ICD-9-CM codes for acute myocardial infarction, atrial fibrillation/flutter, and heart failure demonstrated high diagnostic accuracy, with sensitivity ≥95% and specificity ≥90% for all three conditions.
Observational (n=458)
None
Random sample of cases and non-cases
Yes
Do ICD-9-CM codes accurately identify cases of acute myocardial infarction, atrial fibrillation/flutter, and heart failure in healthcare administrative databases compared to medical chart review?
ICD-9-CM codes for acute myocardial infarction, atrial fibrillation/flutter, and heart failure in the Umbria Region administrative database show high diagnostic accuracy (≥90%) and can be reliably used for epidemiological and health services research.
Effect estimate: Sensitivity ≥95% and Specificity ≥90% across all three conditions
BACKGROUND: Administrative healthcare databases are useful and inexpensive tools that can provide a comprehensive assessment of the burden of diseases in terms of major outcomes, such as mortality, hospital readmissions, and use of healthcare resources. However, a crucial issue is the reliability of information gathered. The aim of this study was to validate ICD-9 codes for several major cardiovascular conditions, i.e., acute myocardial infarction (AMI), atrial fibrillation/flutter (AF), and heart failure (HF), in order to use them for epidemiological, outcome, and health services research. METHODS: Data from the centralised administrative database of the Umbria Region (890,000 residents, located in Central Italy) were considered. Patients with a first hospital discharge for AMI, AF/flutter, and HF, between 2012 and 2014, were identified using ICD-9-CM codes in primary position. A sample of cases and non-cases was randomly selected, and the corresponding medical charts reviewed by specifically trained investigators. For each disease, case ascertainment was based on all clinical, laboratory, and instrumental examinations available in medical charts. Sensitivity, specificity, and predictive values with 95% confidence intervals (CIs), were calculated. RESULTS: We reviewed 458 medical charts, 128 for AMI, 127 for AF/flutter, 127 for HF, and 76 of non-cases for each condition. Diagnostic accuracy measures of the original discharge diagnosis were as follows. AMI: sensitivity 98% (95% CI, 94-100%), specificity 91% (95% CI, 83-97%), positive predictive value (PPV) 95% (95% CI, 89-98%), negative predictive value (NPV) 97% (95% CI, 91-100%). AF/flutter: sensitivity 95% (95% CI, 90-98%), specificity 95% (95% CI, 87-99%), PPV 97% (95% CI, 92-99%), NPV 92% (95% CI, 84-97%). HF: sensitivity 96% (95% CI, 91-99%), specificity 90% (95% CI, 81-96%), PPV 94% (95% CI, 88-97%), NPV 93% (95% CI, 85-98%). CONCLUSION: The case ascertainment for AMI, AF and flutter, and HF, showed a high level of accuracy (≥ 90%). The healthcare administrative database of the Umbria Region can be confidently used for epidemiological, outcome, and health services research.
Cozzolino et al. (Mon,) conducted a observational in Acute myocardial infarction, atrial fibrillation/flutter, heart failure (n=458). ICD-9-CM codes for cardiovascular diseases (AMI, AF/flutter, HF) vs. Medical chart review (reference standard) was evaluated on Diagnostic accuracy (sensitivity, specificity, positive predictive value, negative predictive value) of ICD-9-CM codes (Sensitivity ≥95% and Specificity ≥90% across all three conditions). ICD-9-CM codes for acute myocardial infarction, atrial fibrillation/flutter, and heart failure demonstrated high diagnostic accuracy, with sensitivity ≥95% and specificity ≥90% for all three conditions.
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