Validation of a computer case definition for sudden cardiac death in opioid users
1 Division of Pharmacoepidemiology, Department of Preventive Medicine, Nashville, TN, USA
2 Departments of Medicine and Pharmacology, Divisions of Cardiology, Nashville, TN, USA
3 Rheumatology (CMS) and, Nashville, TN, USA
4 Clinical Pharmacology, Vanderbilt University, Nashville, TN, USA
5 Department of Pediatrics, Nashville, TN, USA
6 Geriatric Research, Education and Clinical Center, Nashville Veterans Administration Medical Center, Nashville, TN, USA
7 Food and Drug Administration, Silver Spring, MD, USA
8 Department of Preventive Medicine, Vanderbilt University, Village at Vanderbilt, Suite 2600, 1501 21st Ave South, Nashville, TN 37212, USA
BMC Research Notes 2012, 5:473 doi:10.1186/1756-0500-5-473Published: 31 August 2012
To facilitate the use of automated databases for studies of sudden cardiac death, we previously developed a computerized case definition that had a positive predictive value between 86% and 88%. However, the definition has not been specifically validated for prescription opioid users, for whom out-of-hospital overdose deaths may be difficult to distinguish from sudden cardiac death.
We assembled a cohort of persons 30-74 years of age prescribed propoxyphene or hydrocodone who had no life-threatening non-cardiovascular illness, diagnosed drug abuse, residence in a nursing home in the past year, or hospital stay within the past 30 days. Medical records were sought for a sample of 140 cohort deaths within 30 days of a prescription fill meeting the computer case definition. Of the 140 sampled deaths, 81 were adjudicated; 73 (90%) were sudden cardiac deaths. Two deaths had possible opioid overdose; after removing these two the positive predictive value was 88%.
These findings are consistent with our previous validation studies and suggest the computer case definition of sudden cardiac death is a useful tool for pharmacoepidemiologic studies of opioid analgesics.