Feasibility of identifying important changes in care management resulting from cardiovascular magnetic resonance (CMR) using hospital episode data in patients who activate the primary percutaneous coronary intervention (PPCI) pathway

Abstract

Background We determined whether it is feasible to identify important changes in care management resulting from cardiovascular magnetic resonance (CMR) in patients who activate the primary percutaneous coronary intervention (PPCI) pathway from hospital episode data, in order to construct a composite primary outcome (hypothesised to reduce the risk of major adverse cardiac-related events, MACE) to compare patients exposed to CMR or not. Methods We used Hospital Episode Statistics (HES) and Patient Episode Database for Wales (PEDW) to identify clinical events that reflected important changes in management in the year following the index admission in five subgroups of patients who activated the PPCI pathway recruited as part of a feasibility cohort study ( n = 1655 with HES/PEDW data). For all subgroups, we identified frequency of events and time to the first event for each change in management. Results We identified all clinical events (new diagnoses, additional diagnostic tests and procedures) except for medication prescriptions. Diagnostic tests were underestimated because most are carried out in outpatient clinics and outpatient datasets had missing procedure codes for 74% of patients (some tests done in hospital may also not be recorded). We successfully tabulated frequencies of events and distributions of times to first event for most changes in management by CMR status and in CMR / non CMR centres. Conclusions It is feasible to identify changes in care management between patients who have / do not have CMR within relevant patient subgroups. Further work to derive a weighting algorithm is required before attempting to combine the events in a composite endpoint. Electronic supplementary material The online version of this article (10.1186/s12874-019-0755-3) contains supplementary material, which is available to authorized users.

A national registry to assess the value of cardiovascular magnetic resonance imaging after primary percutaneous coronary intervention pathway activation: a feasibility cohort study

“…More research would be needed to develop a specific composite outcome for a patient subgroup. 68 Any multicentre registry set up in this patient population would need to be able to capture new and emerging diagnostic/interventional technologies. During the study, priority for CMR decreased because of the introduction of pressure-wire testing for diagnosing ischaemia in patients with multivessel disease.…”

“…Frequency of patient subgroups by hospitalNote Percentages do not add up to 100 because some patients were in more than one subgroup. Reproduced with permission from Pufulete et al68 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.…”

Correction to: Feasibility of identifying important changes in care management resulting from cardiovascular magnetic resonance (CMR) using hospital episode data in patients who activate the primary percutaneous coronary intervention (PPCI) pathway

“…In the original publication of this article [1], the author noted two corrections after publication. There is a middle initial in John P. Greenwood.An institution’s name in the Funding section should be changed from “NIHR Bristol Biomedical Research Unit for Cardiovascular Disease” to “NIHR Bristol Biomedical Research Centre”.…”