title: Defining and validating comorbidities and procedures in ICD-10 health data in ST-elevation myocardial infarction patients.
abstract: Administrative health databases are used in research to define comorbid conditions, diagnosis, and procedures. Our objectives were to validate a diagnosis of ST-elevation myocardial infarction (STEMI) and invasive cardiac procedure coding against a comprehensive registry of STEMI patients and determine an optimal algorithm for defining comorbidities using administrative hospitalization and ambulatory databases, but without using a physician claims database, which is unavailable for use in many jurisdictions.A registry of consecutive STEMI patients was used to define a reference cohort and linked to the hospitalization and ambulatory databases. Four administrative case definitions for defining comorbidities, as well as STEMI diagnosis and in-hospital procedures using the International Classification of Diseases, 10th Revision (ICD-10) and the Canadian Classification of Health Interventions (CCI) were evaluated. Metrics were used to evaluate algorithm performance and compare discriminative ability using the C statistic.The 3236 patients had median age of 60 years (interquartile range 52-71) and 75.7% were male. A diagnosis of STEMI was correctly identified in the administrative records for 3043 (94.0%) patients. In-hospital procedures (coronary artery bypass grafting, percutaneous coronary intervention, and angiogram) were well identified using administrative definitions (Kappa statistic 0.83-1.00). Validation of comorbidities varied by condition but an algorithm using 2 inpatient/ambulatory visits in the previous 2 years maximized PPV, ranging from 28.6% for previous heart failure to 95.7% for previous MI. The c statistic was similar for each of the methods, ranging from 0.76 to 0.80.ICD-10 and CCI codes can identify hospitalized STEMI patients with high sensitivity and accurately define in-hospital cardiac procedures. Comorbidities can be defined with high PPV using a definition of 2 inpatient/ambulatory visits in the previous 2 years.
authors: University of Alberta, Edmonton Alberta Health Services Mazankowski Alberta Heart Institute University of Calgary, Calgary, Alberta, Canada.
authors: Erik
authors: E
authors: Youngson
authors: Robert C
authors: RC
authors: Welsh
authors: Padma
authors: P
authors: Kaul
authors: Finlay
authors: F
authors: McAlister
authors: Hude
authors: H
authors: Quan
authors: Jeffrey
authors: J
authors: Bakal
mesh_terms: D000368:Aged; D000465:Algorithms; D015897:Comorbidity; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016247:Information Storage and Retrieval; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology*; D012042:Registries; D015203:Reproducibility of Results