Related Experiment Video
Updated: Mar 31, 2026
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Administrative Data and the Philosopher's Stone: Turning Heart Failure Claims Data into Quantitative Assessment of
Tanya Bovitz1, David T Gilbertson1, Charles A Herzog2
1Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minn.
Insights
Assessing left ventricular ejection fraction (LVEF) from heart failure claims is possible. This study found a reliable threshold using administrative and echocardiographic data for LVEF estimation in heart failure patients.
Area of Science:
- Cardiology
- Health Informatics
- Clinical Research
Background:
- Administrative data are crucial for assessing patient-centered clinical outcomes.
- Claims data often lack quantitative metrics like left ventricular ejection fraction (LVEF).
- This study investigated LVEF assessment feasibility using heart failure claims.
Purpose of the Study:
- To determine if left ventricular ejection fraction (LVEF) can be accurately assessed from heart failure administrative claims.
- To establish an optimal LVEF threshold for differentiating systolic and diastolic heart failure using ICD-9-CM codes.
Main Methods:
- Retrospective analysis of administrative and echocardiographic databases.
- Inclusion of heart failure patients (ICD-9-CM 428.XX) with claims and echocardiograms within 30 days.
- Utilized Receiver Operating Characteristic (ROC) curves to identify the optimal LVEF cut-off threshold.
Main Results:
- 2714 echocardiograms were analyzed within 30 days of heart failure diagnosis.
- The optimal LVEF cut-off threshold was determined to be 43.5% (95% CI: 39.5%-44.5%).
- The ROC curve analysis yielded an area under the curve of 0.812, with a positive predictive value of 0.72 and negative predictive value of 0.81.
Conclusions:
- Left ventricular ejection fraction (LVEF) can be assessed using heart failure claims data.
- This method offers a potential way to incorporate quantitative LVEF data into analyses using administrative claims.
- Further studies are needed to validate these findings within study limitations.
Background:
Administrative data are widely used in observational assessment of patient-centered clinical outcomes. In studies of cardiovascular outcomes, claims data are limited by lack of quantitative information, such as left ventricular ejection fraction. We aimed to determine whether left ventricular ejection fraction can be assessed from heart failure claims.
Methods:
This observational, retrospective study used administrative and echocardiographic databases to identify heart failure patients (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 428.XX) who received echocardiograms. The study cohort included patients with at least one inpatient or outpatient claim for systolic (428.2X) or diastolic (428.3X) heart failure from January 1, 2007, through July 10, 2013, who received an echocardiogram within 30 days of the claim. Receiver operating characteristic (ROC) curves were used to determine the optimal left ventricular ejection fraction cut-off threshold between ICD-9-CM heart failure codes 428.2 (systolic) and 428.3 (diastolic). Bootstrapping was used to determine a 95% confidence interval for the best cut-off.
Results:
A total of 2714 echocardiograms with ascertainable left ventricular ejection fraction were performed within 30 days of a heart failure diagnosis. ICD-9-CM codes 428.2 and 428.3 accounted for 28.9% and 18.2%, respectively, of all heart failure codes. The resulting ROC curve had a best threshold cut-off for ejection fractions of 43.5% (confidence interval 39.5%-44.5%). The area under the curve was 0.812, with positive predictive value 0.72 and negative predictive value 0.81.
Conclusions:
Subject to study limitations, we conclude that assessing left ventricular ejection fraction using heart failure claims is possible.
Related Concept Videos
01:30Heart Failure VII: Nursing Interventions
01:29Heart Failure II: Pathophysiology