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Validation of a Case Definition to Identify Patients Diagnosed With Cardiovascular Disease in Canadian Primary Care
Riddhima Dinah Thomas1, Leanne Kosowan2, Mary Rabey3
1UCD School of Medicine, University College Dublin, Belfield, Dublin, Ireland.
Insights
This study validated a primary care electronic medical record definition for cardiovascular disease (CVD), finding an 11.2% prevalence. This definition aids in better prevention and management of CVD.
Area of Science:
- Cardiology
- Public Health
- Health Informatics
Background:
- Cardiovascular disease (CVD) represents a significant global health challenge, being a primary cause of mortality worldwide.
- Accurate identification of CVD cases within primary care is crucial for effective public health strategies and patient management.
- Electronic medical records (EMRs) offer a valuable resource for population health surveillance and disease definition validation.
Purpose of the Study:
- To validate a primary care-based electronic medical record (EMR) case definition for cardiovascular disease (CVD).
- To assess the prevalence of CVD and its components (coronary artery disease, cerebrovascular disease, peripheral vascular disease) in a primary care setting.
- To evaluate the performance characteristics (sensitivity, specificity, predictive values) of the validated EMR case definition for CVD.
Main Methods:
- A retrospective, cross-sectional study utilizing EMR data from 1574 primary care providers in the Canadian Primary Care Sentinel Surveillance Network.
- A reference standard for CVD was established by manually reviewing medical records of a subset of patients (n=2017).
- Validated case definitions were applied to a large active patient population (N=689,301) to estimate CVD prevalence.
Main Results:
- The optimal CVD EMR case definition demonstrated high specificity (97.8%) and good sensitivity (68.5%).
- The overall estimated CVD prevalence in primary care patients was 11.2%, with coronary artery disease being the most common diagnosis (6.4%).
- Component definitions for coronary artery disease showed high sensitivity (91.6%) and specificity (98.3%), while cerebrovascular and peripheral vascular disease definitions had high specificity but lower sensitivity.
Conclusions:
- A validated EMR case definition for CVD in primary care settings has been established.
- The findings highlight the significant burden of CVD in primary care, with a notable prevalence of coronary artery disease.
- Improved CVD case identification through validated EMR definitions can enhance disease prevention and management strategies in primary care settings.
Background:
Cardiovascular disease (CVD) is a leading cause of death globally. This study validates a primary care-based electronic medical record case definition for CVD.
Methods:
This retrospective, cross-sectional study explores electronic medical record data from 1574 primary care providers participating in the Canadian Primary Care Sentinel Surveillance Network. A reference standard was created by reviewing medical records of a subset of patients in this network (n = 2017) for coronary artery disease (CAD), cerebrovascular disease (CeVD), and peripheral vascular disease (PVD). Together, these data produced a CVD reference. We applied validated case definitions to an active patient population (≥ 1 visit between January 1, 2018 and December 31, 2019) to estimate prevalence using the exact binomial test (N = 689,301). Descriptive statistics, χ2 tests, and t tests characterized patients with vs without CVD.
Results:
The optimal CVD Case Definition 2 had a sensitivity of 68.5% (95% Confidence Interval [CI]: 61.6%-74.8%), a specificity of 97.8% (95% CI: 97.0%-98.4%), a positive predictive value of 77.7% (95% CI: 71.6%-82.7%), and a negative predictive value of 96.5% (95% CI: 95.8%-97.1%). Included in this CVD definition was a strong CAD case definition with sensitivity of 91.6% (95% CI: 84.6%-96.1%), specificity of 98.3% (95% CI: 97.6%-98.8%), a PPV of 74.8% (95% CI: 67.8%-80.7%), and an NPV of 99.5% (95% CI: 99.1%-99.7%). This CVD definition also included CeVD and PVD case definitions with low sensitivity (77.6% and 36.6%) but high specificity (98.6% and 99.0%). The estimated prevalence of CVD among primary care patients is 11.2% (95% CI, 11.1%-11.3%; n = 77,064); the majority had CAD (6.4%).
Conclusions:
This study validated a definition of CVD and its component parts-CAD, CeVD, and PVD. Understanding the prevalence and disease burden for patients with CVD within primary care settings can improve prevention and disease management.
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