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Hyun K, Redfern J, Briffa T, Chew D, French J, Brieger D. P4343Reconciling acute coronary syndrome diagnoses between linked administrative data and hospital medical records in medical research. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Administrative data incorporating the International Classification of Diseases 10th Revision (ICD-10) is commonly used in cardiac research. Using patient records, diagnoses are systematically coded by trained coders who have limited/no clinical experience. Therefore, it is important to understand how systematically coded cardiac diagnoses compare with clinically assessed diagnoses to better analyse and interpret studies that have used linked administrative data to adjudicate patient's diagnosis.
Purpose
To assess the agreement between the acute coronary syndrome (ACS) diagnoses according to linked data compared to those extracted from hospital medical records by clinicians participating in a national registry and determine the factors associated with diagnoses disagreement.
Methods
The rate of ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable angina (UA) obtained from the medical records, from admission to discharge, for the nationwide SNAPSHOT ACS audit in 2012 were compared to the corresponding ICD-10 Australian Modification (ICD-10-AM) codes using linked data from 6 jurisdictions covering all Australian states (6) and territories (2). The proportions of the overall agreement (OA), the positive agreement (PA) and the Cohen's weighted kappa and the 95% confidence interval (CI) were derived using both data sources for STEMI, NSTEMI and UA individually, where kappa≥0.8 confers strong agreement and 0.6≤kappa<0.8 moderate agreement. The factors associated with the diagnostic disagreement were explored using multilevel multivariable logistic regression model (backward selection method), accounting for the hospital clustering effect.
Results
Overall, 3130 patients had both medical records and linked data available for comparison. The degree of agreement was greatest for STEMI and lowest for UA (STEMI: OA=97%, PA=85%, kappa (95% CI)=0.84 (0.81, 0.87); NSTEMI: OA=91%, PA=81%, kappa (95% CI)=0.76 (0.73,0.79); UA: OA = 81%, PA=53%, kappa (95% CI)=0.41 (0.38, 0.45)). Further, the independent factors associated with the disagreement between the medical records and the linked data were the diagnosis of UA (UA vs. STEMI (odds ratio (95% CI)): 6.85 (4.12, 11.40)), not receiving revascularisation (2.27 (1.69, 3.03)), and the state where the ICD-10-AM was coded (p=0.007) (see Figure).
Figure 1
Conclusion
This study suggests that the agreement between the systematically coded diagnoses from linked administrative data and the diagnosis from the clinical assessment is greater in patients who received revascularisation and worse in those with UA. Also, the degree of agreement varies between states. As the linked data and the ICD codes are being used more often in research to support the evidence-based policies and practice, more attention is needed in testing and improving the accuracy of the ICD-10 codes as well as the ICD-11 codes that are soon to be introduced.
Acknowledgement/Funding
KH is funded by Heart Foundation Postdoctoral Fellowship. SNAPSHOT data linkage project was funded by the NSW Heart Foundation CVRN Project Grant
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Tiver K, Horsfall M, Swan A, De Pasquale C, Horsfall E, Chew D, De Pasquale C. Accuracy of Highly Limited Echocardiographic Screening Images for Diagnosis of Heart Disease; The Quick-Six Study. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Hyun K, Redfern J, Briffa T, Chew D, French J, Brieger D. Reconciling Acute Coronary Syndrome Diagnoses Between Linked Administrative Data and Hospital Medical Records in Medical Research. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Shivakumar S, Joseph M, Swan A, Chew D, Jones D, Hecker T, Sinhal A. Is the Improvement in Mitral Regurgitation Post TAVR an Acute Phenomenon? Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Redfern J, Hyun K, Brieger D, Chew D, French J, Hammett C, Ellis C, Astley C, Carr B, Lefkovits J, Nalliaih K, Lintern K, Briffa T. SNAPSHOT ACS Cohort Follow-Up – What Happens to Australian Patients in the 3 Years after Hospital Discharge: A National Data Linkage Study. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Etaher A, Gibbs O, Saad Y, Frost S, Nguyen T, Ferguson I, Juergens C, Chew D, French J. Type-II MI and Chronic Myocardial Injury Rates, Invasive Management and 4 Year Mortality Among Consecutive Patients Undergoing High Sensitivity Troponin T Testing in the Emergency Department. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Khan E, Chuang A, Halabi A, Tiver K, Horsfall M, Briffa T, Sun B, Cullen L, French J, Chew D. P2713Impact of routine implementation of high sensitivity troponin in a state-wide health service. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Dykes L, Dharmaprani D, McGavigan A, Chew D, Bidargaddi N, Ganesan A. Understanding Adaptive Trial Designs With an Application to a Mobile Health Intervention for Physical Health. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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King A, Gunton J, Perry R, Depasquale C, Chew D, Joseph M. Can Takotsubo Cardiomyopathy be Differentiated from Anterior Myocardial Infarction Using Echocardiography and Patient Demographic Features Without Coronary Angiogram? Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Perry R, Patil S, Horsfall M, Marx C, Chew D, Joseph M, Ganesan A, McGavigan A, Nucifora G, Selvanayagam J. Mechanical Dispersion and Global Longitudinal Strain Improve Risk Stratification of Malignant Ventricular Arrhythmias and Sudden Cardiac Death Over Ejection Fraction Alone. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Jones D, Lehman S, Chew D, Bennetts J, Selvanayagam J, Horsfall M, Chuang A, Sinhal A, Joseph M, Baker R. Effect of Expanded Aortic Stenosis Management Services on Outcomes. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.1020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Astley C, Chew D, Clark R, Keech W, Horsfall M, Tideman P, Tirimacco R, Beltrame J, Tavella R, Zeitz C, Arstall M, Nicholls S. Impact of Cardiac Rehabilitation on Late Clinical Outcomes: Non–Attenders Versus Attenders On Behalf of the South Australian Public Hospital Cardiac Rehabilitation Service Providers. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mella S, Shelton F, Chew D, Winterbottom J, Walijee H, Ishii H, Brown R, Chisholm E. Reducing Paediatric Post-Tonsillectomy Pain. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Chuang M, Halabi A, Horsfall M, Sinhal A, Depasquale C, Vaile J, Khan E, Jones D, Chew D. Invasive Management of Acute Coronary Syndrome: Interaction with Competing Risks. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kuhn L, Page K, Nedkoff L, Chew D, Ellis C, Cullen L, Hyun K, Farouque O, Redfern J, Astley C. A Gender-Based Comparison of Management, In-Hospital and Late Outcomes for Patients with Acute Coronary Syndrome in Australia and New Zealand: Results from the SNAPSHOT ACS Audit. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dalan R, Liew H, Goh L, Gao X, Chew D, Boehm B. The GG genotype of vitamin D metabolism-related gene DHCR7 rs12785878 is more prevalent in the Indians and associated with higher oxidative stress index in Singapore. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Alhammad N, Brieger D, Horsfall M, Hyun K, MacIsaac A, Juergens C, Amerena J, Rankin J, Halabi A, French J, Meredith I, Chew D. Are The Benefits of Invasive Management Associated with GRACE Predicted Risk Modified by Age and Renal Function? Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sanfilippo F, Horsfall M, Nedkoff L, Hickling S, Briffa T, Chew D. Continued Long-Term Risk of Death and Cardiovascular Events in Population Cohorts of MI From Two Australian States. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Koh Y, Tavella R, Worthley M, Zeitz C, Chew D, Arstall M, Beltrame J. Characterising the Use of Fractional Flow Reserve (FFR) a Valuation Among Patients Undergoing Elective Angiography for Stable Angina: Insights From the CADOSA Registry. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pasupathy S, Tavella R, Potamianos R, Arstall M, Chew D, Worthley M, Zeitz C, Beltrame J. Diagnostic Utility of Cardiac Magnetic Resonance Imaging (CMR) in Myocardial Infarction with Non Obstructive Coronary Arteries (MINOCA) Patients. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gunton J, Jones J, Nandal S, Alhammad N, Hartshorne T, Jones D, O'Shea C, Chew D, Marwick T, De Pasquale C. Evaluation of the “Door-Bell Test”, a Test of Frailty and HF Cardiorespiratory Status on Heart Failure Hospital Discharge, and its Relationship to Future Events. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Halliday L, Tavella R, Arstall M, Chew D, Worthley M, Zeitz C, Beltrame J. Stroke in Patients Undergoing Coronary Angiography and Percutaneous Coronary Intervention: Insights From the CADOSA Registry. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Eng-Frost J, Tavella R, Arstall M, Worthley M, Chew D, Zeitz C, Beltrame J. Determinants of Obstructive Coronary Artery Disease in Patients Undergoing Elective Coronary Angiography. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chuang M, MacIssac A, Lefkovits J, Harper R, Slawomirski L, Horsfall M, Buchan H, Ellis C, Brieger D, Briffa T, Chew D. Variation in Coronary Angiography Across Australia: Exploring the Correlations with Sociodemographic-Health Service and Disease Burden Indices. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Halabi A, Chew D, Horsfall M, Huyn K, MacIsaac A, Juergens C, Amerena J, Rankin J, Brieger D. Insights Into the Use of Interventional Management in Acute Coronary Syndromes in Australia Over the Last 15 years. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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