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Published on: December 28, 2012

Diagnostic codes for sudden cardiac death and ventricular arrhythmia functioned poorly to identify outpatient events

Sean Hennessy1, Charles E Leonard, Cristin M Palumbo

  • 1Center for Clinical Epidemiology & Biostatistics, Department of Biostatistics & Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6021, USA. hennessy@mail.med.upenn.edu

Pharmacoepidemiology and Drug Safety
|July 10, 2008
PubMed

Insights

Computerized codes for sudden cardiac death and ventricular arrhythmia (SD/VA) hospitalizations in the General Practice Research Database (GPRD) are not reliable for identifying outpatient events. Case-by-case verification is recommended for future studies.

Area of Science:

  • Pharmacovigilance
  • Cardiology
  • Health Informatics

Background:

  • The General Practice Research Database (GPRD) is a valuable resource for studying medication effects.
  • Accurate identification of adverse events like sudden cardiac death and ventricular arrhythmia (SD/VA) is crucial for drug safety research.
  • The validity of using computerized diagnostic codes for SD/VA in the GPRD for outpatient medication studies is uncertain.

Purpose of the Study:

  • To assess the accuracy of OXMIS/Read diagnostic codes for hospitalizations due to SD/VA within the GPRD.
  • To determine the utility of these codes for research on the arrhythmogenic effects of outpatient medications.

Main Methods:

  • Identified patients with putative SD/VA hospitalizations linked to outpatient prescriptions for cisapride, domperidone, or metoclopramide.
  • Surveyed general practitioners (GPs) and reviewed hospital discharge summaries.
  • Calculated the positive predictive value (PPV) of diagnostic codes for identifying outpatient events precipitating hospitalization.

Main Results:

  • Of 84 putative SD/VA events, 30 were confirmed via GP questionnaires (79% response rate).
  • The PPV for any SD/VA diagnosis was high at 93% (95% CI, 78-99%).
  • However, the PPV for SD/VA originating in an outpatient setting precipitating hospitalization was low at 23% (95% CI, 10-42%), with most codes reflecting in-hospital events.

Conclusions:

  • Computerized SD/VA codes show good agreement with physician diagnoses but are poor indicators of outpatient events leading to hospitalization.
  • Future research using the GPRD for SD/VA events necessitates individual case verification to ensure accuracy.
Abstract

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