title: Identification of Heart Failure Events in Medicare Claims: The Atherosclerosis Risk in Communities (ARIC) Study.
abstract: BACKGROUND
  We examined the accuracy of Medicare heart failure (HF) diagnostic codes in the identification of acute decompensated (ADHF and chronic stable (CSHF) HF.
  
  
  RESULTS
  Hospitalizations were identified from medical discharge records for Atherosclerosis Risk in Communities (ARIC) study participants with linked Medicare Provider Analysis and Review (MedPAR) files for the years 2005-2009. The ARIC study classification of ADHF and CSHF, based on adjudicated review of medical records, was considered to be the criterion standard. A total 8,239 ARIC medical records and MedPAR records meeting fee-for-service (FFS) criteria matched on unique participant ID and date of discharge (68.5% match). Agreement between HF diagnostic codes from the 2 data sources found in the matched records for codes in any position (κ > 0.9) was attenuated for primary diagnostic codes (κ < 0.8). Sensitivity of HF diagnostic codes found in Medicare claims in the identification of ADHF and CSHF was low, especially for the primary diagnostic codes.
  
  
  CONCLUSIONS
  Matching of hospitalizations from Medicare claims with those obtained from abstracted medical records is incomplete, even for hospitalizations meeting FFS criteria. Within matched records, HF diagnostic codes from Medicare show excellent agreement with HF diagnostic codes obtained from medical record abstraction. The Medicare data may, however, overestimate the occurrence of hospitalized ADHF or CSHF.
authors.affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina. Electronic address: anna_newton@unc.edu.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Kucharska-Newton
authors.affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Heiss
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Hanyu
authors.initials: H
authors.lastname: Ni
authors.affiliation: Department of Health Policy and Management, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Sally C
authors.initials: SC
authors.lastname: Stearns
authors.affiliation: Division of Public Health Sciences, Wake Forest University, Winston-Salem, North Carolina.
authors.forename: Nicole
authors.initials: N
authors.lastname: Puccinelli-Ortega
authors.affiliation: Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Wruck
authors.affiliation: Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Lloyd
authors.initials: L
authors.lastname: Chambless
mesh_terms: D000208:Acute Disease; D000067575:Administrative Claims, Healthcare; D000368:Aged; D050197:Atherosclerosis / Q000453:epidemiology*; D002908:Chronic Disease; D059019:Clinical Coding; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D011446:Prospective Studies; D012111:Residence Characteristics; D014481:United States / Q000453:epidemiology
keywords: Heart failure; Medicare claims; diagnostic codes; validation