1Department of Medicine, University of Massachusetts Medical School, Baystate Medical Center, Springfield, Massachusetts; 2Division of Public Health Policy, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts; 3Division of Cardiovascular Medicine, University of Massachusetts Medical School, Baystate Medical Center, Springfield, Massachusetts; 4Institute for Healthcare Delivery and Population Science at University of Massachusetts Medical School, Baystate, Springfield, Massachusetts.
Disclosures
All authors report no conflicts of interest.
Funding
Dr. Pack was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health, under Award Number 1K23HL135440. Dr. Lagu was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health, under Award Number K01HL114745. Dr. Lindenauer was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number 1K24HL132008
Prior studies of stress cardiomyopathy (SCM) have used International Classification of Diseases (ICD) codes to identify patients in administrative databases without evaluating the validity of these codes. Between 2010 and 2016, we identified 592 patients discharged with a first known principal or secondary ICD code for SCM in our medical system. On chart review, 580 charts had a diagnosis of SCM (positive predictive value 98%; 95% CI: 96.4-98.8), although 38 (6.4%) did not have active clinical manifestations of SCM during the hospitalization. Moreover, only 66.8% underwent cardiac catheterization and 91.5% underwent echocardiography. These findings suggest that, although all but a few hospitalized patients with an ICD code for SCM had a diagnosis of SCM, some of these were chronic cases, and numerous patients with a new diagnosis of SCM did not undergo a complete diagnostic workup. Researchers should be mindful of these limitations in future studies involving administrative databases.
