Completeness and diagnostic validity of recording acute myocardial infarction events in primary care, hospital care, disease registry, and national mortality records: cohort study.
Completeness and diagnostic validity of recording acute myocardial infarction events in primary care, hospital care, disease registry, and national mortality records: cohort study.
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DOI：
10.1136/bmj.f2350
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发表时间：
2013-05-20
期刊：
影响因子：
--
通讯作者：
Hemingway H
中科院分区：
文献类型：
--
作者：
Herrett E;Shah AD;Boggon R;Denaxas S;Smeeth L;van Staa T;Timmis A;Hemingway H
目的确定在初级保健、医院保健、疾病登记和死亡登记四个国家健康档案来源中心肌梗死记录的完整性和诊断有效性。设计队列研究。参与者2003年1月至2009年3月期间，英格兰有21 482名急性心肌梗死患者，通过四个前瞻性收集的链接电子健康记录来源确认：临床实践研究数据链接(初级保健数据)、医院流行病学统计(入院)、疾病登记处MINAP(心肌梗死国家审计项目)和国家统计局死亡率登记处(原因特定死亡数据)。建立一个国家(英格兰)和一个卫生系统(国家卫生服务)。主要指标急性心肌梗死的记录、发病率、急性心肌梗死一年内的所有原因死亡率，以及急性心肌梗死的诊断有效性与疾病登记中的心电图和肌钙蛋白结果(金标准)进行比较。结果在初级保健、入院和登记来源中确定的患者中，危险因素和非心血管并存情况相似。在初级保健中记录的急性心肌梗死患者中，直接所有原因死亡率最高，这(与住院和疾病登记来源不同)包括没有到达医院的患者，但在一年中，来自各个来源的队列死亡率相似。非致死性急性心肌梗死患者5561例(31.0%)在三个来源均有记录，至少两个来源有11482例(63.9%)。与使用所有三个来源相比，使用一个来源的急性心肌梗死的粗略发病率被低估了25%-50%。与疾病登记中定义的急性心肌梗死相比，初级保健记录的急性心肌梗死的阳性预测值为92.2%(95%可信区间为91.6%~92.8%)，住院记录的阳性预测值为91.5%(90.8%至92.1%)。结论每个数据源都遗漏了相当大比例(25%-50%)的心肌梗死事件。没有使用初级保健、医院护理、疾病登记和死亡证明中链接的电子健康记录，可能会导致对心肌梗死的发生率和结果的偏颇估计。试验注册NCT01569139临床试验.gov。
Objective To determine the completeness and diagnostic validity of myocardial infarction recording across four national health record sources in primary care, hospital care, a disease registry, and mortality register. Design Cohort study. Participants 21 482 patients with acute myocardial infarction in England between January 2003 and March 2009, identified in four prospectively collected, linked electronic health record sources: Clinical Practice Research Datalink (primary care data), Hospital Episode Statistics (hospital admissions), the disease registry MINAP (Myocardial Ischaemia National Audit Project), and the Office for National Statistics mortality register (cause specific mortality data). Setting One country (England) with one health system (the National Health Service). Main outcome measures Recording of acute myocardial infarction, incidence, all cause mortality within one year of acute myocardial infarction, and diagnostic validity of acute myocardial infarction compared with electrocardiographic and troponin findings in the disease registry (gold standard). Results Risk factors and non-cardiovascular coexisting conditions were similar across patients identified in primary care, hospital admission, and registry sources. Immediate all cause mortality was highest among patients with acute myocardial infarction recorded in primary care, which (unlike hospital admission and disease registry sources) included patients who did not reach hospital, but at one year mortality rates in cohorts from each source were similar. 5561 (31.0%) patients with non-fatal acute myocardial infarction were recorded in all three sources and 11 482 (63.9%) in at least two sources. The crude incidence of acute myocardial infarction was underestimated by 25-50% using one source compared with using all three sources. Compared with acute myocardial infarction defined in the disease registry, the positive predictive value of acute myocardial infarction recorded in primary care was 92.2% (95% confidence interval 91.6% to 92.8%) and in hospital admissions was 91.5% (90.8% to 92.1%). Conclusion Each data source missed a substantial proportion (25-50%) of myocardial infarction events. Failure to use linked electronic health records from primary care, hospital care, disease registry, and death certificates may lead to biased estimates of the incidence and outcome of myocardial infarction. Trial registration NCT01569139 clinicaltrials.gov.
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影响因子：
2.1
作者：
Delaney, Joseph A C;Daskalopoulou, Stella S;Suissa, Samy
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