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. 2023 Jun 12;13(6):e068938.
doi: 10.1136/bmjopen-2022-068938.

Validation of diagnosis of acute myocardial infarction and stroke in electronic medical records: a primary care cross-sectional study in Madrid, Spain (the e-MADVEVA Study)

Carmen de Burgos-Lunar  1   2 , Isabel Del Cura-Gonzalez  2   3 , Juan Cárdenas-Valladolid  3   4 , Paloma Gómez-Campelo  5 , Juan C Abánades-Herranz  6 , Ana Lopez-de-Andres  7 , Mercedes Sotos-Prieto  8 , Victor Iriarte-Campo  9 , Carmen Y Fuentes-Rodriguez  1 , Rafael Gómez-Coronado  1 , Miguel A Salinero-Fort  10   9
Affiliations

Validation of diagnosis of acute myocardial infarction and stroke in electronic medical records: a primary care cross-sectional study in Madrid, Spain (the e-MADVEVA Study)

Carmen de Burgos-Lunar et al. BMJ Open. .

Abstract

Objectives: To validate the diagnoses of acute myocardial infarction (AMI) and stroke recorded in electronic medical records (EMR) and to estimate the population prevalence of both diseases in people aged ≥18 years.

Design: Cross-sectional validation study.

Setting: 45 primary care centres.

Participants: Simple random sampling of diagnoses of AMI and stroke (International Classification of Primary Care-2 codes K75 and K90, respectively) registered by 55 physicians and random age-matched and sex-matched sampling of the records that included in primary care EMRs in Madrid (Spain).

Primary and secondary outcome measures: Sensitivity, specificity, positive and negative predictive values and overall agreement were calculated using the kappa statistic. Applied gold standards were ECGs, brain imaging studies, hospital discharge reports, cardiology reports and neurology reports. In the case of AMI, the ESC/ACCF/AHA/WHF Expert Consensus Document was also used. Secondary outcomes were the estimated prevalence of both diseases considering the sensitivity and specificity obtained (true prevalence).

Results: The sensitivity of a diagnosis of AMI was 98.11% (95% CI, 96.29 to 99.03), and the specificity was 97.42% (95% CI, 95.44 to 98.55). The sensitivity of a diagnosis of stroke was 97.56% (95% CI, 95.56 to 98.68), and the specificity was 94.51% (95% CI, 91.96 to 96.28). No differences in the results were found after stratification by age and sex (both diseases). The prevalence of AMI and stroke was 1.38% and 1.27%, respectively.

Conclusion: The validation results show that diagnoses of AMI and stroke in primary care EMRs constitute a helpful tool in epidemiological studies. The prevalence of AMI and stroke was lower than 2% in the population aged over 18 years.

Keywords: EPIDEMIOLOGY; Myocardial infarction; PRIMARY CARE; Stroke.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart of EMR and patients’ selection. AMI, acute myocardial infarction; EMR, electronic medical records.
Figure 2
Figure 2
Prevalence of AMI and stroke in the e-MADVEVA Study vs Spanish National Health Survey 2017. AMI, acute myocardial infarction; EMR, electronic medical record.
See this image and copyright information in PMC

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