Sensitivity, specificity, positive and negative predictive values of identifying atrial fibrillation using administrative data: a systematic review and meta-analysis
Received 21 February 2019
Accepted for publication 29 April 2019
Published 23 August 2019 Volume 2019:11 Pages 753—767
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 3
Editor who approved publication: Professor Henrik Toft Sørensen
Ren Jie Robert Yao,1 Jason G Andrade,1 Marc W Deyell,1 Heather Jackson,2 Finlay A McAlister,3 Nathaniel M Hawkins1
1Division of Cardiology, University of British Columbia, Vancouver, Canada; 2Cardiac Services British Columbia, Vancouver, Canada; 3Division of General Internal Medicine, University of Alberta, Edmonton, Canada
Correspondence: Nathaniel M Hawkins
University of British Columbia, BC Centre for Improved Cardiovascular Health, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
Tel +1 604 875 4111
Fax +1 604 875 5504
Introduction: Atrial fibrillation (AF) is the commonest arrhythmia and a major cause of stroke and health care utilization. Researchers and administrators use electronic health data to assess disease burden, quality and variance in care, value of interventions and prognosis. We performed a systematic review and meta-analysis to assess the validity of AF case definitions in administrative databases.
Methods: Medline was searched from 2000 to 2018. Extracted information included sensitivity, specificity, positive and negative predictive values (PPV and NPV) for various AF case definitions. Estimates were pooled using random-effects models due to significant heterogeneity between studies.
Results: We identified 24 studies, including 21 from North America or Scandinavia. Hospital, ambulatory and mixed data sources were assessed in 10, 4 and 10 studies, respectively. Nine different AF case definitions were evaluated, most based on ICD-9 or 10 codes. Twenty-two studies assessed case definitions in patients diagnosed with AF and thus could generate PPV alone. Half the studies sampled unrestricted populations including a mix of those with and without AF to assess sensitivity. Only 13 studies included ECG confirmation as a gold standard. The pooled random effects estimates were: sensitivity 80% (95% CI 72–86%); specificity 98% (96–99%); PPV 88% (82–94%); NPV 97% (94–99%). Only 3 studies reported all accuracy parameters and included rhythm monitoring in the gold standard definition.
Conclusion: Relatively few studies examined sensitivity, and fewer still included rhythm monitoring in the gold standard comparison. Administrative data may fail to identify a significant proportion of patients with AF. This, in turn, may bias estimates of quality of care and prognosis.
Keywords: atrial fibrillation, registries, validation studies, accuracy, sensitivity, specificity
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