Table 3.

Sensitivity of Medicare claims for detection of clinically recorded cardiovascular diagnoses and procedures, according to claims-based ascertainment algorithma

EventNo. in Clinical Database (Reference)Single claims, ±30-d Window for Claims Ascertainment (Sensitivity % [95% CI])Single Claims,Expanded Window for Claims Ascertainment (Sensitivity % [95% CI])Adapted “Hebert Method” for Diagnoses (Sensitivity % [95% CI])c
TotalMedicare EligiblebPart APart BPart A or BPart APart BPart A or B
Diagnoses
    myocardial infarction823080.0% (78.0 to 92.0%)83.3% (72.1 to 94.5%)83.3% (72.1 to 94.5%)NCNCNC80.0% (78.0 to 92.0%)
    congestive heart failure exacerbation854075.0% (63.7 to 86.3%)85.0% (75.7 to 94.3%)92.5% (85.6 to 99.4%)77.5% (66.5 to 86.4%)eNCNC92.5% (85.6 to 99.4%)
    atrial fibrillation513281.3% (67.7 to 94.8%)84.4% (71.8 to 97.0%)93.8% (85.4 to 100.0%)90.6% (80.5 to 100.0%)f87.5% (76.0 to 99.0%)e96.9% (90.9 to 100.0%)e93.8% (85.4 to 100.0%)
    stroke or transient ischemic attack271675.0% (53.8 to 96.2%)81.3% (62.1 to 100.0%)87.5% (71.3 to 100.0%)NCNCNC87.5% (71.3 to 100.0%)
    venous thromboembolism381883.3% (66.1 to 100.0%)77.8% (58.6 to 97.0%)83.3% (66.1 to 100.0%)88.9% (74.4 to 100.0%)f88.9% (74.4 to 100.0%)f94.4% (83.3 to 100.0%)f83.3% (66.1 to 100.0%)
Procedures
    cardiac catheterization642295.4% (66.7 to 100.0%)90.9% (78.9 to 100.0%)95.4% (66.7 to 100.0%)100.0%d95.4% (66.7 to 100.0%)e100.0%d
    coronary artery bypass grafting194100.0%75.0% (32.6 to 100.0%)100.0%NCNCNC
    amputation258100.0%87.5% (64.6 to 100.0%)100.0%NCNCNC
    peripheral revascularization21683.3% (53.5 to 100.0%)100.0%100.0%NCNCNC
  • a CI, confidence interval.

  • b Claims sensitivity was computed using a reference standard of events recorded in the clinical database among Medicare-insured transplant recipients with sustained Medicare benefits at the time of the clinical event of interest.

  • c Diagnoses based on one Part A claim or two Part B claims submitted at least 1 d but no more than 365 d apart, in which case the latest claim date is defined as date of diagnosis; final diagnosis date was allowed to fall up to 30 d after the date in the clinical record. Medicare Part A represents institutional claims; Medicare Part B represents physician/suppliers.

    Expanded claims-ascertainment windows were explored at

  • d ±45,

  • e ±60, and

  • f ±90 d. Results for the narrowest expanded window that maximized detection of events in the clinical record are reported. NC, no change in sensitivity with expanded window up to ±90 d.