title: Predictors of self-report of heart failure in a population-based survey of older adults.
abstract: BACKGROUND
  Little research has been conducted on the predictors of self-report or patient awareness of heart failure (HF) in a population-based survey. The objective of this study was to (1) test the agreement between Medicare administrative and Health and Retirement Study (HRS) survey data and (2) determine predictors associated with self-report of HF, using a validated Medicare claims algorithm as the reference standard. We hypothesized that those who self-reported HF were more likely to have a higher number of HF-related claims.
  
  
  RESULTS
  Secondary data analysis was conducted using the 2004 wave of the HRS linked to 2002 to 2004 Medicare claims (n=5573 respondents aged ≥ 67 years). Concordance between self-report of HF in the HRS and Medicare claims was calculated. Logistic regression was performed to identify predictors associated with self-report HF. HF prevalence by self-report was 4.6%. Self-report of HF and claims agreement was 87% (κ=0.34). The presence of >1 HF inpatient claims was associated with greater odds of self-report (odds ratio [OR], 1.92; 95% CI, 1.23-3.00). Greater odds of self-reporting HF was also associated with ≥ 4 HF claims (OR, 2.74; 95% CI, 1.36-5.52). Blacks (OR, 0.28; 95% CI, 0.14-0.55) and Hispanics (OR, 0.30; 95% CI, 0.11-0.83) were less likely to self-report HF compared with whites in the final model.
  
  
  CONCLUSIONS
  Self-report of HF is an insensitive method for accurately identifying HF cases, especially in those with less-severe disease and who are nonwhite. There may be limited awareness of HF among older minority patients despite having clinical encounters during which HF is coded as a diagnosis.
authors.affiliation: Division of Geriatric Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109-2007, USA. tanruff@umich.edu
authors.forename: Tanya R
authors.initials: TR
authors.lastname: Gure
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: McCammon
authors.forename: Christine T
authors.initials: CT
authors.lastname: Cigolle
authors.forename: Todd M
authors.initials: TM
authors.lastname: Koelling
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Blaum
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Langa
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001364:Awareness; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D006306:Health Surveys; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D006801:Humans; D007345:Insurance Claim Review; D016015:Logistic Models; D008297:Male; D006278:Medicare; D016017:Odds Ratio; D010361:Patients / Q000523:psychology*; D011237:Predictive Value of Tests; D057566:Self Report; D012959:Socioeconomic Factors; D014481:United States