Dale R Burwen1, Chunyuan Wu2, Dominic Cirillo3, Jacques E Rossouw4, Karen L Margolis5, Marian Limacher6, Robert Wallace7, Matthew Allison8, Charles B Eaton9, Monika Safford10, Matthew Freiberg11. 1. National Heart, Lung, and Blood Institute, Bethesda, MD, United States. Electronic address: dale.burwen@ahrq.hhs.gov. 2. Fred Hutchinson Cancer Research Center, Seattle, WA, United States. 3. University of Rochester Medical Center, Rochester, NY, United States. 4. National Heart, Lung, and Blood Institute, Bethesda, MD, United States. 5. HealthPartners Institute for Education and Research, Minneapolis, MN, United States. 6. Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, FL, United States. 7. University of Iowa, Iowa City, IA, United States. 8. University of California, San Diego, CA, United States. 9. Departments of Family Medicine and Epidemiology, Brown University, and Memorial Hospital of Rhode Island, Pawtucket, RI, United States. 10. University of Alabama, Birmingham, AL, United States. 11. Vanderbilt University, Nashville, TN, United States.
Abstract
INTRODUCTION: Our objective was to compare Medicare claims to physician review and adjudication of medical records for identifying venous thromboembolism (VTE), and to assess VTE incidence, recurrence, and mortality in a large national cohort of post-menopausal women followed up to 19years. MATERIALS AND METHODS: We used detailed clinical data from the Women's Health Initiative (WHI) linked to Medicare claims. Agreement between data sources was evaluated among 16,003 women during 1993-2010. A claims-based definition was selected to analyze VTE occurrence and impact among 71,267 women during 1993-2012. RESULTS: Our VTE definition had 83% sensitivity. Positive predictive value was 69% when all records were included, and 94% after limiting Medicare records to those with a WHI hospitalization adjudicated. Annualized VTE incidence was 4.06/1000person-years (PY), recurrence was 5.30/100PY, and both rates varied by race/ethnicity. Post-VTE mortality within 1year was 22.49% from all causes, including 1.01% from pulmonary embolism, 10.40% from cancer, and 11.08% from other causes. Cancer-related VTE compared to non-cancer VTE had significantly (p<0.001) higher recurrence (9.86/100PY vs. 4.43/100PY) and mortality from all causes (45.89% vs. 12.28%), but not from pulmonary embolism (0.40% vs. 1.27%). CONCLUSIONS: Medicare claims compared reasonably well to physician adjudication. The combined data sources provided new insights about VTE burden and prognosis in older women. Published by Elsevier Ltd.
INTRODUCTION: Our objective was to compare Medicare claims to physician review and adjudication of medical records for identifying venous thromboembolism (VTE), and to assess VTE incidence, recurrence, and mortality in a large national cohort of post-menopausal women followed up to 19years. MATERIALS AND METHODS: We used detailed clinical data from the Women's Health Initiative (WHI) linked to Medicare claims. Agreement between data sources was evaluated among 16,003 women during 1993-2010. A claims-based definition was selected to analyze VTE occurrence and impact among 71,267 women during 1993-2012. RESULTS: Our VTE definition had 83% sensitivity. Positive predictive value was 69% when all records were included, and 94% after limiting Medicare records to those with a WHI hospitalization adjudicated. Annualized VTE incidence was 4.06/1000person-years (PY), recurrence was 5.30/100PY, and both rates varied by race/ethnicity. Post-VTE mortality within 1year was 22.49% from all causes, including 1.01% from pulmonary embolism, 10.40% from cancer, and 11.08% from other causes. Cancer-related VTE compared to non-cancer VTE had significantly (p<0.001) higher recurrence (9.86/100PY vs. 4.43/100PY) and mortality from all causes (45.89% vs. 12.28%), but not from pulmonary embolism (0.40% vs. 1.27%). CONCLUSIONS: Medicare claims compared reasonably well to physician adjudication. The combined data sources provided new insights about VTE burden and prognosis in older women. Published by Elsevier Ltd.
Entities:
Keywords:
Deep venous thrombosis; Medicare claims; Pulmonary embolism; Venous thromboembolism
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