Comparable Ascertainment of Newly-Diagnosed Atrial Fibrillation Using Active Cohort Follow-Up versus Surveillance of Centers for Medicare and Medicaid Services in the Atherosclerosis Risk in Communities Study
Comparable Ascertainment of Newly-Diagnosed Atrial Fibrillation Using Active Cohort Follow-Up versus Surveillance of Centers for Medicare and Medicaid Services in the Atherosclerosis Risk in Communities Study
复制标题
DOI：
10.1371/journal.pone.0094321
复制
发表时间：
2014-04-11
期刊：
影响因子：
3.7
通讯作者：
Alonso, Alvaro
中科院分区：
文献类型：
--
作者：
Bengtson, Lindsay G. S.;Kucharska-Newton, Anna;Alonso, Alvaro
目的：流行病学研究越来越多地使用管理数据来识别房颤(AF)。事件自动对焦的捕获没有很好的记录。在社区动脉粥样硬化风险研究中，我们基于积极的队列随访和医疗保险和医疗补助服务中心的监测数据，检验了房颤诊断的发生率和一致性。方法：包括1991年至2009年连续至少12个月的住院和门诊覆盖的社区队列参与者中没有普遍房颤的患者的住院和门诊保险。在积极的社区动脉粥样硬化风险研究随访中，年度电话记录了住院和死亡情况，并带有房颤诊断代码。结果：在10,134名符合条件的队列参与者中，根据社区动脉粥样硬化风险和医疗保险和医疗补助服务中心的数据，738人患上了房颤；仅使用社区动脉粥样硬化风险和医疗保险和医疗补助服务中心的数据，分别确定了另外93例和288例事件房颤。社区和医疗保险和医疗补助服务中心的动脉粥样硬化风险每千人年发病率分别为10.8(95%可信区间：10.1-11.6)和13.6(95%可信区间：12.8-14.4)；符合率为96%；kappa为0.77(95%可信区间：0.75-0.80)。在考虑了社会人口学因素后，一个系统比另一个系统更早地确定房颤与任何心血管疾病风险因素无关。额外的医疗保险和医疗补助服务事件中心没有改变观察到的危险因素和房颤之间的关联。结论：在按服务付费的参与者中，积极队列随访的房颤发生率略低于医疗保险和医疗补助服务监测中心，因为后者包括门诊房颤。符合率很高，结合这两种方法可以提供新诊断的房颤的更完整的图像。
Objective: Increasingly, epidemiologic studies use administrative data to identify atrial fibrillation (AF). Capture of incident AF is not well documented. We examined incidence rates and concordance of AF diagnosis based on active cohort follow-up versus surveillance of Centers for Medicare and Medicaid Services data in the Atherosclerosis Risk in Communities study.Methods: Atherosclerosis Risk in Communities cohort participants without prevalent AF enrolled in fee-for-service Medicare, with inpatient and outpatient coverage, for at least 12 continuous months between 1991 and 2009 were included. In active Atherosclerosis Risk in Communities study follow-up, annual telephone calls captured hospitalizations and deaths with incident AF diagnosis codes. For Centers for Medicare and Medicaid Services data, incident AF was defined by billed inpatient and outpatient diagnoses.Results: Of 10,134 eligible cohort participants, 738 developed AF according to both Atherosclerosis Risk in Communities and Centers for Medicare and Medicaid Services data; an additional 93 and 288 incident cases were identified using only Atherosclerosis Risk in Communities and Centers for Medicare and Medicaid Services data, respectively. Incidence rates per 1,000 person-years were 10.8 (95% confidence interval: 10.1-11.6) and 13.6 (95% confidence interval: 12.8-14.4) in Atherosclerosis Risk in Communities and Centers for Medicare and Medicaid Services, respectively; agreement was 96%; kappa was 0.77 (95% confidence interval: 0.75-0.80). Earlier AF ascertainment by one system versus the other was not associated with any cardiovascular disease risk factors, after accounting for sociodemographic factors. Additional Centers for Medicare and Medicaid Services events did not alter observed associations between risk factors and AF.Conclusion: Among fee-for-service enrollees, AF incidence rates were slightly lower for active cohort follow-up than for Centers for Medicare and Medicaid Services surveillance, because the latter included outpatient atrial fibrillation. Concordance was high and combining the two approaches could provide a more complete picture of newly-diagnosed AF.