Quality of heart failure registration in primary care: observations from 1 million electronic health records in the...

Area of Science:

• Medical Informatics
• Cardiology
• Primary Care Research

Background:

• Accurate coding of heart failure (HF) in electronic health records (EHRs) is essential for patient care and research.
• Vulnerable patient populations with HF require precise data for effective management.
• Evaluating the accuracy of HF diagnosis registration in primary care EHRs is critical.

Purpose of the Study:

• To assess the accuracy of heart failure (HF) diagnosis coding within primary care electronic health records (EHRs).
• To identify the extent of over- and underregistration of HF diagnoses.
• To understand trends in HF coding accuracy over time.

Main Methods:

• Utilized a primary care database from the Amsterdam Metropolitan Area.
• Identified HF episodes using International Classification of Primary Care (ICPC) codes K77 and K84.03.
• Employed text-based searches to find un-coded HF episodes and expert panel review for validation.

Main Results:

• Analyzed 968,433 records, identifying 19,106 patients with coded HF episodes.
• Found 4.8% overregistration and 11.1% underregistration of HF diagnoses after validation.
• Identified miscoded HF episodes advanced the first diagnosis date in 3.9% of records, with a median shift of 3.45 years.

Conclusions:

• Substantial over- and underregistration of heart failure (HF) persists in primary care EHRs.
• While HF coding accuracy has improved, cautious interpretation of ICPC-coded data remains necessary.
• Findings offer insights for enhancing HF registration practices in primary care settings.