Key result
Defining myocardial infarction using only the primary discharge code position missed ~50% of cases (sensitivity 0.48), while including any discharge position improved sensitivity to 0.63.
Observational (n=25,549)
Yes
Algorithms relying exclusively on primary discharge code position miss approximately 50% of MI cases, suggesting MI should be defined by code 410 in any of the first 5 discharge code positions to improve sensitivity.
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Narrow MI definitions risk under-ascertainment in claims data; extends algorithm validation but leaves optimal positions open for further study.
Bush et al. (2018) conducted an observational in Myocardial infarction (n=25,549). Administrative data (CMS hospitalization records) vs. Hospital surveillance data (ARIC medical record review) was evaluated on Sensitivity and specificity of MI case definitions. Defining myocardial infarction using only the primary discharge code position missed ~50% of cases (sensitivity 0.48), while including any discharge position improved sensitivity to 0.63.
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