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. 2019 May;12(5):e007451.
doi: 10.1161/CIRCINTERVENTIONS.118.007451.

Use of Medicare Claims to Identify Adverse Clinical Outcomes After Mitral Valve Repair

Angela Lowenstern  1   2 , Steven J Lippmann  3 , J Matthew Brennan  1   2 , Tracy Y Wang  1   2 , Lesley H Curtis  3   2 , Ted Feldman  4 , Donald D Glower  5 , Bradley G Hammill  3   2 , Sreekanth Vemulapalli  1   2
Affiliations

Use of Medicare Claims to Identify Adverse Clinical Outcomes After Mitral Valve Repair

Angela Lowenstern et al. Circ Cardiovasc Interv. 2019 May.

Abstract

Background: Clinical event committees are commonly employed for event validation in clinical studies, but little is known about the comparative performance of administrative claims data versus clinician-triggered event adjudication for ascertainment of adverse events in structural heart disease studies.

Methods and results: Medicare claims were linked to 418 patients >65 years of age who underwent transcatheter mitral valve repair (MitraClip) for severe mitral regurgitation from 2007 to 2013 as part of the EVEREST II (Endovascular Valve Edge-to-Edge Repair Study II) High-Risk Registry or the REALISM (Real World Expanded Multicenter Study of the MitraClip System) Continued-Access Registry. Each registry adjudicated mortality, heart failure hospitalization, renal failure, ventilation, and bleeding/transfusion within 1 year. Concordance of claims-based outcomes with events was assessed in 3 ways: 1-year occurrence, cumulative incidence, and synchrony of first events. For event occurrence, positive predictive value (PPV) of claims versus adjudication was the highest for mortality (PPV=97%) and heart failure hospitalization (PPV=69%) but lower for bleeding (PPV=40%) and renal failure (PPV=19%). Whereas claims-based cumulative incidence for mortality, heart failure hospitalization, and renal failure were consistent with clinician-triggered adjudication, incidence curves for bleeding events and ventilation diverged, with claims identifying a greater number of events. When events were detected by both methods, however, over 75% of event dates matched exactly. Mitral valve reinterventions were identified through claims with perfect sensitivity and specificity relative to physician adjudication.

Conclusions: Ascertainment of mortality, heart failure hospitalization, and renal failure was highly concordant between physician adjudication and administrative claims. Further work is necessary to determine the role of administrative claims in event ascertainment in both prospective and retrospective studies of structural heart disease.

Keywords: heart failure; humans; mitral valve; mitral valve insufficiency; registries.

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Figures

Central Figure:
Central Figure:
Cumulative Incidence of Events Identified by Physician Adjudication versus Claims Data a) Mortality; b) Renal Failure; c) Heart Failure Hospitalization; d) Ventilation; e) Bleeding
Figure 1:
Figure 1:
Study Cohort
Figure 2:
Figure 2:
Cumulative Incidence of a) mortality b) heart failure hospitalization c) renal failure d) ventilation and e) bleeding in the first year after index MitraClip
Figure 2:
Figure 2:
Cumulative Incidence of a) mortality b) heart failure hospitalization c) renal failure d) ventilation and e) bleeding in the first year after index MitraClip
Figure 2:
Figure 2:
Cumulative Incidence of a) mortality b) heart failure hospitalization c) renal failure d) ventilation and e) bleeding in the first year after index MitraClip
Figure 2:
Figure 2:
Cumulative Incidence of a) mortality b) heart failure hospitalization c) renal failure d) ventilation and e) bleeding in the first year after index MitraClip
Figure 3.
Figure 3.
Synchrony of matched first event dates in the registry data those in the Medicare claims data. A difference of <0 signifies that the registry event date preceded the CMS event date. Outcomes with only 1 definition are included in both sets. Least restrictive definitions include: Bleeding, definition 4; Heart Failure, definition 4; Renal Failure, definition 4; Ventilation, definition 1 Most restrictive definitions include: Bleeding, definition 1; Heart Failure, definition 1; Renal Failure, definition 1; Ventilation, definition 1
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Comment in

  • Putting Theory to the Test.
    Strom JB, Yeh RW. Strom JB, et al. Circ Cardiovasc Interv. 2019 May;12(5):e007953. doi: 10.1161/CIRCINTERVENTIONS.119.007953. Circ Cardiovasc Interv. 2019. PMID: 31084240 Free PMC article. No abstract available.

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