Key result
ICD codes in ICI patients correlate well with VTE and MI but poorly with HF and myocarditis.
Why the study?
True cardiovascular event rates and the accuracy of ICD code diagnoses in immune checkpoint inhibitor-treated patients remain uncertain in real-world populations with background cardiovascular disease.
What is the incidence of cardiovascular events in ICI-treated patients, and how accurate are ICD codes compared to adjudicated diagnoses?
Cohort (n=1,813)
No
What is the incidence of cardiovascular events in ICI-treated patients, and how accurate are ICD codes compared to adjudicated diagnoses?
Effect estimate: κ = 0.82 (95% CI 0.79-0.85)
ICD codes are reliable for identifying VTE and MI in ICI-treated patients but are less accurate for heart failure and myocarditis, highlighting the need for standardized adjudication in cardio-oncology research.
ICD codes poorly match adjudication for myocarditis and HF in ICI patients; leaves open need for standardized endpoint validation in real-world cardio-oncology studies.
Background: There is growing recognition of the risk of cardiovascular (CV) events, particularly myocarditis, in the context of immune checkpoint inhibitor (ICI) therapy; however, true event rates in real-world populations and in the background of CV disease remain uncertain. Objectives: The authors sought to determine CV event occurrence in ICI-treated patients and assess the accuracy of diagnosis by International Classification of Diseases (ICD) code compared with adjudication using established definitions and full-source documentation review. Methods: Electronic medical record extraction identified potential CV events in ICI-treated patients in the University of Colorado Health system. Two cardiologists independently adjudicated events using standardized definitions. Agreement between ICD codes and adjudicated diagnoses was assessed using the kappa statistic. Results: The cohort comprised 1,813 ICI-treated patients with a mean follow-up of 4.6 ± 3.4 years (3.2 ± 3.2 years pre-ICI and 1.4 ± 1.4 years post-ICI). Venous thromboembolic events (VTEs) were the most common event, occurring in 11.4% of patients pre-ICI and 11.3% post-ICI therapy. Post-ICI therapy, the crude rates of myocardial infarction (MI), heart failure, and stroke were 3.0%, 2.8%, and 1.6%, respectively. Six patients (0.3%) developed myocarditis post-ICI. Agreement between the ICD code and adjudication was greater for VTE (κ = 0.82; 95% CI: 0.79-0.85) and MI (κ = 0.74; 95% CI: 0.66-0.82) and worse for myocarditis (κ = 0.50; 95% CI: 0.20-0.80) and heart failure (κ = 0.47; 95% CI: 0.40-0.54). Conclusions: ICD codes correlated well with adjudicated events for VTE and MI, but correlation was worse for heart failure and myocarditis. Adjudication with standardized definitions can enhance the understanding of the incidence of CV events related to ICI therapy.
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Kondapalli et al. (2022) conducted a cohort in Cardiovascular events (n=1,813). Immune checkpoint inhibitor (ICI) therapy vs. Pre-ICI therapy period / Adjudicated diagnosis was evaluated on Agreement between ICD code and adjudicated diagnosis for venous thromboembolic events (VTE) (κ = 0.82, 95% CI 0.79-0.85). In ICI-treated patients, ICD codes correlated well with adjudicated events for VTE (κ=0.82) and MI (κ=0.74), but poorly for heart failure (κ=0.47) and myocarditis (κ=0.50).
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