通过不列颠哥伦比亚省加拿大初级保健监测网络识别慢性阻塞性肺疾病患者中的心力衰竭：病例推导研究。
Identifying heart failure in patients with chronic obstructive lung disease through the Canadian Primary Care Sentinel Surveillance Network in British Columbia: a case derivation study.
机构信息
School of Population and Public Health (Vijh), Centre for Health Services and Policy Research (Wong, Peterson, Ezzat, Gibb) and School of Nursing (Wong, Ezzat), University of British Columbia, Vancouver, BC; Primary Care Research Unit (Grandy) and Department of Family Medicine (Grandy), Dalhousie University, Halifax, NS; Division of Cardiology (Hawkins), University of British Columbia, Vancouver, BC.
School of Population and Public Health (Vijh), Centre for Health Services and Policy Research (Wong, Peterson, Ezzat, Gibb) and School of Nursing (Wong, Ezzat), University of British Columbia, Vancouver, BC; Primary Care Research Unit (Grandy) and Department of Family Medicine (Grandy), Dalhousie University, Halifax, NS; Division of Cardiology (Hawkins), University of British Columbia, Vancouver, BC
出版信息
CMAJ Open. 2021 Apr 16;9(2):E376-E383. doi: 10.9778/cmajo.20200183. Print 2021 Apr-Jun.
BACKGROUND
Heart failure (HF) poses a substantial global health burden, particularly in patients with chronic obstructive pulmonary disease (COPD). The objective of this study was to validate an electronic medical record-based definition of HF in patients with COPD in primary care practices in the province of British Columbia, Canada.
METHODS
We conducted a cross-sectional retrospective chart review from Sept. 1, 2018, to Dec. 31, 2018, for a cohort of patients from primary care practices in BC whose physicians were recruited through the BC node of the Canadian Primary Care Sentinel Surveillance Network. Heart failure case definitions were developed by combining diagnostic codes, medication information and laboratory values available in primary care electronic medical records. These were compared with HF diagnoses identified through detailed chart review as the gold standard. Sensitivity, specificity, negative (NPV) and positive predictive values (PPV) were calculated for each definition.
RESULTS
Charts of 311 patients with COPD were reviewed, of whom 72 (23.2%) had HF. Five categories of definitions were constructed, all of which had appropriate sensitivity, specificity and NPV. The optimal case definition consisted of 1 HF billing code or a specific combination of medications for HF. This definition had an excellent specificity (93.3%, 95% confidence interval [CI] 89.4%-96.1%), sensitivity (90.3%, 95% CI 81.0%-96.0%), PPV (80.2%, 95% CI 69.9%-88.3%) and NPV (97.0%, 95% CI 93.8%-98.8%).
INTERPRETATION
This comprehensive case definition improves upon previous primary care HF definitions to include medication codes and laboratory data, along with previously used billing codes. A case definition for HF was derived and validated and can be used with data from electronic medical records to identify HF in patients with COPD in primary care accurately.
背景
心力衰竭（HF）在慢性阻塞性肺疾病（COPD）患者中造成了巨大的全球健康负担。本研究的目的是在加拿大不列颠哥伦比亚省的初级保健实践中验证一种基于电子病历的 COPD 患者 HF 定义。
方法
我们进行了一项横断面回顾性图表审查，从 2018 年 9 月 1 日至 2018 年 12 月 31 日，纳入不列颠哥伦比亚省初级保健实践的患者队列，其医生通过加拿大初级保健监测网络的不列颠哥伦比亚节点招募。HF 病例定义是通过结合初级保健电子病历中可用的诊断代码、药物信息和实验室值来制定的。这些定义与通过详细图表审查确定的 HF 诊断作为金标准进行了比较。计算了每种定义的敏感性、特异性、阴性预测值（NPV）和阳性预测值（PPV）。
结果
共审查了 311 例 COPD 患者的图表，其中 72 例（23.2%）患有 HF。构建了五类定义，所有定义均具有适当的敏感性、特异性和 NPV。最佳病例定义包括 1 个 HF 计费代码或特定的 HF 药物组合。该定义具有极好的特异性（93.3%，95%置信区间 [CI] 89.4%-96.1%）、敏感性（90.3%，95% CI 81.0%-96.0%）、PPV（80.2%，95% CI 69.9%-88.3%）和 NPV（97.0%，95% CI 93.8%-98.8%）。
解释
这种综合病例定义改进了以前的初级保健 HF 定义，包括药物代码和实验室数据，以及以前使用的计费代码。已经得出并验证了 HF 的病例定义，并且可以使用电子病历中的数据准确识别初级保健中的 COPD 患者的 HF。
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