Differentiation of subclasses in pulmonary hypertension based on statutory health insurance data. Feasibility study


Pulmonary hypertension (PH) is considered the most serious and potentially fatal chronic condition of the pulmonary circulation. It is a hemodynamic and pathophysiological condition, which has been defined as an increase in mean pulmonary arterial pressure of 25 mmHg or more at rest as assessed by right heart catheterization.
PH can develop from various underlying diseases, which are categorized into 5 groups resulting in the clinical classification of PH into subgroups (Dana Point Classification). The therapy of PH varies between these 5 subgroups and the application of therapeutical guidelines requires the identification of the PH-subgroup for each PH patient.
As the differentiation of the clinical subgroups of PH is not reflected in the ICD-10-GM coding guidelines, it is impossible to classify study participants directly into PH subgroups in studies investigating therapeutical aspects of PH based on health insurance data.
The aim of this study is to develop an algorithm based on health insurance data that allows a differentiation of PH patients into the 5 subgroups of the clinical classification of PH. Such a classification of insured persons suffering from PH would facilitate the identification of inappropriate therapies like e.g. the off-label use of drugs for the different subgroups by using data of health insurance providers. Further, the study will determine age-stratified incidence and prevalence estimates for PH in Germany.
Based on the proceeding in differential doagnostic of PH subgroups in the clinical setting we conceived and investigated several algorithms. However, only indirect measures as could be used for indirect validation of the class assignment. Overall, no satisfying method could be developed to assign patients with PH diagnoses to the classes of the Dana Point classification using claims data of GePaRD. With all algorithms the number of cases with possible assignment to several classes was still considerable. Missing information about disease severity, the temporal order of comorbidities, the importance of comorbidities with regard to the differential diagnosis of PH as well as missing coding of diagnostic procedures and their results rendered the assignment of PH cases to the Dana Point classification inconclusive.

Funding period

Begin:   July 2013
End:   April 2015


  • Pharmaceutical industry


Dr. rer. nat. Ingo Langner