Comparing methods to identify general internal medicine clinic patients with chronic heart failure

Edmunds M. Udris, David H. Au, Mary B. McDonell, Leway Chen, Donald C. Martin, William M. Tierney, Stephan D. Fihn

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objectives: Identification of patients with left ventricular systolic dysfunction is the first step in identifying which patients may benefit from clinical practice guidelines. The purpose of this study was to develop and validate a computerized tool using clinical information that is commonly available to identify patients with left ventricular systolic dysfunction (LVSD). Methods: We performed a cross-sectional study of patients seen in a Department of Veterans Affairs General Internal Medicine Clinic who had echocardiography or radionuclide ventriculography performed as part of their clinical care. Results: We identified 2246 subjects who had at least one cardiac imaging study. A total of 778 (34.6%) subjects met study criteria for LVSD. Subjects with LVSD were slightly older than subjects without LVSD (70 years vs 68 years, P = .00002) but were similar with regard to sex and race. Subjects with LVSD were more likely to have prescriptions for angiotensin-converting enzyme (ACE) inhibitors, carvedilol, digoxin, loop diuretics, hydralazine, nitrates, and angiotensin II receptor antagonists. Of the variables included in the final predictive model, ACE inhibitors, loop diuretics, and digoxin exerted the greatest predictive power. Discriminant analysis demonstrated that models containing pharmacy information were consistently more accurate (75% accurate [65% sensitivity, 81% specificity]) than those models that contained only International Classification of Diseases, 9th revision (ICD-9), codes, including ICD-9 codes for congestive heart failure (72% accurate [80% sensitivity, 68% specificity]). Conclusions: We demonstrated that an automated, computer-driven algorithm identifying LVSD permits simple, rapid, and timely identification of patients with congestive heart failure by use of only routinely collected data. Future research is needed to develop accurate electronic identification of heart failure and other common chronic conditions.

Original languageEnglish
Pages (from-to)1003-1009
Number of pages7
JournalAmerican Heart Journal
Volume142
Issue number6
DOIs
StatePublished - 2001

Fingerprint

Left Ventricular Dysfunction
Internal Medicine
Heart Failure
Sodium Potassium Chloride Symporter Inhibitors
Digoxin
International Classification of Diseases
Angiotensin-Converting Enzyme Inhibitors
Radionuclide Ventriculography
Sensitivity and Specificity
Hydralazine
Angiotensin Receptor Antagonists
Discriminant Analysis
Veterans
Practice Guidelines
Nitrates
Prescriptions
Echocardiography
Cross-Sectional Studies

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Udris, E. M., Au, D. H., McDonell, M. B., Chen, L., Martin, D. C., Tierney, W. M., & Fihn, S. D. (2001). Comparing methods to identify general internal medicine clinic patients with chronic heart failure. American Heart Journal, 142(6), 1003-1009. https://doi.org/10.1067/mhj.2001.119130

Comparing methods to identify general internal medicine clinic patients with chronic heart failure. / Udris, Edmunds M.; Au, David H.; McDonell, Mary B.; Chen, Leway; Martin, Donald C.; Tierney, William M.; Fihn, Stephan D.

In: American Heart Journal, Vol. 142, No. 6, 2001, p. 1003-1009.

Research output: Contribution to journalArticle

Udris, EM, Au, DH, McDonell, MB, Chen, L, Martin, DC, Tierney, WM & Fihn, SD 2001, 'Comparing methods to identify general internal medicine clinic patients with chronic heart failure', American Heart Journal, vol. 142, no. 6, pp. 1003-1009. https://doi.org/10.1067/mhj.2001.119130
Udris, Edmunds M. ; Au, David H. ; McDonell, Mary B. ; Chen, Leway ; Martin, Donald C. ; Tierney, William M. ; Fihn, Stephan D. / Comparing methods to identify general internal medicine clinic patients with chronic heart failure. In: American Heart Journal. 2001 ; Vol. 142, No. 6. pp. 1003-1009.
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