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

Maria Pufulete*, Jessica Harris, Stephen Dorman, Lynn Cook, Chiara Bucciarelli-Ducci, John P Greenwood , Richard A Anderson, Rachel Brierley, Barnaby Reeves

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)

137 Downloads (Pure)

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 Remove capital letters as in the Keywords or vice
versa? At the moment it is not consistent. (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.
Original languageEnglish
Article number116
Number of pages10
JournalBMC Medical Research Methodology
Volume19
Issue number1
DOIs
Publication statusPublished - 6 Jun 2019

Structured keywords

  • BTC (Bristol Trials Centre)
  • Centre for Surgical Research

Keywords

  • Patient episode database Wales (PEDW)
  • England
  • Hospital Episode Statistics (HES)
  • Primary percutaneous coronary intervention (PPCI)
  • Cardiovascular magnetic resonance (CMR)

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