Lessons learned from the design and implementation of myocardial infarction adjudication tailored for HIV clinical cohorts

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, Richard D Moore, S. Napravnik, J. J. Eron, P. Hunt, E. Geng, P. Hsue, G. S. BarnesJ. Mcreynolds, I. Peter, C. Grunfeld, M. S. Saag, M. M. Kitahata

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)996-1005
Number of pages10
JournalAmerican Journal of Epidemiology
Volume179
Issue number8
DOIs
StatePublished - Apr 15 2014
Externally publishedYes

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Myocardial Infarction
HIV
Confidence Intervals
Troponin
Cocaine
Research
Information Systems
Sepsis
Electrocardiography
Acquired Immunodeficiency Syndrome
Cardiovascular Diseases
Physicians
Enzymes

Keywords

  • HIV
  • myocardial infarction
  • validation

ASJC Scopus subject areas

  • Epidemiology

Cite this

Crane, H. M., Heckbert, S. R., Drozd, D. R., Budoff, M. J., Delaney, J. A. C., Rodriguez, C., ... Kitahata, M. M. (2014). Lessons learned from the design and implementation of myocardial infarction adjudication tailored for HIV clinical cohorts. American Journal of Epidemiology, 179(8), 996-1005. https://doi.org/10.1093/aje/kwu010

Lessons learned from the design and implementation of myocardial infarction adjudication tailored for HIV clinical cohorts. / Crane, H. M.; Heckbert, S. R.; Drozd, D. R.; Budoff, M. J.; Delaney, J. A C; Rodriguez, C.; Paramsothy, P.; Lober, W. B.; Burkholder, G.; Willig, J. H.; Mugavero, M. J.; Mathews, W. C.; Crane, P. K.; Moore, Richard D; Napravnik, S.; Eron, J. J.; Hunt, P.; Geng, E.; Hsue, P.; Barnes, G. S.; Mcreynolds, J.; Peter, I.; Grunfeld, C.; Saag, M. S.; Kitahata, M. M.

In: American Journal of Epidemiology, Vol. 179, No. 8, 15.04.2014, p. 996-1005.

Research output: Contribution to journalArticle

Crane, HM, Heckbert, SR, Drozd, DR, Budoff, MJ, Delaney, JAC, Rodriguez, C, Paramsothy, P, Lober, WB, Burkholder, G, Willig, JH, Mugavero, MJ, Mathews, WC, Crane, PK, Moore, RD, Napravnik, S, Eron, JJ, Hunt, P, Geng, E, Hsue, P, Barnes, GS, Mcreynolds, J, Peter, I, Grunfeld, C, Saag, MS & Kitahata, MM 2014, 'Lessons learned from the design and implementation of myocardial infarction adjudication tailored for HIV clinical cohorts', American Journal of Epidemiology, vol. 179, no. 8, pp. 996-1005. https://doi.org/10.1093/aje/kwu010
Crane, H. M. ; Heckbert, S. R. ; Drozd, D. R. ; Budoff, M. J. ; Delaney, J. A C ; Rodriguez, C. ; Paramsothy, P. ; Lober, W. B. ; Burkholder, G. ; Willig, J. H. ; Mugavero, M. J. ; Mathews, W. C. ; Crane, P. K. ; Moore, Richard D ; Napravnik, S. ; Eron, J. J. ; Hunt, P. ; Geng, E. ; Hsue, P. ; Barnes, G. S. ; Mcreynolds, J. ; Peter, I. ; Grunfeld, C. ; Saag, M. S. ; Kitahata, M. M. / Lessons learned from the design and implementation of myocardial infarction adjudication tailored for HIV clinical cohorts. In: American Journal of Epidemiology. 2014 ; Vol. 179, No. 8. pp. 996-1005.
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AU - Mcreynolds, J.

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