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The validity of heart failure diagnoses obtained from administrative registers
Markku Mähönen1, Antti Jula, Kennet Harald
1Department of Public Health, University of Helsinki, Helsinki, Finland. markku.mahonen@helsinki.fi
Insights
Administrative registers accurately identify heart failure (HF) cases with high specificity, making them useful for follow-up studies. However, their modest sensitivity requires caution for surveillance purposes.
Area of Science:
- Epidemiology
- Health Informatics
- Cardiology
Background:
- Population-based administrative registers offer a potential method for identifying heart failure (HF) cases.
- The accuracy and reliability of HF classifications derived from these registers require thorough validation.
Purpose of the Study:
- To assess the validity of heart failure (HF) diagnoses identified through record linkage of Finnish administrative databases.
- To compare the accuracy of administrative register classifications against a gold standard established by expert physician review.
Main Methods:
- Linked nationwide Finnish registers (Hospital Discharge, Causes of Death, Drug Reimbursement, pharmacy data) with FINRISK 1997 survey data.
- Defined HF cases in registers based on hospitalizations, special drug reimbursements, or furosemide use.
- Established a gold standard by having three independent physicians assess cases, considering brain natriuretic peptide levels and digoxin use.
Main Results:
- The administrative registers demonstrated high specificity (99.7%) for identifying heart failure (HF) cases.
- Positive predictive value was 85.9%, and negative predictive value was 97.9%.
- The sensitivity of the registers for detecting HF was modest at 48.5%.
Conclusions:
- Administrative register classification of heart failure (HF) exhibits high specificity, suitable for utilization in follow-up studies where HF is an endpoint.
- The moderate sensitivity indicates that administrative data should be used cautiously for public health surveillance of HF.
Background:
Population-based administrative registers could be used for identifying heart failure (HF) cases. However, the validity of the classification obtained from administrative registers is not known.
Design:
The validity of HF diagnoses obtained by record linkage of administrative databases in Finland was assessed against classification by three independent physicians.
Methods:
Data from the nationwide registers in Finland - the Hospital Discharge Register, Causes of Death Register, Drug Reimbursement Register, and pharmacy prescription data - were linked with the FINRISK 1997 survey data. Cases with hospitalizations before the survey date with HF as one of the discharge diagnoses, cases with special reimbursement for HF drugs before the survey date and cases with the use of furosemide before the survey date were classified as HF in the registers. All these cases, cases with baseline brain natriuretic peptide > 100 pg/ml, and cases with use of digoxin were independently assessed by two physicians as HF/no HF. Discrepant cases were solved by a third physician. This classification was considered as the gold standard, against which the registers were assessed.
Results:
The specificity of the registers was 99.7% (95% CI 99.5-99.8%), positive predictive value 85.9% (95% CI 79.7-90.5%), negative predictive value 97.9% (95% CI 97.6-98.2%), and sensitivity 48.5% (95% CI 42.9-54.2%).
Conclusions:
Classification obtained from administrative registers has high specificity and can be used in follow-up studies with HF as an end point. Sensitivity is modest and administrative data should be used with caution for surveillance.
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