Identification of heart failure hospitalisation from NHS Digital data: comparison with expert adjudication

Fardad Soltani, Joshua Bradley, Antonio Bonandi, Nicholas Black, John Farrant, Adam Pailing, Christopher Orsborne, Simon Williams, Erik B Schelbert, Susanna Dodd, Richard Williams, Niels Peek, Matthias Schmitt, Theresa McDonagh, Christopher Miller

Research output: Contribution to journalArticlepeer-review


Background and Aims: Population-wide, person-level, linked electronic health record data are increasingly used to estimate epidemiology, guide resource allocation, and identify events in clinical trials. The accuracy of data from NHS Digital (now part of NHS England) for identifying hospitalisation for heart failure (HHF), a key HF standard, is not clear. This study aimed to evaluate the accuracy of NHS Digital data for identifying HHF.
Methods: Patients experiencing at least one HHF, as determined by NHS Digital data, and age and sex matched patients not experiencing HHF, were identified from a prospective cohort study and underwent expert adjudication. Three code sets commonly used to identify HHF were applied to the data and compared with expert adjudication (I50: International Classification of Diseases (ICD)-10 codes beginning I50; OIS: Clinical Commissioning Groups Outcomes Indicator Set; NICOR: National Institute for Cardiovascular Outcomes Research, used as the basis for the National Heart Failure Audit in England and Wales).
Results: 504 patients underwent expert adjudication, of which 10 (2%) were adjudicated to have experienced HHF. Specificity was high across all three code sets in the first diagnosis position (I50: 96·2% [95% confidence interval, CI: 94·1 – 97·7%]; NICOR: 93·3% [CI 90·8 – 95·4%]; OIS: 95·6% [CI 93·3 – 97·2%]), but decreased substantially as the number of diagnosis positions expanded. Sensitivity (40·0% [CI 12·2 – 73·8%]) and positive predictive value (PPV) (highest with I50: 17·4% [CI 8·1 – 33·6%]) were low in the first diagnosis position for all coding sets. PPV was higher for the National Heart Failure Audit criteria, albeit modestly (36·4%; [16·6 – 62·2%]).
Conclusions: NHS Digital data were not able to accurately identify HHF, and should not be used in isolation for this purpose.

Original languageEnglish
JournalESC Heart Failure
Publication statusAccepted/In press - 19 Dec 2023


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