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Comment & Response |

Stroke Risk Following Perioperative Atrial Fibrillation—Reply

Gino Gialdini, MD1; Prashant D. Bhave, MD2; Hooman Kamel, MD3
[+] Author Affiliations
1Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York
2Division of Cardiology, University of Iowa Carver College of Medicine, Iowa City
3Department of Neurology, Weill Cornell Medical College, New York, New York
JAMA. 2014;312(22):2410-2411. doi:10.1001/jama.2014.14505.
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In Reply Dr Kurlansky raises a concern about the positive predictive value of diagnosis codes used to identify perioperative AF in our study of the long-term risk of stroke associated with this condition. Two separate issues should be considered in this regard.

The sensitivity of 88% and specificity of 86% that we cited concerned the present-on-admission status for a given diagnosis code, not the diagnosis code itself. In other words, among patients with a documented diagnosis of AF during a surgical hospitalization, the present-on-admission indicator would be expected to be 88% sensitive and 86% specific for distinguishing cases of AF that were diagnosed prior to the hospitalization compared with new-onset cases during the hospitalization. Given a true prevalence of approximately 67% for preexisting AF in the perioperative setting,1 the positive and negative predictive values for preexisting (as opposed to new-onset) cases of AF would be expected to be approximately 80% to 90%.

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December 10, 2014
Paul Kurlansky, MD
1Department of Surgery, Columbia University, New York, New York
JAMA. 2014;312(22):2410. doi:10.1001/jama.2014.14490.
December 10, 2014
Pierluigi Tricoci, MD, MHS, PhD
1Division of Cardiology, Duke Clinical Research Institute, Durham, North Carolina
JAMA. 2014;312(22):2410. doi:10.1001/jama.2014.14496.
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