Validation of obesity coding among newly treated nonvalvular atrial fibrillation patients using an integrated electronic medical record and claims database

AbstractBackgroundClinical decision support tools for atrial fibrillation (AF) should include CHA2DS2- VASc scores to guide oral anticoagulant (OAC) treatment.ObjectiveWe compared automated, electronic medical record (EMR) generated CHA2DS2- VASc scores to clinician-documented scores, and report the resulting proportions of patients in the OAC treatment group.MethodsPatients were included if they had both a clinician documented and EMR-generated CHA2DS2-VASc score on the same day. EMR scores were based on billing codes, left ventricular ejection fraction from echocardiograms, and demographics; documented scores were identified using natural language processing. Patients were deemed “re-classified” if the EMR score was ≥2 but the documented score was <2, and vice versa. For the overall cohort and subgroups (sex and age group), we compared mean scores using paired t-tests and re-classification rates using chi-squared tests.ResultsAmong 5,767 patients, the mean scores were higher using EMR compared to documented scores (4.05 [SD 2.1] versus 3.13 [SD 1.8]; p<0.01) for the full cohort, and all subgroups (p<0.01 for all comparisons). If EMR scores were used to determine OAC treatment instead of documented scores, 8.3% (n=479, p<0.01) of patients would be re-classified, with 7.2% moving into and 1.1% moving out of the treatment group. Among 2,322 women, 4.7% (n=109, p<0.01) would be re-classified, with 4.1% into and 0.7% out of the treatment group. Among 3,445 men, 10.7% (n=370, p<0.01) would be re-classified, with 9.2% into and 1.5% out of the treatment group. Among 2,060 patients <65 years old, 18.1% (n=372, p<0.01) would be re-classified, with 15.8% into and 2.3% out of the treatment group. Among 1,877 patients 65-74 years old, 5.4% (n=101, p<0.01) would be re-classified, with 4.4% into and 1.0% out of the treatment group. Among 1,830 patients ≥75 years old, <1% would move into to the treatment group and none would move out of the treatment group.ConclusionsEMR-based CHA2DS2-VASc scores were, on average, almost a full point higher than the clinician-documented scores. Using EMR scores in lieu of documented scores would result in a significant proportion of patients moving into the treatment group, with the highest re-classifications rates in men and patients <65 years old.

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Abstract 21: Comparison of Methods to Identify Atrial Fibrillation Patients from the Electronic Medical Record

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.12.suppl_1.21 ◽

2019 ◽

Vol 12 (Suppl_1) ◽

Author(s):

Rebeka Mukherjee ◽

Aubrey E Jones ◽

Ian Hackett ◽

Donald M Llyod-Jones ◽

Jennifer Springer ◽

...

Keyword(s):

Atrial Fibrillation ◽

Medical Record ◽

Electronic Medical Record ◽

Comparison Of Methods

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Abstract 159: Evaluation of Clinical Outcomes among Nonvalvular Atrial Fibrillation Patients Treated With Warfarin or Rivaroxaban Stratified by Presence or Absence of CKD in a Claims Database

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.159 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Matthew R Weir ◽

Lloyd Haskell ◽

Jeffrey S Berger ◽

Veronica Ashton ◽

François Laliberté ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Major Bleeding ◽

Bleeding Event ◽

Data Availability ◽

Thromboembolic Events ◽

Bleeding Events ◽

Nonvalvular Atrial Fibrillation ◽

Claims Database ◽

Increased Risk

Introduction: Renal functional impairment is linked to an increased risk of thromboembolic and bleeding events in patients with nonvalvular atrial fibrillation (NVAF) treated with warfarin and rivaroxaban. Anticoagulants such as warfarin and rivaroxaban are often recommended to reduce the risk of stroke in NVAF patients. The purpose of this study was to evaluate and compare thromboembolic and bleeding event rates for warfarin and rivaroxaban patients stratified by presence of chronic kidney disease (CKD). Methods: Claims from the IMS Health Real-World Data Adjudicated Claims database from 05/2011-6/2015 were analyzed. Adult patients with NVAF who had ≥6 months of baseline data prior to the first dispensing of warfarin or rivaroxaban after 11/2011 were included. Patients were followed until the end of index therapy or end of data availability/insurance coverage. Outcomes were stratified by presence of CKD for ischemic stroke, major bleeding, and a composite measure of thromboembolic events (ischemic stroke, myocardial infarction (MI) or venous thromboembolism (VTE)) and analyzed using hazard ratios (HRs). Adjustments for confounding were made with inverse probability of treatment weights (IPTW). Results: The analysis included 39,872 rivaroxaban (9.0% [3,572 of 39,872] with CKD) and 48,637 warfarin patients (16.9% [8,230 of 48,637] with CKD). As expected, thromboembolic and bleeding events were more common in patients with CKD than those without CKD. Rivaroxaban patients had significantly lower risk of ischemic stroke, both in the overall population (HR = 0.79 [0.68-0.90], p=0.0008) and for those with CKD (HR = 0.55 [0.40-0.77], p=0.0004). A composite of thromboembolic events were lower with rivaroxaban irrespective of CKD. Major bleeding rates were comparable across all groups. Table 1 reports incidence rates and HRs stratified by presence of CKD. Conclusions: This study suggests that, in an adult population with NVAF, rivaroxaban-treated patients had fewer ischemic strokes across all patients, including patients with renal impairment. Rivaroxaban-treated patients also had significantly better outcomes for the composite (VTE, MI, or stroke) measure across all groups. Bleeding rates were comparable across all groups.

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