Anatomic and physiologic classification of adults with congenital heart disease to predict adverse outcomes: Use of...

Area of Science:

• Cardiology
• Medical Informatics
• Public Health

Background:

• The 2018 American Heart Association/American College of Cardiology (AHA/ACC) guidelines use an anatomic physiologic (AP) classification for adults with congenital heart disease (ACHD).
• Existing International Classification of Diseases (ICD) codes do not fully capture all conditions within the ACHD AP classification.
• A need exists for an ICD code-based system to approximate the ACHD AP classification for population studies.

Purpose of the Study:

• To develop and validate an ICD code-based classification system for adults with congenital heart disease (ACHD).
• To compare the predictive accuracy of an ICD code-based ACHD classification with traditional medical record review for adverse outcomes.

Main Methods:

• 232 adults with congenital heart defects (CHDs) were identified using ICD codes and validated via chart review.
• Individuals were categorized into four modified AP classification groups based on native anatomy and physiology.
• Two classification methods were used: medical record review and ICD/CPT code-based analysis.
• A composite outcome (death, ED visits, hospitalizations) was assessed at least 6 months post-classification.

Main Results:

• 28.4% of participants experienced a composite outcome a median of 1.6 years after their index encounter.
• No significant difference was observed in predicting the composite outcome between the chart review and ICD code-based classification methods.
• Both methods demonstrated comparable predictive accuracy for the composite outcome.

Conclusions:

• Modified AP classification using ICD codes is comparable to chart review in predicting outcomes for adults with congenital heart disease (ACHD).
• An ICD code-based classification system is a valuable tool for population-based ACHD surveillance using administrative data.
• This approach facilitates large-scale studies on CHD outcomes and management.