{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T11:23:30Z","timestamp":1791890610594,"version":"4.3.4"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,8,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Canadian Cardiovascular Society (\n              <jats:styled-content style=\"fixed-case\">CCS<\/jats:styled-content>\n              ) angina severity classification is associated with mortality, myocardial infarction, and coronary revascularization in clinical trial and registry data. The objective of this study was to determine associations between\n              <jats:styled-content style=\"fixed-case\">CCS<\/jats:styled-content>\n              class and all\u2010cause mortality and healthcare utilization, using natural language processing to extract\n              <jats:styled-content style=\"fixed-case\">CCS<\/jats:styled-content>\n              classifications from clinical notes.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              In this retrospective cohort study of veterans in the United States with stable angina from January 1, 2006, to December 31, 2013, natural language processing extracted\n              <jats:styled-content style=\"fixed-case\">CCS<\/jats:styled-content>\n              classifications. Veterans with a prior diagnosis of coronary artery disease were excluded. Outcomes included all\u2010cause mortality (primary), all\u2010cause and cardiovascular\u2010specific hospitalizations, coronary revascularization, and 1\u2010year healthcare costs. Of 299\u00a0577 veterans identified, 14\u00a0216 (4.7%) had \u22651\n              <jats:styled-content style=\"fixed-case\">CCS<\/jats:styled-content>\n              classification extracted by natural language processing. The mean age was 66.6\u00b19.8\u00a0years, 99% of participants were male, and 81% were white. During a median follow\u2010up of 3.4\u00a0years, all\u2010cause mortality rates were 4.58, 4.60, 6.22, and 6.83 per 100\u00a0person\u2010years for\n              <jats:styled-content style=\"fixed-case\">CCS<\/jats:styled-content>\n              classes I,\n              <jats:styled-content style=\"fixed-case\">II<\/jats:styled-content>\n              ,\n              <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content>\n              , and\n              <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content>\n              , respectively. Multivariable adjusted hazard ratios for all\u2010cause mortality comparing\n              <jats:styled-content style=\"fixed-case\">CCS II<\/jats:styled-content>\n              ,\n              <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content>\n              , and\n              <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content>\n              with those in class I were 1.05 (95% CI, 0.95\u20131.15), 1.33 (95% CI, 1.20\u20131.47), and 1.48 (95% CI, 1.25\u20131.76), respectively. The multivariable hazard ratio comparing\n              <jats:styled-content style=\"fixed-case\">CCS IV<\/jats:styled-content>\n              with\n              <jats:styled-content style=\"fixed-case\">CCS<\/jats:styled-content>\n              I was 1.20 (95% CI, 1.09\u20131.33) for all\u2010cause hospitalization, 1.25 (95% CI, 0.96\u20131.64) for acute coronary syndrome hospitalizations, 1.00 (95% CI, 0.80\u20131.26) for heart failure hospitalizations, 1.05 (95% CI, 0.88\u20131.25) for atrial fibrillation hospitalizations, 1.92 (95% CI, 1.40\u20132.64) for percutaneous coronary intervention, and 2.51 (95% CI, 1.99\u20133.16) for coronary artery bypass grafting surgery.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Natural language processing\u2013extracted\n              <jats:styled-content style=\"fixed-case\">CCS<\/jats:styled-content>\n              classification was positively associated with all\u2010cause mortality and healthcare utilization, demonstrating the prognostic importance of anginal symptom assessment and documentation.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.119.012811","type":"journal-article","created":{"date-parts":[[2019,7,31]],"date-time":"2019-07-31T09:04:28Z","timestamp":1564563868000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":28,"title":["Angina Severity, Mortality, and Healthcare Utilization Among Veterans With Stable Angina"],"prefix":"10.1161","volume":"8","author":[{"given":"Mina","family":"Owlia","sequence":"first","affiliation":[{"name":"Leon H. Charney Division of Cardiology Department of Medicine New York University School of Medicine New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Dodson","sequence":"additional","affiliation":[{"name":"Leon H. Charney Division of Cardiology Department of Medicine New York University School of Medicine New York NY"},{"name":"Department of Population Health New York University School of Medicine New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan B.","family":"King","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences University of Utah Salt Lake City UT"},{"name":"Department of Pharmacy Kaiser Permanente Colorado Aurora CO"},{"name":"George E. 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