Validation of Medication Proxies for the Identification of Hospitalizations for Major Adverse Cerebro-Cardiovascular Events.

IF 3.4 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology Pub Date : 2025-03-28 eCollection Date: 2025-01-01 DOI:10.2147/CLEP.S508754

Dennis Steenhuis, Xuechun Li, Talitha L Feenstra, Eelko Hak

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引用次数: 0

Abstract

Purpose: To date, complete and long-term registrations of diseases and events are not available in every situation. As a useful proxy, medication usage data is very promising. For instance, real-world dispensing data from pharmacies are attractive because of the high validity of drug dispensing data, large sample sizes, and long-term registration. However, before application as a proxy, validity must be assessed. Therefore, in this study, we aim to assess the validity of various medicines used as a proxy for major adverse cardio-cerebrovascular events (MACCE), that is, to identify an incident or previous hospitalization for a MACCE.

Patients and methods: Using the claims database of a large Dutch healthcare insurer, we estimated the concordance between hospitalization claims for MACCE and specific claims for dispensings to treat MACCE in a cohort of patients on primary preventive antihypertensive and/or antihyperlipidemic therapy between 2013 and 2020.

Results: In a cohort of more than 110,000 patients, a dispensing of either vitamin K antagonists, platelet aggregation inhibitors, or nitrates was predictive of an incident hospitalization for a MACCE between 2013 and 2020, with a sensitivity of 71.5% (95% CI: 70.4-72.5%) and specificity of 93.2% (95% CI 91.1-93.4%), and any history of hospitalization for a MACCE (prevalence) with a sensitivity of 86.9% (95% CI: 86.5-87.3%) and specificity of 81.9 (956% CI: 81.6-82.1%), while positive predicted value remains low. Sensitivity analyses across age, sex, and patients with asthma/COPD or diabetes showed a similarly good performance.

Conclusion: Claims for the dispensings of vitamin K antagonists, platelet aggregation inhibitors, and/or nitrates can be validly used as a proxy for new and previous hospitalization for MACCE in patients on primary preventive therapy. Further study is required to assess the validity of such dispensing claims for non-hospitalized cerebro-cardiovascular events and whether the results are generalizable in non-Dutch cohorts.

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确认主要不良脑血管事件住院治疗的药物替代指标。

目的：迄今为止，并不是在每种情况下都有完整和长期的疾病和事件登记。作为一个有用的代理，药物使用数据是非常有希望的。例如，来自药店的真实调剂数据具有吸引力，因为药物调剂数据的高有效性、大样本量和长期注册。然而，在申请代理之前，必须评估有效性。因此，在本研究中，我们的目的是评估各种药物作为主要不良心脑血管事件（MACCE）代理的有效性，即确定MACCE事件或既往住院。患者和方法：使用荷兰一家大型医疗保险公司的索赔数据库，我们估计了2013年至2020年间一组接受初级预防降压和/或抗高脂血症治疗的MACCE住院索赔与配药治疗MACCE的具体索赔之间的一致性。结果：在超过11万名患者的队列中，分配维生素K拮抗剂、血小板聚集抑制剂或硝酸盐可预测2013年至2020年间MACCE住院事件，敏感性为71.5% (95% CI: 70.4-72.5%)，特异性为93.2% (95% CI: 91.1-93.4%)，任何MACCE住院史（患病率）的敏感性为86.9% (95% CI: 86.5-87.3%)，特异性为81.9 (956% CI：81.6-82.1%)，阳性预测值仍然较低。跨年龄、性别、哮喘/慢性阻塞性肺病或糖尿病患者的敏感性分析显示出类似的良好表现。结论：维生素K拮抗剂、血小板聚集抑制剂和/或硝酸盐的配药主张可以有效地用作MACCE患者新住院和既往住院治疗的替代指标。需要进一步的研究来评估这种分配声明对非住院脑血管事件的有效性，以及结果是否可推广到非荷兰队列。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Epidemiology Medicine-Epidemiology

CiteScore

6.30

自引率

5.10%

发文量

169

审稿时长

16 weeks

期刊介绍： Clinical Epidemiology is an international, peer reviewed, open access journal. Clinical Epidemiology focuses on the application of epidemiological principles and questions relating to patients and clinical care in terms of prevention, diagnosis, prognosis, and treatment. Clinical Epidemiology welcomes papers covering these topics in form of original research and systematic reviews. Clinical Epidemiology has a special interest in international electronic medical patient records and other routine health care data, especially as applied to safety of medical interventions, clinical utility of diagnostic procedures, understanding short- and long-term clinical course of diseases, clinical epidemiological and biostatistical methods, and systematic reviews. When considering submission of a paper utilizing publicly-available data, authors should ensure that such studies add significantly to the body of knowledge and that they use appropriate validated methods for identifying health outcomes. The journal has launched special series describing existing data sources for clinical epidemiology, international health care systems and validation studies of algorithms based on databases and registries.