<p>Validity of Acute Cardiovascular Outcome Diagnoses Recorded in European Electronic Health Records: A Systematic Review</p>

Abstract

Background: Electronic health records are widely used in cardiovascular disease research. We appraised the validity of stroke, acute coronary syndrome and heart failure diagnoses in studies conducted using European electronic health records. Methods: Using a prespecified strategy, we systematically searched seven databases from dates of inception to April 2019. Two reviewers independently completed study selection, followed by partial parallel data extraction and risk of bias assessment. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value estimates were narratively synthesized and heterogeneity between sensitivity and PPV estimates were assessed using I 2. Results: We identified 81 studies, of which 20 validated heart failure diagnoses, 31 validated acute coronary syndrome diagnoses with 29 specifically recording estimates for myocardial infarction, and 41 validated stroke diagnoses. Few studies reported specificity or negative predictive value estimates. Sensitivity was ≤66% in all but one heart failure study, ≥80% for 91% of myocardial infarction studies, and ≥70% for 73% of stroke studies. PPV was ≥80% in 74% of heart failure, 88% of myocardial infarction, and 70% of stroke studies. PPV by stroke subtype was variable, at ≥80% for 80% of ischaemic stroke but only 44% of haemorrhagic stroke. There was considerable heterogeneity (I 2 >75%) between sensitivity and PPV estimates for all diagnoses. Conclusion: Overall, European electronic health record stroke, acute coronary syndrome and heart failure diagnoses are accurate for use in research, although validity estimates for heart failure and individual stroke subtypes were lower. Where possible, researchers should validate data before use or carefully interpret the results of previous validation studies for their own study purposes.

Validating Acute Myocardial Infarction Diagnoses in National Health Registers for Use as Endpoint in Research: The Tromsø Study

“…Results from previous studies and systematic reviews indicate PPV and sensitivity ranging from less than 50% to over 90%. 5 , 10 , 14–17 In line with our study, most studies found that the PPV was higher than the sensitivity. Of particular interest, a previous study validating MI diagnoses in the same two registers as our study (The Norwegian Myocardial Infarction Register and the Norwegian Patient Register) found similar results as we did, with a sensitivity of 85–86% and a PPV of 95–97%.…”

“…Ascertaining cases through expert review of medical records is considered the gold standard of data collection methods and is widely used in health register validation studies. 5 Consequently, it is to be expected that the Tromsø Study Cardiovascular Disease Register is highly correct and complete. However, manual data collection is quite resource intensive as it involves a meticulous and time-consuming effort by trained reviewers.…”

Risk of acute respiratory infection and acute cardiovascular events following acute respiratory infection among adults with increased cardiovascular risk in England between 2008 and 2018: a retrospective, population-based cohort study

“…For our main analysis, we used a broad definition for acute cardiovascular events of acute coronary syndrome (myocardial infarction and unstable angina), left ventricular heart failure, stroke or transient ischaemic attack, acute limb ischaemia, or cardiovascular death. We included diagnoses recorded in the CPRD or HES APC, with the codes used informed by previous studies, 21 and cardiovascular deaths (ICD-10 codes I00–I99) recorded by the ONS. In further analyses, we also assessed each cardiovascular condition separately.…”

Use of pragmatic and explanatory trial designs in acute care research: lessons from COVID-19

“…The validity of electronic health record data might be high for some conditions such as stroke and acute coronary syndrome and low for others such as acute respiratory distress syndrome. 95 , 96 Furthermore, depending on the informatic tool used, data might not be available in real time, raising concerns about safety monitoring and adverse event reporting.…”