Novel Method of Atrial Fibrillation Case Identification and Burden Estimation Using the MIMIC-III Electronic Health Data Set. (October 2019)

• Record Type: Journal Article
• Authors: Ding, Eric Y.; Albuquerque, Daniella; Winter, Michael; Binici, Sophia; Piche, Jaclyn; Bashar, Syed Khairul; Chon, Ki; Walkey, Allan J.; McManus, David D.
• Is Part Of: Journal of intensive care medicine. Volume 34:Number 10(2019)
• Page Start: 851
• Page End: 857
• Publication Date: 2019-10
• Subjects: atrial fibrillation -- nurse documentation -- sepsis -- accuracy -- case identification; Critical care medicine -- Periodicals; Critical Care -- Periodicals; Soins intensifs -- Périodiques; Soins intensifs; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.02805
• DOI: 10.1177/0885066619866172
• Languages: English
• ISSNs: 0885-0666

Abstract

Background: Atrial fibrillation (AF) portends poor prognoses in intensive care unit patients with sepsis. However, AF research is challenging: Previous studies demonstrate that International Classification of Disease ( ICD ) codes may underestimate the incidence of AF, but chart review is expensive and often not feasible. We aim to examine the accuracy of nurse-charted AF and its temporal precision in critical care patients with sepsis. Methods: Patients with sepsis with continuous electrocardiogram (ECG) waveforms were identified from the Medical Information Mart for Intensive Care (MIMIC-III) database, a de-identified, single-center intensive care unit electronic health record (EHR) source. We selected a random sample of ECGs of 6 to 50 hours' duration for manual review. Nurse-charted AF occurrence and onset time and ICD-9 -coded AF were compared to gold-standard ECG adjudication by a board-certified cardiac electrophysiologist blinded to AF status. Descriptive statistics were calculated for all variables in patients diagnosed with AF by nurse charting, ICD-9 code, or both. Results: From 142 ECG waveforms (58 AF and 84 sinus rhythm), nurse charting identified AF events with 93% sensitivity (95% confidence interval [CI]: 87%-100%) and 87% specificity (95% CI: 80%-94%) compared to the gold standard manual ECG review. Furthermore, nurse-charted AF onset time was within 1 hour of expert reader onset time for 85% of the reviewed tracings. The ICD-9 codes were 97% sensitive (95% CI: 88-100%) and 82% specific (95% CI: 74-90%) for incident AF during admission but unable to identify AF time of onset. Conclusion: Nurse documentation of AF in EHR is accurate and has high precision for determining AF onset to within 1 hour. Our study suggests that nurse-charted AF in the EHR represents a potentially novel method for AF case identification, timing, and burden estimation.