Performance of Electronic Health Record Diagnosis Codes for Ambulatory Heart Failure Encounters

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Performance of Electronic Health Record Diagnosis Codes for Ambulatory Heart Failure Encounters

Introduction

Observational studies using International Classification of Diseases and Related Health Problems (ICD) diagnostic codes and administrative claims have been used extensively in the United States to gain insights on patient characteristics and outcomes in real-world populations. Importantly, observational studies frequently provide more generalizable information about populations living with various medical conditions compared to registries or randomized controlled trials, which are vulnerable to selection bias. One of the most common conditions examined over the past several years using ICD diagnosis codes has been heart failure (HF). (1–3) Indeed, many studies have used ICD diagnostic codes to identify HF patients in large administrative claims-based databases from Medicare and the Healthcare Cost and Utilization Project (HCUP) (4,5), providing many important insights on hospitalized patients with HF.

There is emerging interest in leveraging ICD diagnosis codes within the electronic medical record (EMR) to improve our knowledge and understanding of patient characteristics and outcomes of ambulatory HF patients, which comprise a substantial proportion of the HF population. To effectively utilize the EMR for this purpose, reliably differentiating heart failure with reduced ejection fraction (HFrEF) from heart failure with preserved ejection fraction (HFpEF) is important, given known differences in their pathophysiology and disease trajectories.(4,6,7) However, the diagnostic performance of ICD-10 diagnosis codes specifically abstracted from the EMR for HFrEF and HFpEF in the ambulatory setting are unknown. We therefore sought to examine the diagnostic performance of ICD-10 diagnosis codes for HFrEF and HFpEF abstracted from the EMR in the ambulatory setting using echocardiography data as the gold standard, among patients from the New York City Clinical Data Research Network (NYC-CDRN).(8)

Background:

There is interest in leveraging the electronic medical record (EMR) to improve knowledge and understanding of patient characteristics and outcomes of ambulatory heart failure (HF) patients. However, the diagnostic performance of ICD-10 diagnosis codes from the EMR for patients with heart failure with reduced and preserved ejection fraction (HFrEF and HFpEF) in the ambulatory setting are unknown.

Methods:

We examined a cohort of patients aged ≥18 with at least 1 outpatient encounter for HF between January 2016 and June 2018, and an echocardiogram conducted within 180 days of the outpatient encounter for HF. We defined HFrEF encounters as those with ICD-10 codes of I50.2x (systolic heart failure); and defined HFpEF encounters as those with ICD-10 codes of I50.3x (diastolic heart failure). The referent definitions of HFrEF and HFpEF were based on echocardiograms conducted within 180 days of the ambulatory encounter for HF. hfref icd 10, hfref icd 10, hfref medical abbreviation, hfref vs hfpef, icd 10 code for hfref, hfpef vs hfref 880, hfref definition, what is hfref,hfref treatment

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