scholarly journals Coding Variation and Adherence to Methodological Standards in Cardiac Research Using the National Inpatient Sample

2021 ◽  
Vol 8 ◽  
Author(s):  
John W. Ostrominski ◽  
Javier Amione-Guerra ◽  
Brian Hernandez ◽  
Joel E. Michalek ◽  
Anand Prasad
Keyword(s):  
Artery Bypass ◽  
Coronary Intervention ◽  
National Inpatient Sample ◽  
Substantial Variation ◽  
Case Definitions ◽  
Unique Case ◽  
Percutaneous Coronary ◽  
Trends Over Time ◽  
Administrative Code ◽  
Over Time

Background: Code selection is crucial to the accuracy and reproducibility of studies using administrative data, however a comprehensive assessment of coding trends for major cardiac diagnoses and procedures is lacking. We aimed to evaluate trends in administrative code utilization for major cardiac diagnoses and procedures, and adherence to required methodological practices in cardiac research using the National Inpatient Sample (NIS).Methods: In this observational study of 445 articles, ICD-9-CM codes corresponding to acute myocardial infarction (AMI), heart failure, atrial fibrillation, percutaneous coronary intervention, and coronary artery bypass grafting were collected and analyzed. The NIS was used to compare the number of hospitalizations between the most frequently encountered AMI case definitions. Key elements were abstracted from each article to evaluate adherence to required methodological practices.Results: Variation in code utilization was observed for each diagnosis and procedure assessed, and the number of unique case definitions published per year increased throughout the study period (P < 0.001), driven largely by the significant increase in articles per year (P < 0.001). Off-target codes were observed in 39 (8.8%) studies. Upon reintroduction into the NIS for 2008–2012, the most commonly encountered case definitions for AMI were found to yield significantly different estimates of AMI hospitalizations and hospitalization trends over time. Three hundred and ninety-nine articles (84%) did not adhere to one or more required research practices. Overall adherence was superior for publications in higher-impact journals (P = 0.002).Conclusions: Substantial variation in code selection exists for major cardiac diagnoses and procedures, and non-adherence to methodological standards is widespread. These data have important implications for the accuracy and generalizability of analyses using the NIS.

Abstract 13290: Variation in Coding for Major Cardiac Diagnoses and Procedures in Cardiac Research Using the National Inpatient Sample

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
John W Ostrominski ◽  
Javier Amione-Guerra ◽  
Brian Hernandez ◽  
Joel Michalek ◽  
Anand Prasad
Keyword(s):  
Artery Bypass ◽  
National Level ◽  
Coronary Intervention ◽  
National Inpatient Sample ◽  
Case Definitions ◽  
Unique Case ◽  
Percutaneous Coronary ◽  
Guidance Documents ◽  
Primary Focus ◽  
Administrative Code

Introduction: Code selection is crucial to the accuracy and reproducibility of studies using administrative data, however a comprehensive assessment of coding trends for major cardiac diagnoses and procedures is lacking. Hypothesis: Given the absence of consensus guidelines for administrative code utilization, heterogeneity in code selection for major cardiovascular diagnoses and procedures will be uncovered. Methods: We queried PubMed, CINAHL, Scopus, Medline, and the HCUP Publication Search from inception through March 1st, 2018 for all publications using the National Inpatient Sample (NIS), featuring a primary focus on the heart. ICD-9-CM codes reported for acute myocardial infarction (AMI), heart failure (HF), atrial fibrillation (AF), percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) were collected and analyzed for accuracy and consistency. All studies were also evaluated for adherence to required methodological practices as per previously reported methods. Results: Of 2637 articles identified, 445 were included in the observational analysis. 399 articles (84%) did not adhere to one or more research practices required by the AHRQ, however overall adherence was superior for publications in higher impact journals ( P = 0.0019). Heterogeneity in code utilization was observed for each diagnosis and procedure assessed, with up to 37 unique case definitions reported for HF and PCI. Nonspecific codes were included in 39 (8.8%) studies, and coding heterogeneity increased throughout the study period ( P trend < 0.001 for all cardiac diagnoses and procedures). Coding schema endorsed by national-level clinical guidance documents were infrequently represented, reported in only 8.9% and 1.3% of AMI and HF articles, respectively. Upon reintroduction into the NIS for the period of 2008 to 2012, selected unique case definitions for AMI were found to yield significantly different estimates of AMI incidence. Conclusions: Substantial heterogeneity in code selection exists for major cardiac diagnoses and procedures, with important implications for the accuracy and generalizability of analyses using the NIS. Further efforts are required to establish consensus protocols to ensure consistency in code utilization.

Sex-specific effects of diabetes on adverse outcomes after percutaneous coronary intervention: Trends over time

2007 ◽  
Vol 153 (6) ◽  
pp. 970-978 ◽  
Author(s):  
Kimberly P. Champney ◽  
Emir Veledar ◽  
Mitchel Klein ◽  
Habib Samady ◽  
Deborah Anderson ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
Specific Effects ◽  
Percutaneous Coronary ◽  
Trends Over Time ◽  
Over Time

Clinical Implications of the SYNTAX Study

2009 ◽  
Vol 4 (1) ◽  
pp. 48 ◽  
Author(s):  
Patrick Serruys ◽  
Scot Garg ◽  
◽  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
De Novo ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Syntax Score ◽  
Cerebrovascular Events ◽  
Percutaneous Coronary ◽  
Syntax Study ◽  
Better Than

Recent years have seen an ongoing debate as to whether coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI) is the most appropriate revascularisation strategy for patients with coronary heart disease (CAD). The Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) study was conducted with the intention of defining the specific roles of each therapy in the management of de novo three-vessel disease or left main CAD. Interim results after 12 months show that PCI leads to significantly higher rates of major adverse cardiac or cerebrovascular events compared with CABG (17.8 versus 12.4; p=0.002), largely owing to increased rates of repeat revascularisation. However, CABG was much more likely to lead to stroke. Interestingly, categorisation of patients by severity of CAD complexity according to the SYNTAX score has shown that there are certain patients in whom PCI can yield results that are comparable to, if not better than, those achieved with CABG. Careful clinical evaluation and comprehensive assessment of CAD severity, alongside application of the SYNTAX score, can aid practitioners in selecting the most suitable therapy for each individual CAD patient.

Design and Rationale of the National Tunisian Registry of Percutaneous coronary Intervention: Protocol for a Prospective, Multicenter Trial (Preprint)

2020 ◽  
Author(s):  
Rania Hammami ◽  
Slim Boudiche ◽  
Rami Tlili ◽  
Nejeh Ben Hlima ◽  
Ahmed Jamel ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Clinical Epidemiology ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Long Term Results ◽  
Adverse Cardiovascular Event ◽  
Chronic Occlusion ◽  
Percutaneous Coronary ◽  
Intervention Protocol

BACKGROUND Coronary diseases remain the first cause of death in the world; the management of this condition has improved, thanks to new technical tools and multicentric registries. Recently in Tunisia, the number of intervention procedures has markedly increased, giving the explosion of cardiovascular risk factors among Tunisian people. OBJECTIVE The aim of the study was to investigate the in-hospital and one-year clinical outcome of patients treated with percutaneous coronary intervention (PCI) in Tunisia. METHODS We will conduct a prospective, multicentric, observational study including patients > 18 year-old who underwent a PCI between 31January and 30 June 2020. The primary end point are the occurrence of a major adverse cardiovascular event , defined as cardiovascular death, myocardial infarction, cerebrovascular accident, and target vessel revascularization with either repeat PCI or coronary artery bypass surgery (CABG). Secondary end-points consist in procedural success rate, stent thrombosis, and the rate of redo-PCI/CABG for in-stent restenosis. RESULTS Results will be available at the end of the study as well as the demographic profile and general risk profile of Tunisian patients undergoing PCI. The complexity level of procedures, as left main, bifurcation, chronic occlusion PCI will be analyzed and immediate as well as long term results will be determined. NATURE-PCI will be the first national multicentric registry of angioplasty in Africa. CONCLUSIONS This study would add data and provide a valuable opportunity for real-world clinical epidemiology and practice in the field of interventional cardiology in Tunisia with insights into the uptake of contemporary coronary artery disease in this developing region. CLINICALTRIAL clinicaltrials.gov

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