Concept: Congestive Heart Failure (CHF)

Introduction

Congestive Heart Failure (CHF), also called congestive cardiac failure (CCF) or just heart failure, is the inability of the heart to pump a sufficient amount of blood throughout the body, or requiring elevated filling pressures in order to pump effectively. CHF is an abnormal cardiac condition that reflects impaired cardiac pumping and blood flow. The pooling of blood leads to congestion in body tissue (Lix et al., 2006).

This concept describes the methods used to investigate CHF in MCHP research projects.

MCHP Algorithms

The following methods have been used in MCHP research to identify individuals with CHF.

DATA SOURCES:

In the following algorithms:


• hospitalization / hospital separation information is found in the Hospital Abstracts data; and
  
• physician visit / physician claims information is found in the Medical Services (Physician Claims) data.

In some algorithms, the medication/prescription drug information is found in the Drug Program Information Network data

1. Lix et al. (2006)

In Defining and Validating Chronic Diseases: An Administrative Data Approach by Lix et al. (2006), CHF was in the top 10 diseases given highest research priority by the Working Group. Although validation data existed for CHF, the number of cases was too small to produce reliable results so CHF was not investigated any further. During the project, a literature search was performed and they produced a summary of previous research methods used to identify congestive heart failure (CHF) cases from administrative data. Appendix Table A.7 in this publication lists the findings (author, source, diagnosis/treatment codes and algorithms, study cohort, validation method and comments) from this literature review.

2. Katz et al. (2010)

In Physician Integrated Network Baseline Evaluation: Linking Electronic Medical Records and Administrative Data by Katz et al. (2010) , they defined CHF using the following diagnoses codes: ICD-9-CM: 428 or ICD-10-CA: I50 from hospital abstracts or medical services/physician claims data.

In this study, outcomes / indicators for quality of care were measured by treatment with Angiotensin Converting Enzyme Inhibitors (ACEI) or Angiotensin II Receptor Blockers (ARB) with Anatomical Therapeutic Chemical (ATC) codes: C09A, C09B, C09C or C09D.

3. Hilderman et al. (2011)

In the Manitoba Immunization Study by Hilderman et al. (2011), CHF was defined as:


• one or more hospitalizations with diagnosis code ICD-9-CM: 428 or ICD-10-CA: I50.0, I50.1, I50.9, I13.0, I13.2 in any diagnosis field over three years of data; OR
  
• one or more physician claims with ICD-9-CM diagnosis code 428 over three years of data.

4. Katz et al. (2013)

In Understanding the Health System Use of Ambulatory Care Patients by Katz et al. (2013), CHF was defined as:


• at least one hospital diagnosis: heart failure (ICD-10-CA code: I50), congestive heart failure (ICD-10-CA code: I50.0) in three years OR
  
• at least three ambulatory visit diagnoses: heart failure (ICD-9-CM code: 402, 428) in three years.

For more information on the CHF cohort and the Quality of Care Indicators used in this report, please see:


• Congestive Heart Failure Cohort
  
• Congestive Heart Failure Quality of Care Indicators

5. Fransoo et al. (2013) and Fransoo et al. (2019)

In The 2013 RHA Indicators Atlas by Fransoo et al. (2013) and The 2019 RHA Indicators Atlas by Fransoo et al. (2019) residents were considered to have CHF if they met one of the following conditions:


• one or more inpatient hospitalizations in one year with a diagnosis for CHF: ICD-9-CM code 428 or ICD-10-CA code I50; OR
  
• two or more physician visits in one year with a diagnosis for CHF (ICD-9-CM code 428).

Only Manitoba residents aged 40 and older were included.

For more information, please see:


• section 4.9 Congestive Heart Failure (CHF) Prevalence in the 2013 deliverable; and
  
• section 4.10 Congestive Heart Failure (CHF) Prevalence in the 2019 deliverable.

6. Katz et al. (2014)

In the Physician Integrated Network: A Second Look deliverable by Katz et al. (2014), they investigated two indicators related to CHF management: 1) initiation of drug treatment and 2) persistence of drug treatment. The first indicator measured the proportion of newly diagnosed patients aged 20+ who filled a prescription for either angiotension-converting enzyme inhibitors (ACEI) or angiotension II receptor blocker (ARB) within three months of diagnoses (initiation of treatment). The second indicator measured the percentage of these same patients who had a prescription filled for 80% of the days between CHF diagnosis and end of the study period (persistence of treatment).

CHF patients were identified by:


• one or more inpatient hospitalizations in one year with a diagnosis for CHF: ICD-9-CM code 428 or ICD-10-CA code I50; OR
  
• two or more physician visits in one year with a diagnosis for CHF (ICD-9-CM code 428).
  
  NOTE:
  
  1. Patients who had a CHF diagnosis within one year prior to the one that fell within the study time period were excluded.
     
  2. ACEI medications were defined by the ATC codes: C09A and C09B. ARB medications were defined by the ATC codes: C09C and C09D.

For more information, please see Chapter 4: Disease Management - Congestive Heart Failure Management: Initiation and Persistence of Drug Treatment in this deliverable.

7. Chartier et al. (2015)

In the Care of Manitobans Living with Chronic Kidney Disease deliverable by Chartier et al. (2015) they investigated the prevalence and relative risk of CHF as a comorbidity to chronic kidney disease (CKD) and end stage kidney disease (ESKD). CHF was defined as Manitoba residents receiving one of the following diagnoses in the three-year fiscal period 2009/10-2011/12, using the following algorithm:


• Age Groups:
  
  • Adults: 40 years and older
  
  
• Codes and Conditions:
  
  
  • one or more inpatient hospitalizations with congestive heart failure (ICD-9-CM: 428, ICD-10-CA: I50); or
    
  • two or more physician claims with congestive heart failure (prefix=7, ICD-9-CM: 428)

For more information, on the prevalence and relative risk of CHF as a comorbidity to ESK and CKD, see:

• Table 4.1 Physical Health of Adults in End Stage Kidney Disease; and
  
• Table 4.5 Physical Health of Adults in Chronic Kidney Disease.
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