Outcome
Our primary outcome was the period prevalence of CV testing. We defined CV as having an echocardiogram or stress test 1 year before the SCD score and 2 years after the score. The rationale for including echocardiograms and stress tests is that they represent the most commonly initial tests used in cardiology. We did not include electrocardiograms as the rate was low and the possibility of undercoding. We defined having an echocardiogram or stress test done by the CPT code. (see table 1 supplementary appendix). The validity of these codes has been previously validated.14
Our secondary outcome was all cause mortality. The database captures mortality via the National Technical Information Service (NTIS) Limited Access Death Master File (LAMDF) as well as from an institutionally generated death flag within the EHR system.