Validation of Acute Myocardial Infarction Cases in the National Health Insurance Research Database in Taiwan

Background: The aim of this study was to determine the validity of acute myocardial infarction (AMI) diagnosiscoding in the National Health Insurance Research Database (NHIRD) by cross-comparisons of discharge diagnoseslisted in the NHIRD with those in the medical records obtained from a medical center in Taiwan.Methods: This was a cross-sectional study comparing records in the NHIRD and discharge notes in one medicalcenter (DNMC) in the year 2008. Positive predictive values (PPVs) for AMI diagnoses were evaluated by reviewingthe relevant clinical and laboratory data recorded in the discharge notes of the medical center. Agreement incomorbidities, cardiac procedures, and antiplatelet agent (aspirin or clopidogrel) prescriptions between the twodatabases was evaluated.Results: We matched 341 cases of AMI hospitalizations from the two databases, and 338 cases underwent completechart review. Of these 338 AMI cases, 297 were confirmed with clinical and lab data, which yielded a PPVof 0.88.The consistency rate for coronary intervention, stenting, and antiplatelet prescription at admission was high, yieldinga PPVover 0.90. The percentage of consistency in comorbidity diagnoses was 95.9% (324/338) among matched AMIcases.Conclusions: The NHIRD appears to be a valid resource for population research in cardiovascular diseases.Key words: acute myocardial infarction; NHIRD; Taiwan; validity; pharmacoepidemiology