Case Definitions for Acute Myocardial Infarction in Administrative Databases and Their Impact on In-Hospital Mortality Rates
Article first published online: 28 JUN 2012
© Health Research and Educational Trust
Health Services Research
Volume 48, Issue 1, pages 290–318, February 2013
How to Cite
Metcalfe, A., Neudam, A., Forde, S., Liu, M., Drosler, S., Quan, H. and Jetté, N. (2013), Case Definitions for Acute Myocardial Infarction in Administrative Databases and Their Impact on In-Hospital Mortality Rates. Health Services Research, 48: 290–318. doi: 10.1111/j.1475-6773.2012.01440.x
- Issue published online: 7 JAN 2013
- Article first published online: 28 JUN 2012
- Administrative data;
- acute myocardial infarction;
- validation studies;
- international classification of disease (ICD) codes;
To identify validated ICD-9-CM/ICD-10 coded case definitions for acute myocardial infarction (AMI).
Ovid Medline (1950–2010) was searched to identify studies that validated acute myocardial infarction (AMI) case definitions. Hospital discharge abstract data and chart data were linked to validate identified AMI definitions.
Systematic literature review, chart review, and administrative data analysis.
Data Collection/Extraction Methods
Data on sensitivity/specificity/positive and negative predictive values (PPV and NPV) were extracted from previous studies to identify validated case definitions for AMI. These case definitions were validated in administrative data through chart review and applied to hospital discharge data to assess in-hospital mortality.
Of the eight ICD-9-CM definitions validated in the literature, use of ICD-9-CM code 410 to define AMI had the highest sensitivity (94 percent) and specificity (99 percent). In our data, ICD-9-CM/ICD-10 codes 410/I21-I22 in all available coding fields had high sensitivity (83.3 percent/82.8 percent) and PPV (82.8 percent/82.2 percent). The in-hospital mortality among AMI patients identified using this case definition was 7.6 percent in ICD-9-CM data and 6.6 percent in ICD-10 data.
We recommend that ICD-9-CM 410 or ICD-10 I21-I22 in the primary diagnosis coding field should be used to define AMI. The use of a consistent validated case definition would improve comparability across studies