基于电子健康记录的定义对心力衰竭患者的准确性
Sharon Klein1, Amrita Mukhopadhyay2, Carine E Hamo3
1Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA.
The American journal of medicine
|July 20, 2025
概括
电子健康记录 (EHR) 缺乏标准化的心力衰竭定义. 开发并验证了八个基于EHR的定义,发现它们识别了真实病例,但错过了许多患者,突出了评估心力衰竭患病率的更好方法的需要.
科学领域:
- 心脏病学 心脏病学
- 医疗信息学 医疗信息学
- 流行病学 流行病学
背景情况:
- 电子健康记录 (EHR) 被广泛使用,但缺乏标准化的方法来识别心力衰竭 (HF) 患者.
- 在EHR数据中准确识别HF患者对于流行病学研究和临床护理至关重要.
研究的目的:
- 开发和验证使用EHR数据识别心力衰竭患者的多个定义.
- 评估这些定义在捕捉真实高频病例中的性能.
主要方法:
- 开发了八个不同的HF定义,结合ICD-10代码和射出分数 (EF) ≤40%.
- 使用分层采样和医生图表审查对心力衰竭的通用定义进行验证的定义.
- 使用灵敏度和积极预测值来评估性能.
主要成果:
- 确定了超过41,000名符合至少一个基于EHR的HF定义的患者.
- 对528名采样患者的医生图表审查显示,对定义的高正预测值 (80.7%98.6%).
- 敏感度从10.3%到42.0%不等,表明低估了HF患病率.
结论:
- 基于EHR的定义可以识别真正的心力衰竭病例,但捕获不到所有HF患者的一半.
- 目前的定义严重低估了HF的患病率,需要更全面的方法来评估流行病学负担.
- 需要改进EHR数据的利用,才能准确地了解心力衰竭的全部范围.
相关概念视频
Heart Failure IV: Classification and Diagnostic Evaluation
33
Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...
33
Pathophysiology of Heart Failure
1.9K
Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
1.9K
Heart Failure VII: Nursing Interventions
140
The first step in nursing management of a patient with heart failure involves thoroughly assessing the patient's medical history.Subjective Data: Obtain the patient's medical history of coronary artery disease, hypertension, myocardial infarction, and symptoms like dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.Objective Data: Conduct a physical examination to identify findings such as jugular vein distention, pulmonary crackles, tachycardia, murmurs, peripheral edema, and vital signs,...
140
Heart Failure I: Introduction
55
Heart failure refers to a clinical syndrome caused by structural or functional cardiac disorders that prevent the heart from pumping an adequate amount of blood to meet the body's metabolic needs. This condition often arises from myocardial infarction or ischemia, leading to decreased cardiac output, reduced tissue perfusion, impaired gas exchange, fluid volume imbalance, and decreased functional ability.Heart failure can result from disruptions in the mechanisms that regulate cardiac output...
55
Heart Failure V: Medical Management
26
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
26
Methods of Documentation VII: EMR
917
Electronic Medical Records (EMRs) primarily center around electronically documenting patients' health information within a single healthcare organization or practice. They contain essential clinical data related to a patient's medical history, diagnoses, medications, treatment plans, lab results, and other pertinent information relevant to the specific encounter or episode of care. EMRs are designed to streamline documentation and workflow processes within individual healthcare...
917


