What is the clinical evidence from this study?

Study design: Observational. Population: Severe mitral regurgitation (n=418). Intervention: Administrative claims data (Medicare) vs. Clinician-triggered event adjudication. Primary outcome: Concordance of claims-based outcomes with adjudicated events (1-year occurrence, cumulative incidence, and synchrony).

May 1, 2019Open Access

Use of Medicare Claims to Identify Adverse Clinical Outcomes After Mitral Valve Repair

Key Result

Administrative claims data demonstrated high positive predictive value for ascertaining mortality (97%) and heart failure hospitalization (69%) compared to physician adjudication at 1 year.

Study Design

Type

Observational (n=418)

Multicenter

Yes

Structured PICO

Does administrative claims data accurately identify adverse clinical outcomes compared to clinician-triggered event adjudication in patients undergoing transcatheter mitral valve repair?

Population

418 patients >65 years of age who underwent transcatheter mitral valve repair for severe mitral regurgitation, followed for 1 year to compare event ascertainment methods.

Exposure

Ascertainment of adverse events using administrative Medicare claims data

Comparator

Clinician-triggered event adjudication

Outcome

Concordance of claims-based outcomes with adjudicated events (mortality, heart failure hospitalization, renal failure, ventilation, and bleeding/transfusion) within 1 year

Administrative claims data showed high concordance with physician adjudication for mortality and heart failure hospitalization, but lower concordance for bleeding and renal failure.

Abstract

BACKGROUND: Clinical event committees are commonly employed for event validation in clinical studies, but little is known about the comparative performance of administrative claims data versus clinician-triggered event adjudication for ascertainment of adverse events in structural heart disease studies. METHODS AND RESULTS: Medicare claims were linked to 418 patients >65 years of age who underwent transcatheter mitral valve repair (MitraClip) for severe mitral regurgitation from 2007 to 2013 as part of the EVEREST II (Endovascular Valve Edge-to-Edge Repair Study II) High-Risk Registry or the REALISM (Real World Expanded Multicenter Study of the MitraClip System) Continued-Access Registry. Each registry adjudicated mortality, heart failure hospitalization, renal failure, ventilation, and bleeding/transfusion within 1 year. Concordance of claims-based outcomes with events was assessed in 3 ways: 1-year occurrence, cumulative incidence, and synchrony of first events. For event occurrence, positive predictive value (PPV) of claims versus adjudication was the highest for mortality (PPV=97%) and heart failure hospitalization (PPV=69%) but lower for bleeding (PPV=40%) and renal failure (PPV=19%). Whereas claims-based cumulative incidence for mortality, heart failure hospitalization, and renal failure were consistent with clinician-triggered adjudication, incidence curves for bleeding events and ventilation diverged, with claims identifying a greater number of events. When events were detected by both methods, however, over 75% of event dates matched exactly. Mitral valve reinterventions were identified through claims with perfect sensitivity and specificity relative to physician adjudication. CONCLUSIONS: Ascertainment of mortality, heart failure hospitalization, and renal failure was highly concordant between physician adjudication and administrative claims. Further work is necessary to determine the role of administrative claims in event ascertainment in both prospective and retrospective studies of structural heart disease.