Hospital Variation in the Use of Noninvasive Cardiac Imaging And

Supplementary Online Content

Safavi KC, Li S-X, Dharmarajan K, et al. Hospital variation in the use of noninvasive cardiac imaging and its association with downstream testing, interventions, and outcomes [published online February 10, 2014]. JAMA Intern Med. doi:10.1001/jamainternmed.2013.14407

eTable 1. ICD-9-CM Codes Selected for Inclusion

eTable 2. ICD-9-CM Diagnosis Codes Selected for Exclusion

eTable 3. ICD-9-CM Volume 3 Procedure Codes Selected for Exclusion

eTable 4. Percent of Patients With ICD-9-CM Discharge Diagnosis Codes

eFigure. Patients Included in the Study Cohort

This supplementary material has been provided by the authors to give readers additional information about their work.

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eTable 1. ICD-9-CM Codes Selected for Inclusion

Common causes of Coronary atherosclerosis 414.x chest pain Coxsackie viral disease 74.x Acute pericarditis 420.xx Acute myocarditis 422.xx Anxiety states 300.x Pleurisy 511.x Tietze’s disease 733.6 Mediastinitis 519.2, 519.3 Esophagitis (includes GERD) 530.x Acute gastritis, acute duodenitis 535.x Gastric and duodenal ulcer disease 531.x, 532.x Cholelithiasis, cholecystitis, choledocolithiasis 574.x, 575.x Spondylosis (cervical and thoracic) 721.x Intervertebral disc disease (cervical and thoracic) 722.x Rotator cuff and shoulder disease 726.x Signs and Angina (decubitis, pectoris, prinzmetal) 413.x symptoms of Palpitations cardiac ischemia 785.1 Cardiac dysrhythmias 427.9 Abnormal heart sounds and murmurs 785.3 Nausea 787.x Vomiting 787.x Abdominal bloating 787.3 Abdominal pain 789.0, 789.00, 789.6 Comorbidities Type 2 diabetes (complicated and uncomplicated) 249.xx, 250.xx commonly Disorders of lipid metabolism associated with 272.x coronary artery Hypertension (essential and secondary) disease 401.x Hypertensive heart and/or kidney disease 402.x, 403.x, 404.x Peripheral artery atherosclerosis and renal artery atherosclerosis 440.x Cardiomyopathies 425.x ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification; GERD, gastroesophageal reflux disease

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eTable 2. ICD-9-CM Diagnosis Codes Selected for Exclusion

Aortic dissection 441.x Pulmonary embolism 415.0, 415.1, 415.19 Gastrointestinal ulcer with hemorrhage 531.0, 531.00, 531.01, 531.1, 531.10, 531.11, 531.2, 531.20, 531.21 and/or perforation Acute myocardial infarction 410.x ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification

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eTable 3. ICD-9-CM Volume 3 Procedure Codes Selected for Exclusion

Valvular surgeries 35.x Vascular surgeries 38.x Ventricular assist device placements 37.6 Heart transplantation 37.5x ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification

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eTable 4. Percent of Patients With ICD-9-CM Discharge Diagnosis Codes

ICD-9-CM Discharge Diagnosis Percent of Total Patients

Symptom, pain, chest NEC 24.8

Symptom, pain, chest NOS 20.9

Cardiac dysrhythmias 11.4

Other ischemic heart disease (coronary 9.3 atherosclerosis, specific arteries)

Essential HTN 4.4

Symptom, painful respiration 3.3

Symptoms (tachycardia, palpitations, 3.2

murmurs, chest pain, nausea/vomiting, abdominal tenderness)

DM II (w/ and w/out complications) 3.1

Cholelithiasis (w/ and w/out cholecystitis) 2.3

Symptom, pain, abdominal, site 2.2

Nausea, vomiting, heartburn 2.0

Esophageal diseases (esophagitis, 2.0 reflux, Barrett's)

Gastritis 1.3

Anxiety states (general, acute, hysteria, 1.3

conversion disorder, somatization)

Symptom, pain, precordial 1.1

Hypertensive renal disease 1.0

Other cervical spine disease 0.7

Hypertensive heart disease and renal 0.7 disease

Tietze's disease 0.6

Hypertensive heart disease 0.5

ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification

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eFigure. Patients Included in the Study Cohort

Patients who received at least 1 cardiac enzyme test: 2,507,277

Patients in whom cardiac ischemia was being considered as primary diagnosis 888,292 Patients with acute illness that may warrant cardiac biomarker testing or received cardiac surgery (except CABG), valvular surgeries, vascular surgeries, ventricular assist device placement and heart transplant

865,940

Patients <35, transferred in/out another hospital

715, 413

Patients treated at hospitals that performed <5 revascularization procedures over the study period in AMI patients

586,158

Visits within the follow-up window

549,078

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