Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minn.
Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minn; Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis.
Am J Med. 2016 Feb;129(2):223-5. doi: 10.1016/j.amjmed.2015.10.003. Epub 2015 Oct 28.
Administrative data are widely used in observational assessment of patient-centered clinical outcomes. In studies of cardiovascular outcomes, claims data are limited by lack of quantitative information, such as left ventricular ejection fraction. We aimed to determine whether left ventricular ejection fraction can be assessed from heart failure claims.
This observational, retrospective study used administrative and echocardiographic databases to identify heart failure patients (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 428.XX) who received echocardiograms. The study cohort included patients with at least one inpatient or outpatient claim for systolic (428.2X) or diastolic (428.3X) heart failure from January 1, 2007, through July 10, 2013, who received an echocardiogram within 30 days of the claim. Receiver operating characteristic (ROC) curves were used to determine the optimal left ventricular ejection fraction cut-off threshold between ICD-9-CM heart failure codes 428.2 (systolic) and 428.3 (diastolic). Bootstrapping was used to determine a 95% confidence interval for the best cut-off.
A total of 2714 echocardiograms with ascertainable left ventricular ejection fraction were performed within 30 days of a heart failure diagnosis. ICD-9-CM codes 428.2 and 428.3 accounted for 28.9% and 18.2%, respectively, of all heart failure codes. The resulting ROC curve had a best threshold cut-off for ejection fractions of 43.5% (confidence interval 39.5%-44.5%). The area under the curve was 0.812, with positive predictive value 0.72 and negative predictive value 0.81.
Subject to study limitations, we conclude that assessing left ventricular ejection fraction using heart failure claims is possible.
行政数据在评估以患者为中心的临床结局的观察性研究中被广泛应用。在心血管结局研究中，由于缺乏左心室射血分数等定量信息，理赔数据存在局限性。我们旨在确定能否从心力衰竭理赔中评估左心室射血分数。
本观察性、回顾性研究使用行政和超声心动图数据库，确定了接受超声心动图检查的心力衰竭患者（国际疾病分类，第九版临床修订版[ICD-9-CM]代码 428.XX）。研究队列包括 2007 年 1 月 1 日至 2013 年 7 月 10 日期间至少有一次因收缩性（428.2X）或舒张性（428.3X）心力衰竭的住院或门诊理赔，并在理赔后 30 天内接受超声心动图检查的患者。受试者工作特征（ROC）曲线用于确定 ICD-9-CM 心力衰竭代码 428.2（收缩性）和 428.3（舒张性）之间左心室射血分数的最佳截断阈值。采用自举法确定最佳截断值的 95%置信区间。
共进行了 2714 次超声心动图检查，在心力衰竭诊断后 30 天内可确定左心室射血分数。ICD-9-CM 代码 428.2 和 428.3 分别占所有心力衰竭代码的 28.9%和 18.2%。由此产生的 ROC 曲线具有 43.5%（置信区间 39.5%-44.5%）的最佳截断阈值。曲线下面积为 0.812，阳性预测值为 0.72，阴性预测值为 0.81。
受研究限制，我们的结论是，使用心力衰竭理赔评估左心室射血分数是可行的。
