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Caution warranted with claims-based cardiovascular outcomes; leaves open optimal validation methods for observational research.
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.
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Psaty et al. (2015) studied this question.
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