Identification of Heart Failure Events in Medicare Claims: The Atherosclerosis Risk in Communities (ARIC) Study

Anna M. Kucharska-Newton, Gerardo Heiss, Hanyu Ni, Sally C. Stearns, Nicole Puccinelli-Ortega, Lisa M. Wruck, Lloyd Chambless

Research output: Contribution to journalArticlepeer-review

56 Scopus citations


Background We examined the accuracy of Medicare heart failure (HF) diagnostic codes in the identification of acute decompensated (ADHF and chronic stable (CSHF) HF. Methods and Results Hospitalizations were identified from medical discharge records for Atherosclerosis Risk in Communities (ARIC) study participants with linked Medicare Provider Analysis and Review (MedPAR) files for the years 2005-2009. The ARIC study classification of ADHF and CSHF, based on adjudicated review of medical records, was considered to be the criterion standard. A total 8,239 ARIC medical records and MedPAR records meeting fee-for-service (FFS) criteria matched on unique participant ID and date of discharge (68.5% match). Agreement between HF diagnostic codes from the 2 data sources found in the matched records for codes in any position (κ > 0.9) was attenuated for primary diagnostic codes (κ < 0.8). Sensitivity of HF diagnostic codes found in Medicare claims in the identification of ADHF and CSHF was low, especially for the primary diagnostic codes. Conclusion Matching of hospitalizations from Medicare claims with those obtained from abstracted medical records is incomplete, even for hospitalizations meeting FFS criteria. Within matched records, HF diagnostic codes from Medicare show excellent agreement with HF diagnostic codes obtained from medical record abstraction. The Medicare data may, however, overestimate the occurrence of hospitalized ADHF or CSHF.

Original languageEnglish
Pages (from-to)48-55
Number of pages8
JournalJournal of Cardiac Failure
Issue number1
StatePublished - 2016

Bibliographical note

Publisher Copyright:
© 2016 Elsevier Inc. All rights reserved.


  • Heart failure
  • Medicare claims
  • diagnostic codes
  • validation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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