACEIs were predominantly male and had diabetes, CCB users were generally older (eg, &gt;65 years), and β-blocker users had more comorbidities and concurrent medications. The 1:1 PS-matched subgroups included 619 858 patients for ARB vs ACEI, 619 828 patients for ARB vs β-blocker, and 601 002 patients for ARB vs CCB. Baseline characteristics were equally distributed between comparison groups after matching with propensity scores. Use of ARBs was associated with a decreased incidence of epilepsy compared with ACEIs (adjusted hazard ratio [aHR], 0.75; 95% CI, 0.58-0.96), β-blockers (aHR, 0.70; 95% CI, 0.54-0.90), and a combination of other antihypertensive classes (aHR, 0.72; 95% CI, 0.56-0.95). Subgroup analyses revealed a significant association between ARB use (primarily losartan) and epilepsy incidence in patients with no preexisting history of stroke or cardiovascular disease.Conclusions and RelevanceThis cohort study found that ARBs, mainly losartan, were associated with a lower incidence of epilepsy compared with other antihypertensive agents in hypertensive patients with no preexisting stroke or cardiovascular disease. Further studies, such as randomized clinical trials, are warranted to confirm the comparative antiepileptogenic properties of antihypertensive medications.

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Implementation of an established algorithm and modifications for the identification of epilepsy patients in the veterans health administration

Cited by 10 publications

References 13 publications

The accuracy of using administrative healthcare data to identify epilepsy cases: A systematic review of validation studies

The accuracy of using administrative healthcare data to identify epilepsy cases: A systematic review of validation studies

Association Between Standardized Mortality Ratio and Utilization of Care in US Veterans With Drug-Resistant Epilepsy Compared With All US Veterans and the US General Population

Angiotensin Receptor Blockers for Hypertension and Risk of Epilepsy

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