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Validation of a computer case definition for sudden cardiac death in opioid users

Vivian K Kawai4, Katherine T Murray24, C Michael Stein34, William O Cooper5, David J Graham7, Kathi Hall1 and Wayne A Ray168*

Author Affiliations

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

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BMC Research Notes 2012, 5:473  doi:10.1186/1756-0500-5-473

Published: 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.

Case definition; Automated databases; Sudden cardiac death; Opioids; Propoxyphene