Identification of Acute Decompensated Heart Failure Hospitalizations Using Administrative Data

• Published in: The American journal of cardiology Vol. 119; no. 11; pp. 1791 - 1796
• Main Authors: Huang, Hans, MD, Turner, Matthew, MD, Raju, Srihari, MD, Reich, Jon, MD, Leatherman, Sarah, PhD, Armstrong, Katherine, MPH, Woods, Patricia, RN, MSN, Ferguson, Ryan E., ScD, MPH, Fiore, Louis D., MD, MPH, Lederle, Frank A., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2017; Elsevier Limited
• Subjects: Acute Disease; Adjudication; Alcohols; Algorithms; Amplification; Antibiotics; Arches; Arteriosclerosis; Arthritis; Atherosclerosis; Augmentation; Cardiology; Cardiovascular; Cardiovascular disease; Catheterization; Chronic obstructive pulmonary disease; Circulation; Classification; Clinical trials; Codes; Coding; Congestive heart failure; Coronary artery; Coronary artery disease; Diagnosis; Distension; Diuretics; Documentation; Drinking behavior; Drugs; Dyspnea; Edema; Emergency medical services; Etiology; Fatigue; Female; Follow-Up Studies; Government programs; Health care; Heart; Heart failure; Heart Failure - diagnosis; Heart Failure - epidemiology; Heart Failure - therapy; Hospitalization - trends; Hospitals; Humans; Hypoxia; Incidence; Intervention; Intubation; Kidney diseases; Lung diseases; Male; Mathematical analysis; Medical records; Myocardial infarction; Older people; Pharmacology; Pneumonia; Registries; Renal failure; Respiration; Retrospective Studies; Rheumatoid arthritis; Risk; Sensitivity; Steroids; Time Factors; United States - epidemiology; Heart failure; Clinical trials; Database
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2017.03.007

Abstract Hospitalizations for acute decompensated heart failure (ADHF) is an important outcome in clinical trials and heart failure registries; however the optimal strategy to identify these hospitalizations using International Classification of Diseases Ninth Revision (ICD-9) codes is uncertain. We sought to identify diagnostic codes that improve ascertainment of ADHF hospitalizations. Heart failure related ICD-9 principal discharge codes were used to identify 2,202 hospitalizations within the Minneapolis Veterans Affairs (VA) Medical Center between 2009 and 2014. Two independent reviewers adjudicated 447 of these hospitalizations to determine the accuracy of each code. We then applied our findings to an unadjusted nationwide sample containing the same ICD-9 codes of interest, from which overall positive predictive value (PPV), sensitivity, and accuracy were calculated. Use of 428.x alone resulted in a PPV of 91.3% (95% CI: 91.0-91.7), sensitivity of 97.5% (95% CI: 97.3-97.6), and accuracy of 89.7% (95% CI: 89.4-90.0). Combining 428.x with 402.x1, 404.x1, 415, and 518.4 resulted in improved sensitivity [99.2% (95% CI: 99.0-99.3)] and accuracy [90.7% (95% CI: 90.4-91.1)] while maintaining a PPV of 91.1% (95% CI: 90.7-91.4). Excluding chronic heart failure codes (428.22, 428.32, 428.42) from the proposed strategy resulted in an improvement of PPV to 92.3% (95% CI: 92.0-92.6), though sensitivity and accuracy decreased to 96.6% (95% CI: 96.3-96.8) and 90.0% (95% CI: 89.6-90.3), respectively. In conclusion, a combination of codes including 428.x, 402.x1, 404.x1, 415, and 518.4 improves sensitivity and overall accuracy in ascertaining ADHF events when compared to 428.x alone. This strategy could be further improved by manual adjudication of chronic heart failure codes.