Congestive Heart Failure Incidence and Prognosis: Case Identification Using Central Adjudication Versus Hospital Discharge Diagnoses

Department of Epidemiology, University of Washington, Seattle, WA 98101, and Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN, USA.
Annals of Epidemiology (Impact Factor: 2). 03/2006; 16(2):115-22. DOI: 10.1016/j.annepidem.2005.02.012
Source: PubMed


We compared hospitalized congestive heart failure (CHF) incidence and prognosis estimates using hospital discharge diagnoses or central adjudication.
We used the Cardiovascular Health Study (CHS), a population-based cohort study of 5888 elderly adults. A physician committee adjudicated potential CHF events, confirmed by signs, symptoms, clinical tests, and/or medical therapy. A CHF discharge diagnosis included any of these ICD-9 codes in any position: 428, 425, 398.91, 402.01, 402.11, 402.91, and 997.1. We constructed an inception cohort of 1209 hospitalized, nonfatal, incident CHF cases, identified by discharge diagnosis, adjudication, or both.
Incidence rates for hospitalized CHF were 24.6 per 1000 person-years using discharge diagnoses and 17.1 per 1000 person-years using central adjudication. Compared to the group identified as having CHF by both methods, the group with only a discharge diagnosis (hazard ratio=0.77, 95% confidence interval=0.65-0.91) and the group with central adjudication only (hazard ratio=0.72, 95% confidence interval=0.55-0.94) had lower mortality rates.
In the elderly, studies using only discharge diagnoses, as compared to central adjudication, may estimate higher rates of incident hospitalized CHF. Mortality following CHF onset may be similar for these methods and higher if both methods are used together.

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    • "786.0 Heckbert (40), 2004 USA 1994–2000 34,016 ICD-9: 425, 428 Fisher (11), 1992 USA 1984–1985 7050 ICD-9-CM: 402.01, 402.11, 402.91, 428–428.9 Schellenbaum (24), 2006 USA 1989–1993 1209 ICD-9: 428, 997.1, 425, 402.01, 402.11, 402.91, 398.91 ICD-9: 428, 398.91, 402.01, 402.11, 402.91, 404.00, 404.01 REACH study: 404.03, 404.10, 404.11, 404.13, 404.90, 404.91, 404.93 Fowles (9), 1998 USA 1990–1991 1596 Not reported Kashner (13), 1998 USA 1995 414 ICD-9: 428, 428.0, 428.1, 428.9 Inglesson (27), 2005 Sweden 1976–2001 321 ICD-8: 427.00, 427.10, 428.99 ICD-9: 428 ICD-10: I50, I11.0 Fonseca (26), 2008 Portugal 2001 234 ICD-9: 428, 410–414, 402, 404, 415, 416, 427, 420, 421, 422, 423, 424, 425, 391, 393–398, 745–746 Teng (25), 2008 Australia 1996–2006 1006 ICD-9: 428x, 402.01, 402.11, 402.91, 404.1, 404.3, 425x, 518.4, 514, 391.8, 398.91 ICD-10: I50x, I11.0, I13.0, I13.2, I42x, J81, I01.8, I020 Kumler (29), 2008 Denmark 1998–1999 126 ICD-10: DI50.0–DI50.9 "
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