An algorithm to identify incident myocardial infarction using Medicaid data

• Published in: Pharmacoepidemiology and drug safety Vol. 18; no. 11; pp. 1064 - 1071
• Main Authors: Choma, Neesha N., Griffin, Marie R., Huang, Robert L., Mitchel, Edward F., Kaltenbach, Lisa A., Gideon, Patricia, Stratton, Shannon M., Roumie, Christianne L.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.11.2009
• Subjects: Aged; Aged, 80 and over; Algorithms; Anti-Inflammatory Agents, Non-Steroidal - administration & dosage; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Cohort Studies; Female; Humans; ICD-9; Incidence; Male; Medicaid; Medicaid - statistics & numerical data; Middle Aged; myocardial infarction; Myocardial Infarction - chemically induced; Myocardial Infarction - epidemiology; Retrospective Studies; Tennessee - epidemiology; United States - epidemiology; validation; United States; Tennessee
• ISSN: 1053-8569; 1099-1557
• DOI: 10.1002/pds.1821

Purpose Studies of non‐steroidal anti‐inflammatory drugs (NSAIDs) and cardiovascular events using administrative data require identification of incident acute myocardial infarctions (AMIs) and information on whether confounders differ by NSAID status. Methods We identified patients with a first AMI hospitalization from Tennessee Medicaid files as those with primary ICD‐9 discharge diagnosis 410.x and hospitalization stay of > 2 calendar days. Eligible persons were non‐institutionalized, aged 50–84 years between 1999–2004, had continuous enrollment and no AMI, stroke, or non‐cardiovascular serious medical illness in the prior year. Of 5524 patients with a potential first AMI, a systematic sample (n = 350) was selected for review. Using defined criteria, we classified events using chest pain history, EKG, and cardiac enzymes, and calculated the positive predictive value (PPV) for definite or probable AMI. Results 337 of 350 (96.3%) charts were ed and 307 (91.1%), 6 (1.8%), and 24 (7.1%) events were categorized as definite, probable, and no AMI, respectively. PPV for any definite or probable AMI was 92.8% (95% CI 89.6–95.2); for an AMI without an event in the past year 91.7% (95% CI 88.3–94.2), and for an incident AMI was 72.7% (95% CI 67.7–77.2). Age‐adjusted prevalence of current smoking (46.4% vs. 39.1%, p = 0.35) and aspirin use (36.9% vs. 35.9%, p = 0.90) was similar among NSAID users and non‐users Conclusions ICD‐9 code 410.x had high predictive value for identifying AMI. Among those with AMI, smoking and aspirin use was similar in NSAID exposure groups, suggesting these factors will not confound the relationship between NSAIDs and cardiovascular outcomes. Copyright © 2009 John Wiley & Sons, Ltd.