Pulmonary Arterial Hypertension Identified in Administrative Data Using Collection of Algorithms

A collection of algorithms for detecting pulmonary arterial hypertension (PAH) has been developed to enhance the integrity and value of research findings, better inform policy decisions, and improve quality of care and health for patients, according to study results published in CHEST.

Much of our understanding of PAH stems from single-center studies, which are limited by sample size and generalizability. Currently, there are no standardized, validated methods for distinguishing PAH from other subgroups of pulmonary hypertension (PH) within administrative data. Therefore, researchers aimed to develop and validate a collection of algorithms to detect PAH in administrative data in 2 diverse settings — all Veterans Health Administration (VA) hospitals and the Boston Medical Center (BMC) — by identifying adult patients with incident PH from 2006 to 2017 using International Classification of Diseases (ICD) diagnosis codes.

From this baseline cohort, the following criteria were sequentially applied: diagnosis codes for PAH-associated conditions, procedure codes for right heart catheterizations (RHC), and pharmacy claims for PAH-specific therapy. Each algorithm was validated using a gold standard review of primary clinical data, and sensitivity, specificity, positive predictive values (PPV), and negative predictive values were calculated.

The researchers identified 12,012 patients with PH in VA and 503 patients in BMC; sole use of PH diagnosis codes performed poorly in identifying PAH (PPV, 16.0% in VA; PPV, 36.0% in BMC). However, addition of PAH-associated conditions to the algorithm modestly improved PPV. The best performing algorithm required ICD diagnosis codes, RHC codes, and PAH-specific therapy (specificity, 97.1%; PPV, 70.0% in VA; specificity, 95.0%; PPV, 86.0% in BMC).

“This set of validated algorithms to identify PAH in administrative data can be used by the PAH scientific and clinical community to enhance the reliability and value of research findings, to inform quality improvement initiatives, and to ultimately improve health for PAH patients,” the study authors concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Gillmeyer KR, Nunez ER, Rinne ST, Qian SX, Klings ES, Wiener RS. Development and validation of algorithms to identify pulmonary arterial hypertension in administrative data. CHEST. Published on December 17, 2020. doi:10.1016/j.chest.2020.12.010