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Translating claims‐based CHA 2 DS 2 ‐VaSc and HAS‐BLED to ICD‐10‐CM: Impacts of mapping strategies
Author(s) -
WebsterClark Michael,
Huang TingYing,
Hou Laura,
Toh Sengwee
Publication year - 2020
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.4973
Subject(s) - medicine , confidence interval , atrial fibrillation , stroke (engine) , oral anticoagulant , pharmacoepidemiology , pediatrics , icd 10 , diagnosis code , cardiology , warfarin , population , medical prescription , mechanical engineering , environmental health , psychiatry , engineering , pharmacology
Purpose The CHA 2 DS 2 ‐VaSc and HAS‐BLED risk scores are commonly used in the studies of oral anticoagulants (OACs). The best ways to map these scores to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD‐10‐CM) codes is unclear, as is how they perform in various types of OAC users. We aimed to assess the distributions of CHA 2 DS 2 ‐VaSc and HAS‐BLED scores and C‐statistics for outcome prediction in the ICD‐10‐CM era using different mapping strategies. Methods We compared the distributions of CHA 2 DS 2 ‐VaSc and HAS‐BLED scores from various mapping strategies in atrial fibrillation patients before, during, and after ICD‐10‐CM transition. We estimated the C‐statistics predicting the 90‐day risk of hospitalized stroke (for CHA 2 DS 2 ‐VaSc) or hospitalized bleeding (for HAS‐BLED) in patients identified at least 6 months after the ICD‐10‐CM transition, overall and by anticoagulant type. Results Forward‐backward mapping produced higher CHA 2 DS 2 ‐VaSc and HAS‐BLED scores in the ICD‐10‐CM era compared to the ICD‐9‐CM era: the mean difference was 0.074 (95% confidence interval 0.064‐0.085) for CHA 2 DS 2 ‐VaSc and 0.055 (0.048‐0.062) for HAS‐BLED. Both scores had higher C‐statistics in patients taking no OACs (0.697 [0.677‐0.717] for CHA 2 DS 2 ‐VaSc; 0.719 [0.702‐0.737] for HAS‐BLED) or direct OACs (0.695 [0.654‐0.735] for CHA 2 DS 2 ‐VaSc; 0.700 [0.673‐0.728] for HAS‐BLED) than those taking warfarin (0.655 [0.613‐0.697] for CHA 2 DS 2 ‐VaSc; 0.663 [0.6320.695] for HAS‐BLED). Conclusions Existing mapping strategies generally preserved the distributions of CHA 2 DS 2 ‐VaSc and HAS‐BLED scores after ICD‐10‐CM transition. Both scores performed better in patients on no OACs or direct OACs than patients on warfarin.