title: Use of Electronic Health Data to Estimate Heart Failure Events in a Population-Based Cohort with CKD.
abstract: Studies that use electronic health data typically identify heart failure (HF) events from hospitalizations with a principal diagnosis of HF. This approach may underestimate the total burden of HF among persons with CKD. We assessed the accuracy of algorithms for identifying validated HF events from hospitalizations and outpatient encounters, and we used this validation information to estimate the rate of HF events in a large CKD population.
  
  
  
  We identified a cohort of 15,141 adults age 18-89 years with an eGFR<60 ml/min per 1.73 m2from 2008 to 2011. Potential HF events during follow-up were randomly sampled for validation with medical record review. Positive predictive values from the validation study were used to estimate the rate of validated HF events in the full cohort.
  
  
  
  A total of 1864 participants had at least one health care encounter that qualified as a potential HF event during 2.7 years of mean follow-up. Among 313 potential events that were randomly sampled for validation, positive predictive values were 92% for hospitalizations with a principal diagnosis of HF, 32% for hospitalizations with a secondary diagnosis of HF, and 70% for qualifying outpatient HF encounters. Through use of this validation information in the full cohort, the rate of validated HF events estimated from the most comprehensive algorithm that included principal and secondary diagnosis hospitalizations and outpatient encounters was 35.2 events/1000 person-years (95% confidence interval, 33.1 to 37.4), compared with 9.5 events/1000 person-years (95% confidence interval, 8.7 to 10.5) from the algorithm that included only principal diagnosis hospitalizations. Outpatient encounters accounted for 20% of the total number of validated HF events.
  
  
  
  In studies that rely on electronic health data, algorithms that include hospitalizations with a secondary diagnosis of HF and outpatient HF encounters more fully capture the burden of HF, although validation of HF events may be necessary with this approach.
authors: Cardiovascular Health Research Unit.|Departments of Epidemiology.|Medicine, and.
authors: James S
authors: JS
authors: Floyd
authors: Group Health Research Institute, Seattle, Washington.
authors: Robert
authors: R
authors: Wellman
authors: Group Health Research Institute, Seattle, Washington.
authors: Sharon
authors: S
authors: Fuller
authors: Medicine, and.|Kidney Research Institute, University of Washington, Seattle, Washington; and.
authors: Nisha
authors: N
authors: Bansal
authors: Cardiovascular Health Research Unit.|Departments of Epidemiology.|Health Services, and.|Medicine, and.|Group Health Research Institute, Seattle, Washington.
authors: Bruce M
authors: BM
authors: Psaty
authors: Departments of Epidemiology.|Medicine, and.|Kidney Research Institute, University of Washington, Seattle, Washington; and.
authors: Ian H
authors: IH
authors: de Boer
authors: Departments of Epidemiology.|Group Health Research Institute, Seattle, Washington.
authors: Delia
authors: D
authors: Scholes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000553:Ambulatory Care / Q000706:statistics & numerical data; D015331:Cohort Studies; D057286:Electronic Health Records; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000503:physiopathology*; D014861:Washington / Q000453:epidemiology; D055815:Young Adult
keywords: EGFR protein, human; adult; algorithms; chronic kidney disease; electronic health records; epidemiology and outcomes; follow-up studies; heart failure; hospitalization; humans; medical records; outpatients; receptor, epidermal growth factor