Classification of Acute Decompensated Heart Failure An Automated Algorithm Compared With a Physician Reviewer Panel: The Atherosclerosis Risk in Communities Study
Classification of Acute Decompensated Heart Failure An Automated Algorithm Compared With a Physician Reviewer Panel: The Atherosclerosis Risk in Communities Study
复制标题
DOI：
10.1161/circheartfailure.112.000195
复制
发表时间：
2013-07-01
影响因子：
9.7
通讯作者：
Heiss, Gerardo
中科院分区：
文献类型：
--
作者：
Loehr, Laura R.;Agarwal, Sunil K.;Heiss, Gerardo
一个国际专家小组最近提出了一种包括当代生物标志物和超声心动图测量的心力衰竭（HF）终点分类算法。我们的目的是评估这种同步算法对心衰分类的一致性，当应用于从社区医院记录中提取的数据时，由标准化的医生评审小组得出。方法和结果2005-2007年期间，作为社区动脉粥样硬化风险（ARIC）研究的一部分，从美国4个社区监测所有住院患者。根据国际疾病分类出院代码和人口统计数据，从55岁的男性和女性中抽取可能的HF住院病例。心衰分类算法是自动化的，并应用于2729例（n=13854例加权住院）住院患者，其中记录了脑钠肽测量或射血分数（平均年龄，75岁）。自动算法将1403例（54%,n=7534加权）事件归类为急性失代偿性心衰，ARIC评审小组将1748例（68%,n=9276加权）事件归类为急性失代偿性心衰。医师评审小组和自动算法对急性失代偿性心衰的概率校正一致性为中等（=0.39）。以ARIC评审小组为参考标准的自动算法的灵敏度和特异性分别为0.68（95%可信区间，0.67-0.69）和0.75（95%可信区间，0.74-0.76）。结论：尽管自动分类提高了效率并降低了成本，但与标准化的医师评审小组相比，其对心衰住院进行分类的准确性并不高。
Background An algorithm to classify heart failure (HF) end points inclusive of contemporary measures of biomarkers and echocardiography was recently proposed by an international expert panel. Our objective was to assess agreement of HF classification by this contemporaneous algorithm with that by a standardized physician reviewer panel, when applied to data abstracted from community-based hospital records.Methods and Results During 2005-2007, all hospitalizations were identified from 4 US communities under surveillance as part of the Atherosclerosis Risk in Communities (ARIC) study. Potential HF hospitalizations were sampled by International Classification of Diseases discharge codes and demographics from men and women aged 55 years. The HF classification algorithm was automated and applied to 2729 (n=13854 weighted hospitalizations) hospitalizations in which either brain natriuretic peptide measures or ejection fraction were documented (mean age, 75 years). There were 1403 (54%; n=7534 weighted) events classified as acute decompensated HF by the automated algorithm, and 1748 (68%; n=9276 weighted) such events by the ARIC reviewer panel. The chance-corrected agreement between acute decompensated HF by physician reviewer panel and the automated algorithm was moderate (=0.39). Sensitivity and specificity of the automated algorithm with ARIC reviewer panel as the referent standard were 0.68 (95% confidence interval, 0.67-0.69) and 0.75 (95% confidence interval, 0.74-0.76), respectively.Conclusions Although the automated classification improved efficiency and decreased costs, its accuracy in classifying HF hospitalizations was modest compared with a standardized physician reviewer panel.