Angina Severity, Mortality, and Healthcare Utilization Among Veterans With Stable Angina
Background Canadian Cardiovascular Society (CCS) angina severity classification is associated with mortality, myocardial infarction, and coronary revascularization in clinical trial and registry data. The objective of this study was to determine associations between CCS class and all‐cause mortality...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2019-08-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.012811 |
| _version_ | 1818328090300907520 |
|---|---|
| author | Mina Owlia John A. Dodson Jordan B. King Catherine G. Derington Jennifer S. Herrick Steven P. Sedlis Jacob Crook Scott L. DuVall Joanne LaFleur Richard Nelson Olga V. Patterson Rashmee U. Shah Adam P. Bress |
| author_facet | Mina Owlia John A. Dodson Jordan B. King Catherine G. Derington Jennifer S. Herrick Steven P. Sedlis Jacob Crook Scott L. DuVall Joanne LaFleur Richard Nelson Olga V. Patterson Rashmee U. Shah Adam P. Bress |
| author_sort | Mina Owlia |
| collection | DOAJ |
| description | Background Canadian Cardiovascular Society (CCS) angina severity classification is associated with mortality, myocardial infarction, and coronary revascularization in clinical trial and registry data. The objective of this study was to determine associations between CCS class and all‐cause mortality and healthcare utilization, using natural language processing to extract CCS classifications from clinical notes. Methods and Results In this retrospective cohort study of veterans in the United States with stable angina from January 1, 2006, to December 31, 2013, natural language processing extracted CCS classifications. Veterans with a prior diagnosis of coronary artery disease were excluded. Outcomes included all‐cause mortality (primary), all‐cause and cardiovascular‐specific hospitalizations, coronary revascularization, and 1‐year healthcare costs. Of 299 577 veterans identified, 14 216 (4.7%) had ≥1 CCS classification extracted by natural language processing. The mean age was 66.6±9.8 years, 99% of participants were male, and 81% were white. During a median follow‐up of 3.4 years, all‐cause mortality rates were 4.58, 4.60, 6.22, and 6.83 per 100 person‐years for CCS classes I, II, III, and IV, respectively. Multivariable adjusted hazard ratios for all‐cause mortality comparing CCS II, III, and IV with those in class I were 1.05 (95% CI, 0.95–1.15), 1.33 (95% CI, 1.20–1.47), and 1.48 (95% CI, 1.25–1.76), respectively. The multivariable hazard ratio comparing CCS IV with CCS I was 1.20 (95% CI, 1.09–1.33) for all‐cause hospitalization, 1.25 (95% CI, 0.96–1.64) for acute coronary syndrome hospitalizations, 1.00 (95% CI, 0.80–1.26) for heart failure hospitalizations, 1.05 (95% CI, 0.88–1.25) for atrial fibrillation hospitalizations, 1.92 (95% CI, 1.40–2.64) for percutaneous coronary intervention, and 2.51 (95% CI, 1.99–3.16) for coronary artery bypass grafting surgery. Conclusions Natural language processing–extracted CCS classification was positively associated with all‐cause mortality and healthcare utilization, demonstrating the prognostic importance of anginal symptom assessment and documentation. |
| first_indexed | 2024-12-13T12:26:38Z |
| format | Article |
| id | doaj.art-e33fd68f219a41dbaf9e936f0605ce2e |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-13T12:26:38Z |
| publishDate | 2019-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-e33fd68f219a41dbaf9e936f0605ce2e2022-12-21T23:46:18ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-08-0181510.1161/JAHA.119.012811Angina Severity, Mortality, and Healthcare Utilization Among Veterans With Stable AnginaMina Owlia0John A. Dodson1Jordan B. King2Catherine G. Derington3Jennifer S. Herrick4Steven P. Sedlis5Jacob Crook6Scott L. DuVall7Joanne LaFleur8Richard Nelson9Olga V. Patterson10Rashmee U. Shah11Adam P. Bress12Leon H. Charney Division of Cardiology Department of Medicine New York University School of Medicine New York NYLeon H. Charney Division of Cardiology Department of Medicine New York University School of Medicine New York NYDepartment of Population Health Sciences University of Utah Salt Lake City UTDepartment of Pharmacy Kaiser Permanente Colorado Aurora CODepartment of Population Health Sciences University of Utah Salt Lake City UTLeon H. Charney Division of Cardiology Department of Medicine New York University School of Medicine New York NYDepartment of Internal Medicine University of Utah Salt Lake City UTDepartment of Internal Medicine University of Utah Salt Lake City UTDepartment of Pharmacotherapy University of Utah Salt Lake City UTDepartment of Internal Medicine University of Utah Salt Lake City UTDepartment of Internal Medicine University of Utah Salt Lake City UTDepartment of Internal Medicine University of Utah Salt Lake City UTDepartment of Population Health Sciences University of Utah Salt Lake City UTBackground Canadian Cardiovascular Society (CCS) angina severity classification is associated with mortality, myocardial infarction, and coronary revascularization in clinical trial and registry data. The objective of this study was to determine associations between CCS class and all‐cause mortality and healthcare utilization, using natural language processing to extract CCS classifications from clinical notes. Methods and Results In this retrospective cohort study of veterans in the United States with stable angina from January 1, 2006, to December 31, 2013, natural language processing extracted CCS classifications. Veterans with a prior diagnosis of coronary artery disease were excluded. Outcomes included all‐cause mortality (primary), all‐cause and cardiovascular‐specific hospitalizations, coronary revascularization, and 1‐year healthcare costs. Of 299 577 veterans identified, 14 216 (4.7%) had ≥1 CCS classification extracted by natural language processing. The mean age was 66.6±9.8 years, 99% of participants were male, and 81% were white. During a median follow‐up of 3.4 years, all‐cause mortality rates were 4.58, 4.60, 6.22, and 6.83 per 100 person‐years for CCS classes I, II, III, and IV, respectively. Multivariable adjusted hazard ratios for all‐cause mortality comparing CCS II, III, and IV with those in class I were 1.05 (95% CI, 0.95–1.15), 1.33 (95% CI, 1.20–1.47), and 1.48 (95% CI, 1.25–1.76), respectively. The multivariable hazard ratio comparing CCS IV with CCS I was 1.20 (95% CI, 1.09–1.33) for all‐cause hospitalization, 1.25 (95% CI, 0.96–1.64) for acute coronary syndrome hospitalizations, 1.00 (95% CI, 0.80–1.26) for heart failure hospitalizations, 1.05 (95% CI, 0.88–1.25) for atrial fibrillation hospitalizations, 1.92 (95% CI, 1.40–2.64) for percutaneous coronary intervention, and 2.51 (95% CI, 1.99–3.16) for coronary artery bypass grafting surgery. Conclusions Natural language processing–extracted CCS classification was positively associated with all‐cause mortality and healthcare utilization, demonstrating the prognostic importance of anginal symptom assessment and documentation.https://www.ahajournals.org/doi/10.1161/JAHA.119.012811angina pectorishealthcare utilizationmyocardial revascularizationnatural language processing |
| spellingShingle | Mina Owlia John A. Dodson Jordan B. King Catherine G. Derington Jennifer S. Herrick Steven P. Sedlis Jacob Crook Scott L. DuVall Joanne LaFleur Richard Nelson Olga V. Patterson Rashmee U. Shah Adam P. Bress Angina Severity, Mortality, and Healthcare Utilization Among Veterans With Stable Angina Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease angina pectoris healthcare utilization myocardial revascularization natural language processing |
| title | Angina Severity, Mortality, and Healthcare Utilization Among Veterans With Stable Angina |
| title_full | Angina Severity, Mortality, and Healthcare Utilization Among Veterans With Stable Angina |
| title_fullStr | Angina Severity, Mortality, and Healthcare Utilization Among Veterans With Stable Angina |
| title_full_unstemmed | Angina Severity, Mortality, and Healthcare Utilization Among Veterans With Stable Angina |
| title_short | Angina Severity, Mortality, and Healthcare Utilization Among Veterans With Stable Angina |
| title_sort | angina severity mortality and healthcare utilization among veterans with stable angina |
| topic | angina pectoris healthcare utilization myocardial revascularization natural language processing |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.012811 |
| work_keys_str_mv | AT minaowlia anginaseveritymortalityandhealthcareutilizationamongveteranswithstableangina AT johnadodson anginaseveritymortalityandhealthcareutilizationamongveteranswithstableangina AT jordanbking anginaseveritymortalityandhealthcareutilizationamongveteranswithstableangina AT catherinegderington anginaseveritymortalityandhealthcareutilizationamongveteranswithstableangina AT jennifersherrick anginaseveritymortalityandhealthcareutilizationamongveteranswithstableangina AT stevenpsedlis anginaseveritymortalityandhealthcareutilizationamongveteranswithstableangina AT jacobcrook anginaseveritymortalityandhealthcareutilizationamongveteranswithstableangina AT scottlduvall anginaseveritymortalityandhealthcareutilizationamongveteranswithstableangina AT joannelafleur anginaseveritymortalityandhealthcareutilizationamongveteranswithstableangina AT richardnelson anginaseveritymortalityandhealthcareutilizationamongveteranswithstableangina AT olgavpatterson anginaseveritymortalityandhealthcareutilizationamongveteranswithstableangina AT rashmeeushah anginaseveritymortalityandhealthcareutilizationamongveteranswithstableangina AT adampbress anginaseveritymortalityandhealthcareutilizationamongveteranswithstableangina |