Classification of heart failure in the atherosclerosis risk in communities (ARIC) study a comparison of diagnostic criteria

Wayne D. Rosamond, Patricia P. Chang, Chris Baggett, Anna Johnson, Alain G. Bertoni, Eyal Shahar, Anita Deswal, Gerardo Heiss, Lloyd E. Chambless

Research output: Contribution to journalArticle

121 Citations (Scopus)

Abstract

Background-Population-based research on heart failure (HF) is hindered by lack of consensus on diagnostic criteria. Framingham (FRM), National Health and Nutrition Examination Survey (NHANES), Modified Boston (MBS), Gothenburg (GTH), and International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) code criteria, do not differentiate acute decompensated heart failure (ADHF) from chronic stable HF. We developed a new classification protocol for identifying ADHF in the Atherosclerosis Risk in Communities (ARIC) Study and compared it with these other schemes. Methods and Results-A sample of 1180 hospitalizations with a patient address in 4 study communities and eligible discharge codes were selected. After assessing whether the chart contained evidence of possible HF signs, 705 were fully abstracted. Two independent reviewers classified each case as ADHF, chronic stable HF, or no HF, using ARIC classification guidelines. Fifty-nine percent of cases met ARIC criteria for ADHF and 13.9% and 27.1% were classified as chronic stable HF or no HF, respectively. Among events classified as HF by FRM criteria, 68.4% were validated as ADHF, 9.6% as chronic stable HF, and 21.9% as no HF. However, 92.5% of hospitalizations with a primary ICD-9-CM 428 "heart failure" code were validated as ADHF. Sensitivities of comparison criteria to classify ADHF ranged from 38-95%, positive predictive values from 62-92%, and specificities from 19-96%. Conclusions-Although comparison criteria for classifying HF were moderately sensitive in identifying ADHF, specificity varied when applied to a randomly selected set of suspected HF hospitalizations in the community.

Original languageEnglish (US)
Pages (from-to)152-159
Number of pages8
JournalCirculation: Heart Failure
Volume5
Issue number2
DOIs
StatePublished - Mar 2012

Fingerprint

Atherosclerosis
Heart Failure
Hospitalization
International Classification of Diseases
Nutrition Surveys

Keywords

  • Epidemiology
  • Failure
  • Heart

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Classification of heart failure in the atherosclerosis risk in communities (ARIC) study a comparison of diagnostic criteria. / Rosamond, Wayne D.; Chang, Patricia P.; Baggett, Chris; Johnson, Anna; Bertoni, Alain G.; Shahar, Eyal; Deswal, Anita; Heiss, Gerardo; Chambless, Lloyd E.

In: Circulation: Heart Failure, Vol. 5, No. 2, 03.2012, p. 152-159.

Research output: Contribution to journalArticle

Rosamond, Wayne D. ; Chang, Patricia P. ; Baggett, Chris ; Johnson, Anna ; Bertoni, Alain G. ; Shahar, Eyal ; Deswal, Anita ; Heiss, Gerardo ; Chambless, Lloyd E. / Classification of heart failure in the atherosclerosis risk in communities (ARIC) study a comparison of diagnostic criteria. In: Circulation: Heart Failure. 2012 ; Vol. 5, No. 2. pp. 152-159.
@article{896397abcbb4491f9ffc73e92997392b,
title = "Classification of heart failure in the atherosclerosis risk in communities (ARIC) study a comparison of diagnostic criteria",
abstract = "Background-Population-based research on heart failure (HF) is hindered by lack of consensus on diagnostic criteria. Framingham (FRM), National Health and Nutrition Examination Survey (NHANES), Modified Boston (MBS), Gothenburg (GTH), and International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) code criteria, do not differentiate acute decompensated heart failure (ADHF) from chronic stable HF. We developed a new classification protocol for identifying ADHF in the Atherosclerosis Risk in Communities (ARIC) Study and compared it with these other schemes. Methods and Results-A sample of 1180 hospitalizations with a patient address in 4 study communities and eligible discharge codes were selected. After assessing whether the chart contained evidence of possible HF signs, 705 were fully abstracted. Two independent reviewers classified each case as ADHF, chronic stable HF, or no HF, using ARIC classification guidelines. Fifty-nine percent of cases met ARIC criteria for ADHF and 13.9{\%} and 27.1{\%} were classified as chronic stable HF or no HF, respectively. Among events classified as HF by FRM criteria, 68.4{\%} were validated as ADHF, 9.6{\%} as chronic stable HF, and 21.9{\%} as no HF. However, 92.5{\%} of hospitalizations with a primary ICD-9-CM 428 {"}heart failure{"} code were validated as ADHF. Sensitivities of comparison criteria to classify ADHF ranged from 38-95{\%}, positive predictive values from 62-92{\%}, and specificities from 19-96{\%}. Conclusions-Although comparison criteria for classifying HF were moderately sensitive in identifying ADHF, specificity varied when applied to a randomly selected set of suspected HF hospitalizations in the community.",
keywords = "Epidemiology, Failure, Heart",
author = "Rosamond, {Wayne D.} and Chang, {Patricia P.} and Chris Baggett and Anna Johnson and Bertoni, {Alain G.} and Eyal Shahar and Anita Deswal and Gerardo Heiss and Chambless, {Lloyd E.}",
year = "2012",
month = "3",
doi = "10.1161/CIRCHEARTFAILURE.111.963199",
language = "English (US)",
volume = "5",
pages = "152--159",
journal = "Circulation: Heart Failure",
issn = "1941-3297",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Classification of heart failure in the atherosclerosis risk in communities (ARIC) study a comparison of diagnostic criteria

AU - Rosamond, Wayne D.

AU - Chang, Patricia P.

AU - Baggett, Chris

AU - Johnson, Anna

AU - Bertoni, Alain G.

AU - Shahar, Eyal

AU - Deswal, Anita

AU - Heiss, Gerardo

AU - Chambless, Lloyd E.

PY - 2012/3

Y1 - 2012/3

N2 - Background-Population-based research on heart failure (HF) is hindered by lack of consensus on diagnostic criteria. Framingham (FRM), National Health and Nutrition Examination Survey (NHANES), Modified Boston (MBS), Gothenburg (GTH), and International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) code criteria, do not differentiate acute decompensated heart failure (ADHF) from chronic stable HF. We developed a new classification protocol for identifying ADHF in the Atherosclerosis Risk in Communities (ARIC) Study and compared it with these other schemes. Methods and Results-A sample of 1180 hospitalizations with a patient address in 4 study communities and eligible discharge codes were selected. After assessing whether the chart contained evidence of possible HF signs, 705 were fully abstracted. Two independent reviewers classified each case as ADHF, chronic stable HF, or no HF, using ARIC classification guidelines. Fifty-nine percent of cases met ARIC criteria for ADHF and 13.9% and 27.1% were classified as chronic stable HF or no HF, respectively. Among events classified as HF by FRM criteria, 68.4% were validated as ADHF, 9.6% as chronic stable HF, and 21.9% as no HF. However, 92.5% of hospitalizations with a primary ICD-9-CM 428 "heart failure" code were validated as ADHF. Sensitivities of comparison criteria to classify ADHF ranged from 38-95%, positive predictive values from 62-92%, and specificities from 19-96%. Conclusions-Although comparison criteria for classifying HF were moderately sensitive in identifying ADHF, specificity varied when applied to a randomly selected set of suspected HF hospitalizations in the community.

AB - Background-Population-based research on heart failure (HF) is hindered by lack of consensus on diagnostic criteria. Framingham (FRM), National Health and Nutrition Examination Survey (NHANES), Modified Boston (MBS), Gothenburg (GTH), and International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) code criteria, do not differentiate acute decompensated heart failure (ADHF) from chronic stable HF. We developed a new classification protocol for identifying ADHF in the Atherosclerosis Risk in Communities (ARIC) Study and compared it with these other schemes. Methods and Results-A sample of 1180 hospitalizations with a patient address in 4 study communities and eligible discharge codes were selected. After assessing whether the chart contained evidence of possible HF signs, 705 were fully abstracted. Two independent reviewers classified each case as ADHF, chronic stable HF, or no HF, using ARIC classification guidelines. Fifty-nine percent of cases met ARIC criteria for ADHF and 13.9% and 27.1% were classified as chronic stable HF or no HF, respectively. Among events classified as HF by FRM criteria, 68.4% were validated as ADHF, 9.6% as chronic stable HF, and 21.9% as no HF. However, 92.5% of hospitalizations with a primary ICD-9-CM 428 "heart failure" code were validated as ADHF. Sensitivities of comparison criteria to classify ADHF ranged from 38-95%, positive predictive values from 62-92%, and specificities from 19-96%. Conclusions-Although comparison criteria for classifying HF were moderately sensitive in identifying ADHF, specificity varied when applied to a randomly selected set of suspected HF hospitalizations in the community.

KW - Epidemiology

KW - Failure

KW - Heart

UR - http://www.scopus.com/inward/record.url?scp=84860795133&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84860795133&partnerID=8YFLogxK

U2 - 10.1161/CIRCHEARTFAILURE.111.963199

DO - 10.1161/CIRCHEARTFAILURE.111.963199

M3 - Article

C2 - 22271752

AN - SCOPUS:84860795133

VL - 5

SP - 152

EP - 159

JO - Circulation: Heart Failure

JF - Circulation: Heart Failure

SN - 1941-3297

IS - 2

ER -