Comparison of Self-Reported and Medicare Claims-Identified Acute Myocardial Infarction
Background—Cardiovascular disease is often studied through patient self-report and administrative data. Yet, these two sources provide different information, and few studies have compared them.
Methods and Results—We compared data from a longitudinal nationally-representative survey of older Americans with matched Medicare claims. Self-reported acute myocardial infarction (AMI) in the previous two years was compared to claims-identified AMI and acute coronary syndrome (ACS) events. Among the 3.1% of respondents with self-reported AMI, 32.8% had claims-identified AMI, 16.5% non-AMI ACS, and 25.8% other cardiac inpatient visits; 17.3% had no inpatient visits in the previous 2.5 years. Claims-identified AMIs were found in 1.4% of respondents; of these, 67% reported an AMI. Self-reports were less likely among respondents over 75 years (62.7% vs. 74.6%, p = 0.006), with less than high school education (61.6% vs. 71.4%, p = 0.015), with at least one ADL limitation (59.6% vs. 74.7%, p = 0.001), or below the 25th percentile of a word recall memory test (60.7% vs. 71.3%, p = 0.019). Both self-reported and claims-identified cardiac events were associated with increased mortality; the highest mortality was observed among those with claims-identified AMI who did not self-report (OR 2.8, 95% CI 1.5 - 5.1), and among those with self-reported heart attack and claims-identified AMI (2.5, 1.7 - 3.6) or non-AMI ACS (2.7, 1.8 - 4.1).
Conclusions—There is considerable disagreement between self-reported and claims-identified events. Although self-reported AMI may be inaccurate, it indicates increased risk of death, regardless of whether the self-report is confirmed by Medicare claims.
- Received October 17, 2014.
- Revision received February 14, 2015.
- Accepted February 19, 2015.