Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Dec;30(12):1630-1634.
doi: 10.1002/pds.5361. Epub 2021 Oct 1.

Physician adjudication of angioedema diagnosis codes in a population of patients with heart failure prescribed angiotensin-converting enzyme inhibitor therapy

Elizabeth T Mansi  1   2 , Eric S Johnson  2 , Micah L Thorp  3 , Alan S Go  4 , Ming-Sum Lee  5 , Albert Yuh-Jer Shen  5 , Ken J Park  3 , Katarzyna Budzynska  6 , Abraham Markin  7 , Sue Hee Sung  4 , Jamie H Thompson  2 , Matthew T Slaughter  2 , Tiffany Q Luong  8 , Jaejin An  8 , Kristi Reynolds  8 , Douglas W Roblin  9 , Andrea E Cassidy-Bushrow  10 , Jennifer L Kuntz  2 , Raymond G Schlienger  11 , Sigrid Behr  11 , David H Smith  2
Affiliations

Physician adjudication of angioedema diagnosis codes in a population of patients with heart failure prescribed angiotensin-converting enzyme inhibitor therapy

Elizabeth T Mansi et al. Pharmacoepidemiol Drug Saf. 2021 Dec.

Abstract

Purpose: Our objective was to calculate the positive predictive value (PPV) of the ICD-9 diagnosis code for angioedema when physicians adjudicate the events by electronic health record review. Our secondary objective was to evaluate the inter-rater reliability of physician adjudication.

Methods: Patients from the Cardiovascular Research Network previously diagnosed with heart failure who were started on angiotensin-converting enzyme inhibitors (ACEI) during the study period (July 1, 2006 through September 30, 2015) were included. A team of two physicians per participating site adjudicated possible events using electronic health records for all patients coded for angioedema for a total of five sites. The PPV was calculated as the number of physician-adjudicated cases divided by all cases with the diagnosis code of angioedema (ICD-9-CM code 995.1) meeting the inclusion criteria. The inter-rater reliability of physician teams, or kappa statistic, was also calculated.

Results: There were 38 061 adults with heart failure initiating ACEI in the study (21 489 patient-years). Of 114 coded events that were adjudicated by physicians, 98 angioedema events were confirmed for a PPV of 86% (95% CI: 80%, 92%). The kappa statistic based on physician inter-rater reliability was 0.65 (95% CI: 0.47, 0.82).

Conclusions: ICD-9 diagnosis code of 995.1 (angioneurotic edema, not elsewhere classified) is highly predictive of angioedema in adults with heart failure exposed to ACEI.

Keywords: ACE inhibitor; adjudication; angioedema; angioneurotic edema; angiotensin-converting enzyme inhibitor.

PubMed Disclaimer

References

REFERENCES

    1. Brown T, Gonzalez J, Monteleone C. Angiotensin-converting enzyme inhibitor-induced angioedema: a review of the literature. J Clin Hypertens. 2017;19(12):1377-1382. https://doi.org/10.1111/jch.13097
    1. Miller DR, Oliveria SA, Berlowitz DR, Fincke BG, Stang P, Lillienfeld DE. Angioedema incidence in US veterans initiating angiotensin-converting enzyme inhibitors. Hypertension. 2008;51(6):1624-1630. https://doi.org/10.1161/HYPERTENSIONAHA.108.110270
    1. Brown NJ, Ray WA, Snowden M, Griffin MR. Black Americans have an increased rate of angiotensin converting enzyme inhibitor-associated angioedema. Clin Pharmacol Ther. 1996;60(1):8-13. https://doi.org/10.1016/S0009-9236(96)90161-7
    1. Brown NJ, Byiers S, Carr D, Maldonado M, Warner BA. Dipeptidyl peptidase-IV inhibitor use associated with increased risk of ACE inhibitor-associated angioedema. Hypertension. 2009;54(3):516-523. https://doi.org/10.1161/HYPERTENSIONAHA.109.134197
    1. Carucci L, Bova M, Petraroli A, et al. Angiotensin-converting enzyme inhibitor-associated angioedema: from bed to bench. J Investig Allergol Clin Immunol. 2020;30(4):272-280. https://doi.org/10.18176/jiaci.0458

Publication types

MeSH terms

Substances

LinkOut - more resources