国际疾病分类（ICD）-10诊断编码在全国医疗保险样本中用于识别急性心力衰竭住院以及射血分数降低与保留的心力衰竭的有效性。

Validity of International Classification of Diseases (ICD)-10 Diagnosis Codes for Identification of Acute Heart Failure Hospitalization and Heart Failure with Reduced Versus Preserved Ejection Fraction in a National Medicare Sample.

作者信息

Bates Benjamin A, Akhabue Ehimare, Nahass Meghan M, Mukherjee Abhigyan, Hiltner Emily, Rock Joanna, Wilton Brandon, Mittal Garima, Visaria Aayush, Rua Melanie, Gandhi Poonam, Dave Chintan V, Setoguchi Soko

机构信息

Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ (B.A.B., M.R., P.G., C.V.D., S.S.).

Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (B.A.B., E.A., M.M.N., A.M., E.H., J.R., B.W., A.V., S.S.).

出版信息

Circ Cardiovasc Qual Outcomes. 2023 Feb;16(2):e009078. doi: 10.1161/CIRCOUTCOMES.122.009078. Epub 2023 Jan 23.

DOI:10.1161/CIRCOUTCOMES.122.009078

PMID:36688301

Abstract

BACKGROUND

Heart failure (HF) is a leading cause of hospitalization in older adults. Medicare data have been used to assess HF outcomes. However, the validity of ICD-10 diagnosis codes (used since 2015) to identify acute HF hospitalization or distinguish reduced (heart failure with reduced ejection fraction) versus preserved ejection fraction (HFpEF) is unknown in Medicare data.

METHODS

Using Medicare data (2015-2017), we randomly sampled 200 HF hospitalizations with ICD-10 diagnosis codes for HF in the first/second claim position in a 1:1:2 ratio for systolic HF (I50.2), diastolic HF (I50.3), and other HF (I50.X). The primary gold standards included recorded HF diagnosis by a treating physician for HF hospitalization, ejection fraction (EF)≤50 for heart failure with reduced ejection fraction, and EF>50 for HFpEF. If the quantitative EF was not present, then qualitative descriptions of EF were used for heart failure with reduced ejection fraction/HFpEF gold standards. Multiple secondary gold standards were also tested. Gold standard data were extracted from medical records using standardized forms and adjudicated by cardiology fellows/staff. We calculated positive predictive values with 95% CIs.

RESULTS

The 200-chart validation sample included 50 systolic, 50 diastolic, 47 combined dysfunction, and 53 unspecified HF patients. The positive predictive values of acute HF hospitalization was 98% [95% CI, 95-100] for first-position ICD-10 HF diagnosis and 66% [95% CI, 58-74] for first/second-position diagnosis. Quantitative EF was available for ≥80% of patients with systolic, diastolic, or combined dysfunction ICD-10 codes. The positive predictive value of systolic HF codes was 90% [95% CI, 82-98] for EFs≤50% and 72% [95% CI, 60-85] for EFs≤40%. The positive predictive value was 92% [95% CI, 85-100] for HFpEF for EFs>50%. The ICD-10 codes for combined or unspecified HF poorly predicted heart failure with reduced ejection fraction or HFpEF.

CONCLUSIONS

ICD-10 principal diagnosis identified acute HF hospitalization with a high positive predictive value. Systolic and diastolic ICD-10 diagnoses reliably identified heart failure with reduced ejection fraction and HFpEF when EF 50% was used as the cutoff.

摘要

背景

心力衰竭（HF）是老年人住院治疗的主要原因。医疗保险数据已被用于评估HF的治疗结果。然而，在医疗保险数据中，自2015年起使用的国际疾病分类第十版（ICD-10）诊断代码用于识别急性HF住院或区分射血分数降低（射血分数降低的心力衰竭）与射血分数保留（HFpEF）的有效性尚不清楚。

方法

利用医疗保险数据（2015 - 2017年），我们以1:1:2的比例随机抽取了200例因ICD-10诊断代码在首次/第二次索赔位置被诊断为HF的住院患者，分别对应收缩性HF（I50.2）、舒张性HF（I50.3）和其他HF（I50.X）。主要金标准包括主治医生记录的HF住院诊断、射血分数降低的心力衰竭患者射血分数（EF）≤50，HFpEF患者EF>50。如果没有定量EF，则使用EF的定性描述作为射血分数降低的心力衰竭/HFpEF金标准。还测试了多个次要金标准。金标准数据通过标准化表格从病历中提取，并由心脏病学住院医师/工作人员进行判定。我们计算了95%置信区间的阳性预测值。

结果

200份病历验证样本包括50例收缩性HF、50例舒张性HF、47例合并功能障碍和53例未明确的HF患者。首次位置ICD-10 HF诊断的急性HF住院阳性预测值为98% [95%置信区间，95 - 100]，首次/第二次位置诊断的阳性预测值为66% [95%置信区间，58 - 74]。对于收缩性、舒张性或合并功能障碍ICD-10编码的患者，≥80%可获得定量EF。射血分数≤50%时，收缩性HF编码的阳性预测值为90% [95%置信区间，82 - 98]，射血分数≤40%时为72% [95%置信区间，60 - 85]。射血分数>50%时，HFpEF的阳性预测值为92% [95%置信区间，85 - 100]。合并或未明确的HF的ICD-10编码对射血分数降低的心力衰竭或HFpEF的预测效果较差。