Study of Cardiovascular Health Outcomes in the Era of Claims Data: The Cardiovascular Health Study.

Journal Article (Journal Article;Multicenter Study)

BACKGROUND: Increasingly, the diagnostic codes from administrative claims data are being used as clinical outcomes. METHODS AND RESULTS: Data from the Cardiovascular Health Study (CHS) were used to compare event rates and risk factor associations between adjudicated hospitalized cardiovascular events and claims-based methods of defining events. The outcomes of myocardial infarction (MI), stroke, and heart failure were defined in 3 ways: the CHS adjudicated event (CHS[adj]), selected International Classification of Diseases, Ninth Edition diagnostic codes only in the primary position for Medicare claims data from the Center for Medicare & Medicaid Services (CMS[1st]), and the same selected diagnostic codes in any position (CMS[any]). Conventional claims-based methods of defining events had high positive predictive values but low sensitivities. For instance, the positive predictive value of International Classification of Diseases, Ninth Edition code 410.x1 for a new acute MI in the first position was 90.6%, but this code identified only 53.8% of incident MIs. The observed event rates for CMS[1st] were low. For MI, the incidence was 14.9 events per 1000 person-years for CHS[adj] MI, 8.6 for CMS[1st] MI, and 12.2 for CMS[any] MI. In general, cardiovascular disease risk factor associations were similar across the 3 methods of defining events. Indeed, traditional cardiovascular disease risk factors were also associated with all first hospitalizations not resulting from an MI. CONCLUSIONS: The use of diagnostic codes from claims data as clinical events, especially when restricted to primary diagnoses, leads to an underestimation of event rates. Additionally, claims-based events data represent a composite end point that includes the outcome of interest and selected (misclassified) nonevent hospitalizations.

Full Text

Duke Authors

Cited Authors

  • Psaty, BM; Delaney, JA; Arnold, AM; Curtis, LH; Fitzpatrick, AL; Heckbert, SR; McKnight, B; Ives, D; Gottdiener, JS; Kuller, LH; Longstreth, WT

Published Date

  • January 12, 2016

Published In

Volume / Issue

  • 133 / 2

Start / End Page

  • 156 - 164

PubMed ID

  • 26538580

Pubmed Central ID

  • PMC4814341

Electronic International Standard Serial Number (EISSN)

  • 1524-4539

Digital Object Identifier (DOI)

  • 10.1161/CIRCULATIONAHA.115.018610


  • eng

Conference Location

  • United States