Sensitivity, specificity, positive and negative predictive values of identifying atrial fibrillation using administrative data: a systematic review and meta-analysis

Abstract

Introduction

Atrial fibrillation (AF) is the commonest arrhythmia and a major cause of stroke and health care utilization. Researchers and administrators use electronic health data to assess disease burden, quality and variance in care, value of interventions and prognosis. We performed a systematic review and meta-analysis to assess the validity of AF case definitions in administrative databases.

Methods

Medline was searched from 2000 to 2018. Extracted information included sensitivity, specificity, positive and negative predictive values (PPV and NPV) for various AF case definitions. Estimates were pooled using random-effects models due to significant heterogeneity between studies.

Results

We identified 24 studies, including 21 from North America or Scandinavia. Hospital, ambulatory and mixed data sources were assessed in 10, 4 and 10 studies, respectively. Nine different AF case definitions were evaluated, most based on ICD-9 or 10 codes. Twenty-two studies assessed case definitions in patients diagnosed with AF and thus could generate PPV alone. Half the studies sampled unrestricted populations including a mix of those with and without AF to assess sensitivity. Only 13 studies included ECG confirmation as a gold standard. The pooled random effects estimates were: sensitivity 80% (95% CI 72–86%); specificity 98% (96–99%); PPV 88% (82–94%); NPV 97% (94–99%). Only 3 studies reported all accuracy parameters and included rhythm monitoring in the gold standard definition.

Conclusion

Relatively few studies examined sensitivity, and fewer still included rhythm monitoring in the gold standard comparison. Administrative data may fail to identify a significant proportion of patients with AF. This, in turn, may bias estimates of quality of care and prognosis.

Keywords:

• atrial fibrillation
• registries
• validation studies
• accuracy
• sensitivity
• specificity

Abbreviations

AF, atrial fibrillation; AFL, atrial flutter; ICD, International Classification of Diseases; NPV, negative predictive value; PPV, positive predictive value; Sn, sensitivity; Sp, specificity.

Author contributions

All authors contributed toward data analysis, drafting and revising the paper, gave final approval of the version to be published and agree to be accountable for all aspects of the work.

Disclosure

Drs Deyell and Andrade are recipients of Career Scholar awards from the Michael Smith Foundation for Health Research. Dr Hawkins is supported by a Vancouver Coastal Health Clinician Scientist Award, and is the UBC Dr Charles Kerr Distinguished Scholar in Heart Rhythm Management. Dr McAlister is supported by the Alberta Health Services Chair in Cardiovascular Outcomes Research. The authors report no other conflicts of interest in this work.

Supplementary materials

Table S1 PRISMA checklist

Table S2 Search strategy

Figure S1 Flow diagram of study selection.