Cohort Definition Name : Earliest event of Coronary artery disease (CAD)
Contributor name : Joel Swerdel’
Contributor OrcId :
Logic Description : Earliest event of Coronary Artery Disease for the first time in the persons history Indexed on coronary artery disease diagnosis (condition or observation) cohort exit is the end of continuous observation.
Recommended study application : target
Assertion statement : This cohort definition was executed on at least one real person-level observational health data source and resulted in a cohort with at least 1 person.
Target Clinical Description : Coronary Artery disease or CAD is associated with inadequate blood supply to the myocardium (heart muscle). A buildup of plaque can narrow these arteries, decreasing blood flow to your heart. Eventually, the reduced blood flow may cause chest pain (angina), shortness of breath, or other coronary artery disease signs and symptoms. A complete blockage can cause a heart attack.
"Evaluation conclusion : We developed a prevalent cohort definition for coronary artery disease (CAD) using a concept set of 27 concepts which incorporated all those found from the literature review, the analysis of PHOEBE, and orphan concepts in cohort diagnostics. We performed the evaluation across a network of claim data sources and 1 EHR US data source. The data sources are: IBM® MarketScan® Commercial Database (CCAE), Optum’s longitudinal EHR repository (Optum EHR), Optum’s Clinformatics® Data Mart (DOD), IBM® MarketScan® Multi-State Medicaid Database (MDCD), IBM® MarketScan® Medicare Supplemental Database (MDCR), Japan Claims Database (JMDC), Clinical Practice Research Datalink (CPRD) , IQVIA® Australia Longitudinal Patient Data (LPD) database (Australia), IQVIA® Disease Analyzer (DA) France database (France), QVIA® Disease Analyzer (DA) Germany database (Germany), IQVIA® Adjudicated Health Plan Claims Data (formerly PharMetrics Plus) - US database (PharMetrics), IQVIA® Ambulatory EMR (EMR). The algorithm retrieves subjects from all 11 databases tested. There were many beta-blocker drug eras, the first line of therapy for CAD, prior to index. However, beta-blockers are also a common treatment for hypertension which was the most common comorbid condition prior to the initial diagnosis of CAD. Therefore, it did not seem reasonable to adjust the index date for CAD. We developed a more specific cohort requiring a second diagnosis or observation code for CAD in the time period 31-365 days after index. This cohort improves the specificity of the algorithm albeit at the expense of sensitivity as determined by PheValuator. The significant loss in sensitivity precludes its use in our analysis Caution should be used when applying the more specific algorithm for studies where the end-point includes death as this algorithm may be subject to immortal time bias. In addition, caution should be used when using the Australia and France datasets as the rates of CAD decreased precipitously during the past five years which may be due to a dataset artifact.
Performance characteristics were determined for 9 of the 11 databases. The remaining databases did not contain enough subjects to produce an accurate diagnostic model. Using one code (the submitted definition), sensitivity ranged from about 73% in Germany to about 95% in DOD while positive predictive value ranged from about 72% in CPRD to about 97% in MDCR. Using B, sensitivity decreased, ranging from about 13% in CPRD to about 58% in PharMetrics while positive predictive value increased, ranging from 90% in CPRD to > 99% in all databases except for JMDC, CPRD, and CCAE.