Validity of a Discharge Diagnosis of Heart Failure: Implications of Misdiagnosing

Fonseca, Cândida; Sarmento, Pedro Morais; Marquês, Filipa; Ceia, Fátima

doi:10.1111/j.1751-7133.2008.07752.x

Cited by 19 publications

(12 citation statements)

References 37 publications

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“…15,[20][21][22] Common findings have been high specificity but low sensitivity. The administrative registers assessed have been either HDR or HDR and CDR combined.…”

Section: Discussionmentioning

confidence: 97%

The validity of heart failure diagnoses obtained from administrative registers

Mähönen

Jula

Harald

et al. 2012

Eur J Prev Cardiolog

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“…15,[20][21][22] Common findings have been high specificity but low sensitivity. The administrative registers assessed have been either HDR or HDR and CDR combined.…”

Section: Discussionmentioning

confidence: 97%

The validity of heart failure diagnoses obtained from administrative registers

Mähönen

Jula

Harald

et al. 2012

Eur J Prev Cardiolog

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“…Seven studies accepted HF diagnosis documented in the chart (12,(16)(17)(18)(19)(20)(21) and four studies used documented HF diagnosis or a combination of clinical judgement based on information in the chart (eg, test results, diagnostics) (22)(23)(24)(25). Eight studies (15,(25)(26)(27)(28)(29)(30)(31) ascertained HF presence based on diagnostic criteria used by scoring systems from Framingham, Carlson, Boston, the National Health and Nutrition Examination Survey (NHANES), the New York Heart Association (NYHA) or the European Society of Cardiology (ESC). Four studies (25)(26)(27)32) further classified HF according to levels of evidence such as definite or possible HF using the ESC or Boston criteria.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Eight studies (15,(25)(26)(27)(28)(29)(30)(31) ascertained HF presence based on diagnostic criteria used by scoring systems from Framingham, Carlson, Boston, the National Health and Nutrition Examination Survey (NHANES), the New York Heart Association (NYHA) or the European Society of Cardiology (ESC). Four studies (25)(26)(27)32) further classified HF according to levels of evidence such as definite or possible HF using the ESC or Boston criteria. Two studies compared the PPV against different clinical definitions of HF, and found that the PPV varied between criteria used (Lee et al [30], 94% Framingham versus 89% Carlson; McCullough et al [31], 56% NHANES versus 64% Framingham versus 83% NYHA).…”

Section: Literature Reviewmentioning

confidence: 99%

Administrative data have high variation in validity for recording heart failure

Quach

Blais

Quan

2010

Canadian Journal of Cardiology

128

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H eart failure (HF) has been widely studied because of its high mortality and morbidity rates (1-4). Studies on HF have relied on multiple data sources such as surveys, disease registries, hospital charts and administrative data. Of these sources, administrative data have been increasingly used for health services utilization and outcome evaluation.Administrative data result from implementing health care delivery, enrolling members into health insurance plans and reimbursing health care providers for services (5). The types of administrative data depend on the health care system and the funding structure. For example, Canada has a nationally funded health care system that collects hospital discharge data at a national level, while insurance registry, physician services and emergency room visit information is collected at a provincial level. Although these data are not intended for research, they are widely used in surveillance and outcome studies. Therefore, the validity of the research results rely on the quality of the data. Data quality is critical for interpreting variation across studies from different geographical areas.The purpose of the present study was to systematically review the literature pertaining to the validity of administrative data for recording HF and apply the International Classification of Diseases (ICD) HF definitions to Canadian hospital discharge abstract data to explore the prevalence of HF across ICD code definitions. METHODSLiterature review Search strategy: Only English language articles that compared the validity of ICD codes in administrative databases (eg, physician claims data, hospital discharge) with a reference standard (eg, chart review, registry, survey, case notes) were included. The literature search focused on articles published from 1990 to 2008. To identify peerreviewed journal articles, both the Ovid MEDLINE database and EMBASE were searched. Because validation studies were not indexed consistently with standard MeSH terms, the following key search terms were used: 'admin data', 'administrative data', 'population surveillance', 'heart failure', 'congestive heart failure', 'hospital data', 'physician claims', 'claims', 'hospital discharge', 'validation' and 'registries'. Next, Boolean operators were used to join search terms within the database search engines to locate articles. The reference lists from these articles were scanned to identify any additional articles that met heAlth outcomes/public policy ©2010 Pulsus Group Inc. All rights reserved Twenty-one studies validated hospital discharge abstract data; three studies validated physician claims and two studies validated ambulatory care data. Eighteen studies reported sensitivity (range 29% to 89%). Specificity and negative predictive value were greater than 70% across 17 studies. Nineteen studies reported positive predictive values (range 12% to 100%). Ten studies reported kappa values (range 0.39 to 0.84).

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“…In addition, when analysing the 20 medical records with an HF diagnosis and without complementary diagnoses as described in Methods section, none represented a missed cardiomyopathy diagnosis at any time. However, in three cases, the ICD codes for cardiomyopathy were recorded in subsequent years, indicating that causation is necessary when interpreting results from the hospital discharge registry 20, 21, 22…”

Section: Discussionmentioning

confidence: 99%

High validity of cardiomyopathy diagnoses in western Sweden (1989–2009)

et al. 2017

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AimHospital discharges with a diagnosis of cardiomyopathy have more than doubled in Sweden since 1987. We validated the cardiomyopathy diagnoses over this time period to investigate that the increase was real and not a result of improved recognition of the diagnosis and better diagnostic methods.Methods and resultsEvery fifth year from 1989 to 2009, records for all patients with a cardiomyopathy diagnosis were identified by searching the local registers in three hospitals in Västra Götaland, Sweden. The diagnoses were validated according to criteria defined by the European Society of Cardiology from 2008. The population comprised 611 cases with cardiomyopathy diagnoses [mean age 58.9 (SD 15.5) years, 68.2% male], divided into three major groups: dilated, hypertrophic, and other cardiomyopathies. Hypertrophic cardiomyopathy and hypertrophic obstructive cardiomyopathy were analysed as a group. Cardiomyopathies for which there were few cases, such as restrictive, arrhythmogenic right ventricular, left ventricular non‐compaction, takotsubo, and peripartum cardiomyopathies, were analysed together and defined as ‘other cardiomyopathies’. Relevant co‐morbidities were registered. The use of echocardiography was 99.7%, of which 94.6% was complete echocardiography reports. The accuracy rates of the diagnoses dilated cardiomyopathy, hypertrophic cardiomyopathy, and other cardiomyopathies were 85.5%, 87.5%, and 100%, respectively, with no differences between the three hospitals or years studied; nor did the prevalence of co‐morbidities differ.ConclusionsThe accuracy rate of the cardiomyopathy diagnoses from in‐hospital records from >600 patients in western Sweden during a 20 year period was 86.6%, with no significant trend over time, strengthening epidemiological findings that this is likely due to an actual increase in cardiomyopathy diagnoses rather than changes in coding practices. The use of echocardiography was high, and there was no significant difference in co‐morbidities during the study period. The accuracy rate of the cardiomyopathy diagnoses during the 20 year period was high. The use of diagnostic tools did not increase under the study period, and once cardiomyopathy diagnoses were suspected, echocardiography was performed in almost all cases. In this study, the occurrence of cardiomyopathy was increasing over time without significant increase of co‐morbidity, supporting that an actual increase of cardiomyopathy has occurred.

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Validity of a Discharge Diagnosis of Heart Failure: Implications of Misdiagnosing

Cited by 19 publications

References 37 publications

The validity of heart failure diagnoses obtained from administrative registers

The validity of heart failure diagnoses obtained from administrative registers

Administrative data have high variation in validity for recording heart failure

High validity of cardiomyopathy diagnoses in western Sweden (1989–2009)

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