Department of Medicine, Cardiovascular Division (J.B.S., J.S.-C., R.K.W., R.W.Y.), Beth Israel Deaconess Medical Center, Boston, MA.
Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology (J.B.S., J.X., T.S., Y.S., J.S.-C., Z.I.A., R.K.W., R.W.Y.), Beth Israel Deaconess Medical Center, Boston, MA.
Circ Cardiovasc Qual Outcomes. 2022 Oct;15(10):e009162. doi: 10.1161/CIRCOUTCOMES.122.009162. Epub 2022 Aug 27.
Administrative claims for aortic stenosis (AS) regurgitation may be useful, but their accuracy and ability to identify individuals at risk for valve-related outcomes have not been well characterized.
Using echocardiographic (transthoracic echocardiogram [TTE]) reports linked to US Medicare claims, 2017 to 2018, the performance of candidate claims to ascertain AS/aortic regurgitation was evaluated. The optimal performing algorithm was tested against outcomes at 1-year after TTE in a separate 100% sample of US Medicare claims, 2017 to 2019.
Of those included in the derivation (N=5497, mean age 74.4±11.0 years, 49.7% female), any AS or aortic regurgitation was present in 24% and 38.8%, respectively. The sensitivity and specificity of code I35.0 for identification of any AS was 53.1% and 94.8%, respectively. Among those with an I35.0 code, 40.3% had severe AS. Claims were unable to distinguish disease severity (ie, severe versus nonsevere) or subtype (eg, bicuspid or rheumatic AS), and were insensitive and nonspecific for aortic regurgitation of any severity. Among all beneficiaries who received a TTE (N=4 033 844), adjusting for age, sex, and 27 comorbidities, those with an I35.0 code had a higher adjusted risk of all-cause mortality (adjusted hazard ratio, 1.33 [95% CI, 1.31-1.34]), heart failure hospitalization (adjusted hazard ratio, 1.37 [95% CI, 1.34-1.41]), and aortic valve replacement (adjusted hazard ratio, 34.96 [95% CI, 33.74-36.22]).
Among US Medicare beneficiaries receiving a TTE, claims, though identifying a population at significant greater risk of valve-related outcomes, failed to identify nearly half of individuals with AS and were unable to distinguish disease severity or subtype. These results argue against the widespread use of claims to screen for patients with AS and suggests the need for improved coding algorithms and alternative systems to extract TTE data for quality improvement and hospital benchmarking.
主动脉瓣狭窄（AS）反流的行政索赔可能是有用的，但它们识别与瓣膜相关结局风险的准确性和能力尚未得到很好的描述。
使用与美国医疗保险索赔相关联的超声心动图（经胸超声心动图[TTE]）报告，对 2017 年至 2018 年期间候选索赔确定 AS/主动脉瓣反流的性能进行评估。在 2017 年至 2019 年期间的美国医疗保险索赔中，对另一 100%样本的 TTE 后 1 年的结果进行了最佳表现算法的测试。
在纳入的推导人群中（N=5497 例，平均年龄 74.4±11.0 岁，49.7%为女性），分别有 24%和 38.8%存在任何 AS 或主动脉瓣反流。代码 I35.0 识别任何 AS 的敏感性和特异性分别为 53.1%和 94.8%。在有 I35.0 代码的患者中，40.3%患有严重 AS。索赔无法区分疾病严重程度（即严重与非严重）或亚型（例如，二叶式或风湿性 AS），并且对任何严重程度的主动脉瓣反流均不敏感且特异性低。在所有接受 TTE 的受益人中（N=4033844），调整年龄、性别和 27 种合并症后，I35.0 代码的患者全因死亡率（调整后的危险比，1.33[95%CI，1.31-1.34]）、心力衰竭住院率（调整后的危险比，1.37[95%CI，1.34-1.41]）和主动脉瓣置换术（调整后的危险比，34.96[95%CI，33.74-36.22]）的调整风险更高。
在美国接受 TTE 的医疗保险受益人中，尽管索赔确定了一个与瓣膜相关结局风险显著增加的人群，但仍未能识别近一半的 AS 患者，并且无法区分疾病严重程度或亚型。这些结果反对广泛使用索赔来筛查 AS 患者，并表明需要改进编码算法和替代系统来提取 TTE 数据，以进行质量改进和医院基准测试。
