Performance of Electronic Health Record Diagnosis Codes for Ambulatory Heart Failure Encounters.

BACKGROUND: There is interest in leveraging the electronic medical record (EMR) to improve knowledge and understanding of patient characteristics and outcomes of ambulatory heart failure (HF) patients. However, the diagnostic performance of ICD-10 diagnosis codes from the EMR for patients with heart failure with reduced and preserved ejection fraction (HFrEF and HFpEF) in the ambulatory setting are unknown.

METHODS: We examined a cohort of patients aged ≥18 with at least 1 outpatient encounter for HF between January 2016 and June 2018, and an echocardiogram conducted within 180 days of the outpatient encounter for HF. We defined HFrEF encounters as those with ICD-10 codes of I50.2x (systolic heart failure); and defined HFpEF encounters as those with ICD-10 codes of I50.3x (diastolic heart failure). The referent definitions of HFrEF and HFpEF were based on echocardiograms conducted within 180 days of the ambulatory encounter for HF RESULTS: We examined 68,952 encounters among 14,796 unique patients with HF. The diagnostic performance parameters for HFrEF (based on ICD-10 I50.2x only) depended on LVEF cutoff, with a sensitivity ranging from 68-72%, specificity 63-68%, PPV 47-63%, and NPV 73-84%. The diagnostic performance parameters for HFpEF depended on LVEF cutoff, with a sensitivity ranging from 34-39%, specificity 92-94%, PPV 86-93%, and NPV 39%-54%.

CONCLUSIONS: ICD-10 coding abstracted from the EMR for HFrEF vs. HFpEF in the ambulatory setting had suboptimal diagnostic performance, and thus should not be used alone to examine HFrEF and HFpEF in the ambulatory setting.