Diagnostic codes for sudden cardiac death and ventricular arrhythmia functioned poorly to identify outpatient events in EPIC's General Practice Research Database
Pharmacoepidemiology and Drug Safety
Purpose-To examine the validity of OXMIS/Read diagnoses of hospitalization for sudden cardiac death and ventricular arrhythmia (SD/VA) for use in studies of arrhythmogenic effects of outpatient medications in the General Practice Research Database (GPRD). Methods-We identified putative occurrences of hospitalization for SD/VA in patients receiving outpatient prescriptions for cisapride, domperidone, or metoclopramide. We then administered a questionnaire to general practitioners (GPs) caring
... these patients, requested hospital discharge consult letters, and examined the positive predictive value (PPV) of diagnostic codes in identifying outpatient events precipitating hospitalization. Results-We identified 84 putative events, 38 (45%) of which occurred in patients cared for by GPs participating in the follow-up scheme. Thirty of 38 questionnaires (79%) were completed. The PPV for the occurrence of any SD/VA was 93% (95% CI, 78%-99%). However, the PPV for SD/VA occurrence in an outpatient setting precipitating a hospitalization was only 23% (95% CI, 10%-42%). The majority of inpatient diagnostic codes reflected events occurring after hospital admission, not precipitating it. Conclusions-While computerized codes for SD/VA agreed well with physician diagnosis, they operated poorly to identify events occurring in an outpatient setting. Studies of SD/VA in the GPRD should verify events on a case-by-case basis. Key Points • Epidemiologic studies of drug-induced sudden cardiac death and ventricular arrhythmia (SD/VA) have been hampered by challenges in identifying cases that could have resulted from drugs prescribed to outpatients. • In the General Practice Research Database (GPRD), the positive predictive value (using physician questionnaire as the gold standard) for diagnostic codes in identifying a SD/VA occurrence was 93%, yet only 23% for outpatientoccurring events precipitating a hospitalization. • Studies of outpatient drug-induced SD/VA in the GPRD should verify events on a case-by-case basis.