Derivation and Validation of Operational Definitions From Claims Data for Identifying Cardiogenic Shock

OBJECTIVES: To derive and validate a claims-based operational definition for cardiogenic shock (CS) using administrative data against clinically adjudicated reference standards. DESIGN: Diagnostic accuracy study. SETTING: Two independent clinical cohorts, a single-center cardiac ICU (CICU) registry and a multicenter CS registry (REtrospective and prospective observational Study to investigate Clinical oUtcomes and Efficacy of left ventricular assist device for Korean patients with cardiogenic shock [RESCUE]), and a nationwide administrative database from the Korean National Health Insurance Service. PATIENTS: A total of 10,156 patients from the CICU registry and 1,247 patients from the RESCUE registry. For population-level application, 207,419 patients were identified from the national claims database. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A claims-based algorithm defined CS using the International Classification of Diseases, 10th Revision code R57.0 or cardiac disease codes combined with treatment-based criteria reflecting hemodynamic support, including mechanical circulatory support or vasoactive therapy. In the CICU cohort, the algorithm demonstrated a sensitivity of 0.89 and specificity of 0.90, with an overall accuracy of 0.90. In the RESCUE cohort, sensitivity was 0.95. When applied to the nationwide database, 207,419 patients with CS were identified. The cumulative mortality rates were 37.9% at 12 months, 49.9% at 5 years, and 61.7% at 10 years. CONCLUSIONS: A claims-based definition combining diagnostic codes with treatment-based criteria demonstrated high diagnostic performance for identifying CS. This approach enables reliable large-scale epidemiologic studies and long-term outcome assessments using administrative data and may facilitate system-level evaluation of critical care delivery in patients with CS.