Comparison of self-reported and Medicare claims-identified acute myocardial infarction
Laura C Yasaitis1, Lisa F Berkman2, Amitabh Chandra2
1From Harvard Center for Population and Development Studies (L.C.Y., L.F.B.) and John F. Kennedy School of Government (A.C.), Harvard University, Cambridge, MA. yasaitis@hsph.harvard.edu.
Insights
Patient self-reports of heart attack and Medicare claims data show significant discrepancies. However, self-reported heart attacks, even if unconfirmed by claims, signal a higher mortality risk in older adults.
Area of Science:
- Gerontology
- Epidemiology
- Health Services Research
Background:
- Cardiovascular disease research often relies on patient self-reports and administrative data, which yield different information.
- Few studies have directly compared these two data sources for cardiovascular event identification.
Purpose of the Study:
- To compare the concordance between self-reported heart attacks and claims-identified acute myocardial infarction (AMI) and acute coronary syndrome (ACS) in older Americans.
- To assess the association of self-reported and claims-identified cardiac events with mortality.
Main Methods:
- A longitudinal, nationally representative survey of older Americans was matched with Medicare claims data.
- Self-reported heart attacks in the prior two years were compared with claims-identified AMI, non-AMI ACS, and other cardiac claims.
- Mortality risks associated with discrepancies between self-reports and claims were analyzed.
Main Results:
- Only 32.8% of self-reported heart attacks were confirmed by claims-identified AMI, with others identified as non-AMI ACS, other cardiac claims, or having no inpatient visits.
- Claims-identified AMIs were reported by only 67.8% of affected respondents.
- Self-reports were less common in older individuals (>75 years), those with less education, functional limitations, or lower cognitive function.
- Both self-reported and claims-identified events correlated with increased mortality. Notably, claims-identified AMI without self-report and self-reported heart attack with claims-identified AMI/ACS showed the highest mortality risks.
Conclusions:
- Significant disagreement exists between self-reported and claims-identified cardiovascular events.
- Self-reported heart attacks, despite potential inaccuracies, are a significant indicator of increased mortality risk, irrespective of claims confirmation.
- Findings highlight the importance of considering both data sources and patient-reported outcomes in cardiovascular disease research and risk assessment.
Background:
Cardiovascular disease is often studied through patient self-report and administrative data. However, these 2 sources provide different information, and few studies have compared them.
Methods And Results:
We compared data from a longitudinal, nationally representative survey of older Americans with matched Medicare claims. Self-reported heart attack in the previous 2 years was compared with claims-identified acute myocardial infarction (AMI) and acute coronary syndrome. Among the 3.1% of respondents with self-reported heart attack, 32.8% had claims-identified AMI, 16.5% had non-AMI acute coronary syndrome, and 25.8% had other cardiac claims; 17.3% had no inpatient visits in the previous 2.5 years. Claims-identified AMIs were found in 1.4% of respondents; of these, 67.8% reported a heart attack. Self-reports were less likely among respondents >75 years of age (62.7% versus 74.6%; P=0.006), with less than high school education (61.6% versus 71.4%; P=0.015), with at least 1 limitation in activities of daily living (59.6% versus 74.7%; P=0.001), or below the 25th percentile of a word recall memory test (60.7% versus 71.3%; P=0.019). Both self-reported and claims-identified cardiac events were associated with increased mortality; the highest mortality was observed among those with claims-identified AMI who did not self-report (odds ratio, 2.8; 95% confidence interval, 1.5-5.1) and among those with self-reported heart attack and claims-identified AMI (odds ratio, 2.5; 95% confidence interval, 1.7-3.6) or non-AMI acute coronary syndrome (odds ratio, 2.7; 95% confidence interval, 1.8-4.1).
Conclusions:
There is considerable disagreement between self-reported and claims-identified events. Although self-reported heart attack may be inaccurate, it indicates increased risk of death, regardless of whether the self-report is confirmed by Medicare claims.
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