Leon H. Charney Division of Cardiology Department of Medicine New York University School of Medicine New York NY.
Department of Population Health New York University School of Medicine New York NY.
J Am Heart Assoc. 2019 Aug 6;8(15):e012811. doi: 10.1161/JAHA.119.012811. Epub 2019 Jul 31.
Background Canadian Cardiovascular Society (CCS) angina severity classification is associated with mortality, myocardial infarction, and coronary revascularization in clinical trial and registry data. The objective of this study was to determine associations between CCS class and all-cause mortality and healthcare utilization, using natural language processing to extract CCS classifications from clinical notes. Methods and Results In this retrospective cohort study of veterans in the United States with stable angina from January 1, 2006, to December 31, 2013, natural language processing extracted CCS classifications. Veterans with a prior diagnosis of coronary artery disease were excluded. Outcomes included all-cause mortality (primary), all-cause and cardiovascular-specific hospitalizations, coronary revascularization, and 1-year healthcare costs. Of 299 577 veterans identified, 14 216 (4.7%) had ≥1 CCS classification extracted by natural language processing. The mean age was 66.6±9.8 years, 99% of participants were male, and 81% were white. During a median follow-up of 3.4 years, all-cause mortality rates were 4.58, 4.60, 6.22, and 6.83 per 100 person-years for CCS classes I, II, III, and IV, respectively. Multivariable adjusted hazard ratios for all-cause mortality comparing CCS II, III, and IV with those in class I were 1.05 (95% CI, 0.95-1.15), 1.33 (95% CI, 1.20-1.47), and 1.48 (95% CI, 1.25-1.76), respectively. The multivariable hazard ratio comparing CCS IV with CCS I was 1.20 (95% CI, 1.09-1.33) for all-cause hospitalization, 1.25 (95% CI, 0.96-1.64) for acute coronary syndrome hospitalizations, 1.00 (95% CI, 0.80-1.26) for heart failure hospitalizations, 1.05 (95% CI, 0.88-1.25) for atrial fibrillation hospitalizations, 1.92 (95% CI, 1.40-2.64) for percutaneous coronary intervention, and 2.51 (95% CI, 1.99-3.16) for coronary artery bypass grafting surgery. Conclusions Natural language processing-extracted CCS classification was positively associated with all-cause mortality and healthcare utilization, demonstrating the prognostic importance of anginal symptom assessment and documentation.
加拿大心血管学会（CCS）心绞痛严重程度分类与临床试验和注册数据中的死亡率、心肌梗死和冠状动脉血运重建有关。本研究的目的是使用自然语言处理从临床记录中提取 CCS 分类，以确定 CCS 分级与全因死亡率和医疗保健利用之间的关系。
这是一项在美国退伍军人稳定型心绞痛的回顾性队列研究，纳入 2006 年 1 月 1 日至 2013 年 12 月 31 日的患者，使用自然语言处理提取 CCS 分类。排除有冠状动脉疾病既往诊断的退伍军人。主要结局包括全因死亡率（首要结局）、全因和心血管特定的住院治疗、冠状动脉血运重建和 1 年医疗保健费用。在确定的 299577 例退伍军人中，有 14216 例（4.7%）通过自然语言处理提取了≥1 个 CCS 分类。平均年龄为 66.6±9.8 岁，99%的参与者为男性，81%为白人。在中位随访 3.4 年期间，CCS 分级 I、II、III 和 IV 的全因死亡率分别为每 100 人年 4.58、4.60、6.22 和 6.83。多变量校正的全因死亡率风险比比较 CCS II、III 和 IV 与 CCS I 分别为 1.05（95%CI，0.95-1.15）、1.33（95%CI，1.20-1.47）和 1.48（95%CI，1.25-1.76）。CCS IV 与 CCS I 相比，全因住院治疗的多变量风险比为 1.20（95%CI，1.09-1.33），急性冠状动脉综合征住院治疗为 1.25（95%CI，0.96-1.64），心力衰竭住院治疗为 1.00（95%CI，0.80-1.26），心房颤动住院治疗为 1.05（95%CI，0.88-1.25），经皮冠状动脉介入治疗为 1.92（95%CI，1.40-2.64），冠状动脉旁路移植术为 2.51（95%CI，1.99-3.16）。
自然语言处理提取的 CCS 分级与全因死亡率和医疗保健利用呈正相关，这表明对心绞痛症状评估和记录具有预后意义。
