Lessons Learned From the Design and Implementation of Myocardial Infarction Adjudication Tailored for HIV Clinical Cohorts
Year: 2014
Type: article
Abstract: We developed, implemented, and evaluated a myocardial infarction (MI) adjudication protocol for cohort research of human immunodeficiency virus. Potential events were identified through the centralized Centers for AIDS Research Network of Integrated Clinical Systems data repository using MI diagnoses and/or cardiac enzyme laboratory results (1995-2012). Sites assembled de-identified packets, including physician notes and results from electrocardiograms, procedures, and laboratory tests. Information pertaining to the specific antiretroviral medications used was redacted for blinded review. Two experts reviewed each packet, and a third review was conducted if discrepancies occurred. Reviewers categorized probable/definite MIs as primary or secondary and identified secondary causes of MIs. The positive predictive value and sensitivity for each identification/ascertainment method were calculated. Of the 1,119 potential events that were adjudicated, 294 (26%) were definite/probable MIs. Almost as many secondary (48%) as primary (52%) MIs occurred, often as the result of sepsis or cocaine use. Of the patients with adjudicated definite/probable MIs, 78% had elevated troponin concentrations (positive predictive value = 57%, 95% confidence interval: 52, 62); however, only 44% had clinical diagnoses of MI (positive predictive value = 45%, 95% confidence interval: 39, 51). We found that central adjudication is crucial and that clinical diagnoses alone are insufficient for ascertainment of MI. Over half of the events ultimately determined to be MIs were not identified by clinical diagnoses. Adjudication protocols used in traditional cardiovascular disease cohorts facilitate cross-cohort comparisons but do not address issues such as identifying secondary MIs that may be common in persons with human immunodeficiency virus.
Source: American Journal of Epidemiology
DOI: 10.1093/aje/kwu010
Authors: H. M. Crane, S. R. Heckbert, D. R. Drozd, M. J. Budoff, J. A. C. Delaney, C. Rodriguez, P. Paramsothy, W. B. Lober, G. Burkholder, J. H. Willig, M. J. Mugavero, W. C. Mathews, P. K. Crane, R. D. Moore, S. Napravnik, J. J. Eron, P. Hunt, E. Geng, P. Hsue, G. S. Barnes, J. McReynolds, I. Peter, C. Grunfeld, M. S. Saag, M. M. Kitahata
Institutions: University of Washington, Harborview Medical Center
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funders: American Heart Association, Bristol-Myers Squibb, Pfizer, GlaxoSmithKline, Gilead Sciences, University of Washington, Johns Hopkins University, ViiV Healthcare, National Institutes of Health, Agency for Healthcare Research and Quality, Center for AIDS Research, University of Washington, University of North Carolina at Chapel Hill, National Heart, Lung, and Blood Institute, National Institute on Drug Abuse, National Institute of Allergy and Infectious Diseases
Awards: G1392209889, G1531094742, Johns Hopkins HIV Clinical Cohort, G2127051194, G2213881162, G2219438539, G2328354421, G2516619799, G2970457639, G3752196161, G378552126, G3917235369, G3985073149, G440628606, G4575219416, COMPARATIVE EFFECTIVENESS OF LIPID-LOWERING AND ANTIHYPERTENSIVE MEDICATIONS AMON, G5934524914, G6625095162, G7791962275, G9000081321, G9000186388, G9000189727, G9000231798, North American AIDS Cohorts on Collaboration and Design (NAACCORD), The University of North Carolina Center for AIDS Research, G97119092
OpenAlex ID: W2116558875