Hospital discharge data for assessing myocardial infarction events and trends, and effects of diagnosis validation according to MONICA and AHA criteria

Barchielli, Alessandro; Balzi, Daniela; Naldoni, P; Roberts, Anna Teresa; Pennacchio, Francesco; Dima, Francesco; Palmieri, Luigi

doi:10.1136/jech.2010.110908

Cited by 18 publications

(22 citation statements)

References 23 publications

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“…Similar to observations in previous publications, the proportion of NSTEMI was higher in this group. 10,17 In our study, the proportion of MI cases with increased troponins was smaller than that observed in the FINAMI population-based registry (83%) 8 and the Olmsted County Study (74%), 10 but similar to the increased incidence reported in other studies. [5][6][7]9 However, the comparison between studies could be misleading because of potential differences in many factors, such as study design, patient characteristics and troponin assay (type, availability, coefficients of variation, and cutoff selected).…”

Section: Changes In Myocardial Infarction Incidence Due To New Case Dcontrasting

confidence: 45%

New myocardial infarction definition affects incidence, mortality, hospitalization rates and prognosis

Agüero

Marrugat

Elosúa

et al. 2014

Eur J Prev Cardiolog

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Aims: To analyse differences in myocardial infarction incidence, mortality and hospitalization rates, 28-day case-fatality and two-year prognosis using two myocardial infarction case definitions: the classical World Health Organization definition (1994) and the European Society of Cardiology/American College of Cardiology definition (2000), which added cardiac troponin as a diagnostic biomarker. Design: Population-based cohort of 4170 consecutive myocardial infarction patients aged 35-74 years from Girona (Spain) recruited between 2002 and 2009. Methods: Incidence, mortality rates standardized to the European population and 28-day case-fatality were calculated. To estimate the association between case definition and prognosis, Cox models were fitted. Results: Use of the 2000 European Society of Cardiology/American College of Cardiology definition significantly increased myocardial infarction incidence per 100,000 population (238.3 vs. 274.5 in men and 54.1 vs. 69.7 in women). Applying this definition decreased the 28-day case-fatality rate from 26.9% to 23.4% in men, and from 31.0% to 24.1% in women. In the acute phase, patients diagnosed only by increased troponins were significantly less treated with thrombolysis (34.4% vs. 2.0%), angiotensin-converting enzyme inhibitors (71.7% vs. 65.0%) and percutaneous coronary intervention (41.1% vs. 31.7%). Case-fatality at 28 days was significantly better in cases diagnosed only by troponin increase (0.2 % vs. 9.7%), but two-year cardiovascular mortality was higher (7.5% vs. 3.7%). Conclusions: Inclusion of cardiac troponins in myocardial infarction diagnosis increased annual incidence and decreased case-fatality. Diagnosis based only on increased troponins was associated with worse outcome. This group of patients at high risk of death should receive aggressive secondary prevention therapy.

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Section: Changes In Myocardial Infarction Incidence Due To New Case Dcontrasting

confidence: 45%

New myocardial infarction definition affects incidence, mortality, hospitalization rates and prognosis

Agüero

Marrugat

Elosúa

et al. 2014

Eur J Prev Cardiolog

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“…Importantly, agreement within and between studies depends on which external criteria for AMI are used. For example, Barchielli et al [37] applied two sets of criteria to the same cohort and found that PPV varied considerably (PPV 94.6% using AHA Council of Epidemiology and Prevention [25] criteria; PPV 65.3% using WHO MONICA [23] criteria). These findings further emphasize the importance of raw data on markers of myocardial necrosis, ECG and symptoms in order to reconstruct AMI according to different definitions, facilitating comparison of study results and data sharing.…”

Section: Discussionmentioning

confidence: 98%

Use of electronic health records to ascertain, validate and phenotype acute myocardial infarction: A systematic review and recommendations

Rubbo

Fitzpatrick

Denaxas

et al. 2015

International Journal of Cardiology

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Electronic health records (EHRs) offer the opportunity to ascertain clinical outcomes at large scale and low cost, thus facilitating cohort studies, quality of care research and clinical trials. For acute myocardial infarction (AMI) the extent to which different EHR sources are accessible and accurate remains uncertain. Using MEDLINE and EMBASE we identified thirty three studies, reporting a total of 128658 patients, published between January 2000 and July 2014 that permitted assessment of the validity of AMI diagnosis drawn from EHR sources against a reference such as manual chart review. In contrast to clinical practice, only one study used EHR-derived markers of myocardial necrosis to identify possible AMI cases, none used electrocardiogram findings and one used symptoms in the form of free text combined with coded diagnosis. The remaining studies relied mostly on coded diagnosis. Thirty one studies reported positive predictive value (PPV)≥ 70% between AMI diagnosis from both secondary care and primary care EHRs and the reference. Among fifteen studies reporting EHR-derived AMI phenotypes, three cross-referenced ST-segment elevation AMI diagnosis (PPV range 71-100%), two non-ST-segment elevation AMI (PPV 91.0, 92.1%), three non-fatal AMI (PPV range 82-92.2%) and six fatal AMI (PPV range 64-91.7%). Clinical coding of EHR-derived AMI diagnosis in primary care and secondary care was found to be accurate in different clinical settings and for different phenotypes. However, markers of myocardial necrosis, ECG and symptoms, the cornerstones of a clinical diagnosis, are underutilised and remain a challenge to retrieve from EHRs.

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“…The population-based registry, operating in Tuscany since the late 1990s, is based on the record-linkage between hospital discharge and mortality databases. Details on the registry's structure and validation are presented elsewhere (Barchielli et al, 2010). In summary, patients are identified by a personal identification number, which allows to perform anonymously the electronic record linkage among data sources.…”

Section: Health Datamentioning

confidence: 99%

Ozone short-term exposure and acute coronary events: A multicities study in Tuscany (Italy)

Nuvolone¹,

Balzi²,

Pepe³

et al. 2013

Environmental Research

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Hospital discharge data for assessing myocardial infarction events and trends, and effects of diagnosis validation according to MONICA and AHA criteria

Abstract: The study suggests an influence of the new diagnostic criteria on the rising AMI trend observed in the early 2000s, an increase of less severe cases and a decreasing trend of forms with a more extended myocardial damage.

Cited by 18 publications

References 23 publications

New myocardial infarction definition affects incidence, mortality, hospitalization rates and prognosis

New myocardial infarction definition affects incidence, mortality, hospitalization rates and prognosis

Use of electronic health records to ascertain, validate and phenotype acute myocardial infarction: A systematic review and recommendations

Ozone short-term exposure and acute coronary events: A multicities study in Tuscany (Italy)

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