Identifying heart failure using EMR-based algorithms.

BACKGROUND: Heart failure (HF) is a major clinical and public health problem, the management of which will benefit from large-scale pragmatic research that leverages electronic medical records (EMR). Requisite to using EMRs for HF research is the development of reliable algorithms to identify HF patients. We aimed to develop and validate computable phenotype algorithms to identify patients with HF using standardized data elements defined by the Patient Centered Outcomes Research Network (PCORnet) Common Data Model (CDM).
METHODS: We built HF computable phenotypes utilizing the data domains of HF diagnosis codes, prescribed HF-related medications and N-terminal B-type natriuretic peptide (NT-proBNP). Algorithms were validated in a cohort (n = 76,254) drawn from Olmsted County, MN between 2010-2012 a sample of whose records were manually reviewed to confirm HF according to Framingham criteria.
RESULTS: The different algorithms we tested provided different tradeoffs between sensitivity and positive predictive value (PPV). The highest sensitivity (78.7%) algorithm utilized one HF diagnosis code and had the lowest PPV (68.5%). The addition of more algorithm components, such as additional HF diagnosis codes, HF medications or elevated NT-proBNP, improved the PPV while reducing sensitivity. When added to a diagnostic code, the addition of NT-proBNP (>450 pg/mL) had a similar impact compared to additional HF medication criteria, increasing PPV by ∼3-4% and decreasing sensitivity by ∼7-10%.
CONCLUSIONS: Algorithms derived from PCORnet CDM elements can be used to identify patients with HF without manual adjudication with reasonable sensitivity and PPV. Algorithm choice should be driven by the goal of the research.