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The ICD-9 428 primary diagnosis is highly predictive of heart failure using clinical criteria. Examination of hospitalization data up to 1 year prior to the index admission improves comorbidity detection and may provide enhancements to future studies of heart failure mortality.

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T he CArdiovascular HEalth in Ambulatory careResearch Team (CANHEART) was formed in 2012 to measure and improve the cardiovascular health and quality of ambulatory cardiovascular care provided to the adult population of Ontario, Canada. With a population of over 13 million, Ontario is Canada's most populous province and is one of the most ethnically diverse jurisdictions in the world. While previous research has identified traditional risk factors for Background-The CArdiovascular HEalth in Ambulatory care Research Team (CANHEART) is conducting a unique, population-based observational research initiative aimed at measuring and improving cardiovascular health and the quality of ambulatory cardiovascular care provided in Ontario, Canada. A particular focus will be on identifying opportunities to improve the primary and secondary prevention of cardiovascular events in Ontario's diverse multiethnic population. Methods and Results-A population-based cohort comprising 9.8 million Ontario adults ≥20 years in 2008 was assembled by linking multiple electronic survey, health administrative, clinical, laboratory, drug, and electronic medical record databases using encoded personal identifiers. The cohort includes ≈9.4 million primary prevention patients and ≈400 000 secondary prevention patients. Follow-up on clinical events is achieved through record linkage to comprehensive hospitalization, emergency department, and vital statistics administrative databases. Profiles of cardiovascular health and preventive care will be developed at the health region level, and the cohort will be used to study the causes of regional variation in the incidence of major cardiovascular events and other important research questions. Conclusions-Linkage of multiple databases will enable the CANHEART study cohort to serve as a powerful big data resource for scientific research aimed at improving cardiovascular health and health services delivery. Study findings will be shared with clinicians, policy makers, and the public to facilitate population health interventions and quality improvement initiatives. (Circ Cardiovasc Qual Outcomes. 2015;8:204-212.

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Patients with heart failure who are hospitalized in the United States had lower short-term mortality at 30 days, but 1-year mortality rates were not significantly different between the United States and Canada.

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R isk stratification is part of clinical prognostication. Acute myocardial infarction (AMI) is associated with high early mortality, and the Thrombolysis In Myocardial Infarction (TIMI) risk index is one of the more recent models developed to identify high-risk patients.The TIMI Investigators have used randomized clinical trial findings to develop risk stratification models for patients with unstable angina (UA)/non-ST-segment elevation myocardial infarction (non-STEMI) (1) and STEMI (2). From the 'TIMI risk score for STEMI', a simplified 'TIMI risk index' was developed (3). The TIMI risk index is based on age, heart rate (HR) and systolic blood pressure (SBP) alone, so it may be calculated at the time of first contact with the medical system. It has been advocated as a means of rapid and early triage of patients with BACKGROUND: The Thrombolysis In Myocardial Infarction (TIMI) risk index for the prediction of 30-day mortality was developed and validated in patients with ST-segment elevation myocardial infarction (STEMI) who were being treated with thrombolytics in randomized clinical trials. When tested in clinical registries of patients with STEMI, the index performed poorly in an older (65 years and older) Medicare population, but it was a good predictor of early death among the more representative population on the National Registry of Myocardial Infarction-3 and -4 databases. It has not been tested in a population outside the United States or among non-STEMI patients. METHODS: The TIMI risk index was applied to the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) study cohort of 11,510 acute MI patients from Ontario. The model's discriminatory capacity and calibration were tested in all patients and in subgroups determined by age, sex, diagnosis and reperfusion status. RESULTS: The TIMI risk index was strongly associated with 30-day mortality for both STEMI and non-STEMI patients. The C statistic was 0.82 for STEMI and 0.80 for non-STEMI patients, with overlapping 95% CI. The discriminatory capacity was somewhat lower for patients older than 65 years of age (0.74). The model was well calibrated. CONCLUSIONS: The TIMI risk index is a simple, valid and moderately accurate tool for the stratification of risk for early death in STEMI and non-STEMI patients in the community setting. Its routine clinical use is warranted.