Comparison of self-reported and Medicare claims-identified acute myocardial infarction.
BACKGROUND
Cardiovascular disease is often studied through patient self-report and administrative data. However, these 2 sources provide different information, and few studies have compared them.


RESULTS
We compared data from a longitudinal, nationally representative survey of older Americans with matched Medicare claims. Self-reported heart attack in the previous 2 years was compared with claims-identified acute myocardial infarction (AMI) and acute coronary syndrome. Among the 3.1% of respondents with self-reported heart attack, 32.8% had claims-identified AMI, 16.5% had non-AMI acute coronary syndrome, and 25.8% had other cardiac claims; 17.3% had no inpatient visits in the previous 2.5 years. Claims-identified AMIs were found in 1.4% of respondents; of these, 67.8% reported a heart attack. Self-reports were less likely among respondents >75 years of age (62.7% versus 74.6%; P=0.006), with less than high school education (61.6% versus 71.4%; P=0.015), with at least 1 limitation in activities of daily living (59.6% versus 74.7%; P=0.001), or below the 25th percentile of a word recall memory test (60.7% versus 71.3%; P=0.019). Both self-reported and claims-identified cardiac events were associated with increased mortality; the highest mortality was observed among those with claims-identified AMI who did not self-report (odds ratio, 2.8; 95% confidence interval, 1.5-5.1) and among those with self-reported heart attack and claims-identified AMI (odds ratio, 2.5; 95% confidence interval, 1.7-3.6) or non-AMI acute coronary syndrome (odds ratio, 2.7; 95% confidence interval, 1.8-4.1).


CONCLUSIONS
There is considerable disagreement between self-reported and claims-identified events. Although self-reported heart attack may be inaccurate, it indicates increased risk of death, regardless of whether the self-report is confirmed by Medicare claims.
From Harvard Center for Population and Development Studies (L.C.Y., L.F.B.) and John F. Kennedy School of Government (A.C.), Harvard University, Cambridge, MA. yasaitis@hsph.harvard.edu.
Laura C
LC
Yasaitis
From Harvard Center for Population and Development Studies (L.C.Y., L.F.B.) and John F. Kennedy School of Government (A.C.), Harvard University, Cambridge, MA.
Lisa F
LF
Berkman
From Harvard Center for Population and Development Studies (L.C.Y., L.F.B.) and John F. Kennedy School of Government (A.C.), Harvard University, Cambridge, MA.
Amitabh
A
Chandra
D000203:Activities of Daily Living; D054058:Acute Coronary Syndrome / Q000453:epidemiology; D000368:Aged; D004522:Educational Status; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D008569:Memory Disorders / Q000453:epidemiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D015203:Reproducibility of Results; D057566:Self Report; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology
Medicare; acute coronary syndrome; myocardial infarction; patient outcome assessment; survival analysis