Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
Pharmacoepidemiol Drug Saf. 2020 Apr;29(4):409-418. doi: 10.1002/pds.4973. Epub 2020 Feb 17.
The CHA DS -VaSc and HAS-BLED risk scores are commonly used in the studies of oral anticoagulants (OACs). The best ways to map these scores to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes is unclear, as is how they perform in various types of OAC users. We aimed to assess the distributions of CHA DS -VaSc and HAS-BLED scores and C-statistics for outcome prediction in the ICD-10-CM era using different mapping strategies.
We compared the distributions of CHA DS -VaSc and HAS-BLED scores from various mapping strategies in atrial fibrillation patients before, during, and after ICD-10-CM transition. We estimated the C-statistics predicting the 90-day risk of hospitalized stroke (for CHA DS -VaSc) or hospitalized bleeding (for HAS-BLED) in patients identified at least 6 months after the ICD-10-CM transition, overall and by anticoagulant type.
Forward-backward mapping produced higher CHA DS -VaSc and HAS-BLED scores in the ICD-10-CM era compared to the ICD-9-CM era: the mean difference was 0.074 (95% confidence interval 0.064-0.085) for CHA DS -VaSc and 0.055 (0.048-0.062) for HAS-BLED. Both scores had higher C-statistics in patients taking no OACs (0.697 [0.677-0.717] for CHA DS -VaSc; 0.719 [0.702-0.737] for HAS-BLED) or direct OACs (0.695 [0.654-0.735] for CHA DS -VaSc; 0.700 [0.673-0.728] for HAS-BLED) than those taking warfarin (0.655 [0.613-0.697] for CHA DS -VaSc; 0.663 [0.6320.695] for HAS-BLED).
Existing mapping strategies generally preserved the distributions of CHA DS -VaSc and HAS-BLED scores after ICD-10-CM transition. Both scores performed better in patients on no OACs or direct OACs than patients on warfarin.
CHA2DS2-VASc 和 HAS-BLED 风险评分常用于口服抗凝剂（OACs）的研究。将这些评分映射到国际疾病分类，第十版，临床修正版（ICD-10-CM）代码的最佳方法尚不清楚，它们在不同类型的 OAC 用户中的表现也不清楚。我们旨在评估在 ICD-10-CM 时代使用不同映射策略时 CHA2DS2-VASc 和 HAS-BLED 评分的分布以及对结局预测的 C 统计量。
我们比较了在 ICD-10-CM 转换前后，不同映射策略下心房颤动患者的 CHA2DS2-VASc 和 HAS-BLED 评分分布。我们估计了在 ICD-10-CM 转换至少 6 个月后识别的患者中，90 天住院卒中（CHA2DS2-VASc）或住院出血（HAS-BLED）风险的 C 统计量，总体和按抗凝类型。
向前向后映射在 ICD-10-CM 时代产生了比 ICD-9-CM 时代更高的 CHA2DS2-VASc 和 HAS-BLED 评分：CHA2DS2-VASc 的平均差异为 0.074（95%置信区间 0.064-0.085），HAS-BLED 为 0.055（0.048-0.062）。在未服用任何 OACs（CHA2DS2-VASc 为 0.697 [0.677-0.717]；HAS-BLED 为 0.719 [0.702-0.737]）或直接 OACs（CHA2DS2-VASc 为 0.695 [0.654-0.735]；HAS-BLED 为 0.700 [0.673-0.728]）的患者中，这两个评分的 C 统计量均高于服用华法林的患者（CHA2DS2-VASc 为 0.655 [0.613-0.697]；HAS-BLED 为 0.663 [0.6320.695]）。
现有的映射策略通常在 ICD-10-CM 转换后保留了 CHA2DS2-VASc 和 HAS-BLED 评分的分布。与服用华法林的患者相比，在未服用 OACs 或直接 OACs 的患者中，这两个评分的表现都更好。
