• JACC. Heart failure · May 2015

    Multicenter Study

    Assessing the use of international classification of diseases-10th revision codes from the emergency department for the identification of acute heart failure.

    • Natalia Frolova, Jeffrey A Bakal, Finlay A McAlister, Brian H Rowe, Hude Quan, Padma Kaul, and Justin A Ezekowitz.
    • Department of Medicine, University of Alberta, Alberta, Canada.
    • JACC Heart Fail. 2015 May 1; 3 (5): 386-391.

    ObjectivesThe objective of this study was to compare administrative codes with chart review for patients with acute heart failure (AHF).BackgroundAdministrative databases are used in population health research; however, the validity of codes in the emergency department (ED) for AHF compared with chart review is uncertain.MethodsA cohort of 952 patients with suspected AHF were prospectively recruited from 4 EDs in Edmonton, Alberta, Canada, from 2009 to 2012. Patients had their diagnoses adjudicated by expert physicians using a standardized scoring system and detailed chart review. ED and hospital discharge International Classification of Diseases-10th Revision (ICD-10) codes were captured in the main diagnosis or in any diagnostic field.ResultsThe 897 patients had a median age of 77 years (interquartile range: 67 to 85 years), and 806 (90%) were admitted to the hospital. Overall, 809 patients (90.2%) had AHF by adjudication and 660 (73.6%) had ICD-10 code I50.x as a main diagnosis in the ED administrative data, respectively. The positive predictive value of an AHF main diagnosis in the ED administrative data was 93.3% (95% confidence interval [CI]: 92.0% to 94.7%), with sensitivity of 76.1% (95% CI: 75.0% to 77.2%) and specificity of 50.0% (95% CI: 39.8% to 60.1%). The positive predictive value for AHF in any diagnostic field of the ED administrative data was 92.0% (95% CI: 91.1% to 93.0%), with a sensitivity of 89.4% (95% CI: 88.5% to 90.4%) and specificity of 28.4% (95% CI: 20.1% to 37.9%).ConclusionsAn ICD-10 I50.x diagnosis in the ED is highly predictive of AHF compared with chart-level adjudication using a validated score. Thus, the use of these codes in ED administrative databases could identify AHF for clinical and epidemiological studies.Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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