Query purpose:
This definition aims to detect emergency department (ED) visits for Lyme carditis in areas where Lyme disease is common. Lyme carditis occurs when Lyme disease spirochetes (bacteria) invade heart tissue. To fit the Lyme carditis definition, a case must meet definitions for both 1) Lyme disease, and 2) a cardiac syndrome compatible with carditis. The definition is intended for use by state, local, tribal, territorial, and federal public health practitioners to find cases, monitor trends, and potentially detect clusters or outbreaks. This definition is only intended to be applied in areas with high Lyme disease incidence.
How it works:
This definition leverages the Chief Complaint Discharge Diagnosis (CCDD) field to query both discharge diagnosis codes and chief complaint text to identify emergency department visits for patients with Lyme carditis. The definition identifies visits that satisfy conditions of two syntax clauses. Clause 1 indicates visits related to Lyme disease to ensure the visit is consistent with Lyme disease (see Table 1). Clause 2 indicates visits with symptoms and signs consistent with carditis from any cause. For the definition to identify a visit related to Lyme carditis, the visit must be captured based on Clause 1 and Clause 2.
Syntax Plain Language Description:
The definition for Lyme carditis uses discharge diagnosis codes and free-text chief complaint terms. The definition requires that an emergency department visit meet both the general Lyme Disease syndromic surveillance definition (CDC Lyme Disease v1) and contain specific cardiac-related diagnostic codes or chief complaint terms to ensure a visit also meets signs and symptoms consistent with carditis from any cause. Therefore, the general Lyme Disease syndromic surveillance definition includes ICD-10-CM and ICD-9-CM diagnostic codes for Lyme Disease, along with direct mentions of “Lyme disease” (including one common misspelling, ‘Lime’) or a bull’s eye rash (characteristic of EM) in chief complaint text. To ensure that only acute Lyme Disease episodes were captured, we excluded records with chief complaint text that includes ‘history of Lyme’. No specific ICD or SNOMED codes are available for Lyme carditis; therefore, for the cardiac-related diagnostic code portion of the definition, we developed a list of ICD-9-CM and ICD-10-CM codes, and SNOMED concepts that describe myocarditis, pericarditis, or heart block, or chief complaint terms including ‘heart block,’ ‘heartblock,’ ‘atrioventricular block,‘ ‘AV block,’ or ‘carditis.’ The presence of one of these diagnostic codes or one of these terms in the chief complaint text field was sufficient to satisfy the cardiac syndrome definition.
For consideration:
The lack of a specific International Classification of Diseases (ICD) diagnostic code for Lyme carditis adds to the challenge of developing a syndromic surveillance definition. A further limitation was the challenge of accurate and consistent case classification due to the often-equivocal nature of Lyme carditis diagnoses. No single test allows for a conclusive diagnosis of Lyme carditis, which can be a diagnosis of exclusion. Diagnosis is particularly challenging in individuals with cardiac comorbidities who reside in Lyme-endemic areas. Because antibodies to B. burgdorferi may be detected for many years after an episode of Lyme disease, Lyme carditis may be diagnosed in individuals with a remote history of LD who have antibodies to B. burgdorferi but who develop heart block for another reason. Alternatively, because production of antibodies can take several weeks after initial infection, a patient presenting with carditis due to early disseminated Lyme disease may test negative for antibodies to B. burgdorferi, which can make diagnosis challenging. In New York State and other Lyme-endemic areas, healthcare providers may often initiate treatment despite uncertainty about a diagnosis of Lyme carditis, given the potential to treat a reversible cause of heart block and avoid permanent pacemaker placement.
(,(,^lyme^,or,(,(,^ lime ^,or,^lime,or,lime^,),AND,^disease^,),or,^erythem^migran^,or,(,^Bull^,AND,^Eye^,AND,^Rash^,),or,^[;/]A69.2^,or,^;A692^,or,^;23502006^,or,^;69588003^,or,^;426637005^,or,^;714327004^,or,^;33937009^,or,^;718311001^,or,^;230605007^,or,^;715507005^,or,^;77863005^,or,^;230150008^,or,^;733166004^,or,^;735520000^,or,^;088.81^,or,^;08881;^,),ANDNOT,(,^history l[iy]me^,or,^history of l[iy]me^,or,^lyment^,),),AND,(,^;I4[014]^,or,^;I51.[45]^,or,^;I51[45]^,or,^;I3[02]^,or,^;I31.[389]^,or,^;I31[389]^,or,^;I45.[0-69]^,or,^;I45[0-69]^,or,^;I45.89^,or,^;I4589^,or,^;I49.5^,or,^;I495^,or,^;422.9[0-39]^,or,^;4229[0-39];^,or,^;429.[0-1]^,or,^;429[0-1];^,or,^;422.[09]^,or,^;422[09];^,or,^;422;^,or,^;420;^,or,^[;/]420.[09]^,or,^;420[09];^,or,^;420.9[019]^,or,^;4209[019];^,or,^;426.1[0-3]^,or,^;4261[0-3];^,or,^;426.[069]^,or,^;426[069];^,or,^;426.50^,or,^;42650;^,or,^;426.[2-4]^,or,^;426[2-4];^,or,^;426.5[0-4]^,or,^;4265[0-4];^,or,^;426.89^,or,^;42689;^,or,^;427.81^,or,^;42781;^,or,^;^77863005;^,or,^;46701001;^,or,^;50920009;^,or,^;399617002;^,or,^;57809008;^,or,^;194942007;^,or,^;91025000;^,or,^;3238004;^,or,^;15555002;^,or,^;266235007;^,or,^;233881003;^,or,^;11176009;^,or,^;81376009;^,or,^;286954005;^,or,^;128562005;^,or,^;233917008;^,or,^;472809000;^,or,^;27885002;^,or,^;418341009;^,or,^;44808001;^,or,^;233916004;^,or,^;65778007;^,or,^AV block^,or,^atrioventricular block^,or,^heart block^,or,^heartblock^,or,^complete heart^,or,^degree block^,or,^degree heart^,or,^carditis^,)