Send to

Choose Destination
Medicine (Baltimore). 2016 Aug;95(32):e4554. doi: 10.1097/MD.0000000000004554.

Defining and validating comorbidities and procedures in ICD-10 health data in ST-elevation myocardial infarction patients.

Author information

aUniversity of Alberta, Edmonton bAlberta Health Services cMazankowski Alberta Heart Institute dUniversity of Calgary, Calgary, Alberta, Canada.


Administrative health databases are used in research to define comorbid conditions, diagnosis, and procedures. Our objectives were to validate a diagnosis of ST-elevation myocardial infarction (STEMI) and invasive cardiac procedure coding against a comprehensive registry of STEMI patients and determine an optimal algorithm for defining comorbidities using administrative hospitalization and ambulatory databases, but without using a physician claims database, which is unavailable for use in many jurisdictions.A registry of consecutive STEMI patients was used to define a reference cohort and linked to the hospitalization and ambulatory databases. Four administrative case definitions for defining comorbidities, as well as STEMI diagnosis and in-hospital procedures using the International Classification of Diseases, 10th Revision (ICD-10) and the Canadian Classification of Health Interventions (CCI) were evaluated. Metrics were used to evaluate algorithm performance and compare discriminative ability using the C statistic.The 3236 patients had median age of 60 years (interquartile range 52-71) and 75.7% were male. A diagnosis of STEMI was correctly identified in the administrative records for 3043 (94.0%) patients. In-hospital procedures (coronary artery bypass grafting, percutaneous coronary intervention, and angiogram) were well identified using administrative definitions (Kappa statistic 0.83-1.00). Validation of comorbidities varied by condition but an algorithm using 2 inpatient/ambulatory visits in the previous 2 years maximized PPV, ranging from 28.6% for previous heart failure to 95.7% for previous MI. The c statistic was similar for each of the methods, ranging from 0.76 to 0.80.ICD-10 and CCI codes can identify hospitalized STEMI patients with high sensitivity and accurately define in-hospital cardiac procedures. Comorbidities can be defined with high PPV using a definition of 2 inpatient/ambulatory visits in the previous 2 years.

[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Wolters Kluwer Icon for PubMed Central
Loading ...
Support Center