Abstract
Objectives
Acute myocardial infarction (AMI) case ascertainment improves for the UK general population using linked health datasets. Because care pathways for people with chronic kidney disease (CKD) change based on disease severity, AMI case ascertainment for these people may differ compared to the general population. We aimed to determine the association between CKD severity and AMI case ascertainment in two secondary care datasets, and the agreement in estimated glomerular filtration rate (eGFR) between the same datasets.
Methods
We used a cohort study design. Primary care records for people with CKD or risk factors for CKD, identified using the National CKD Audit (2015-2017), were linked to the Myocardial Ischaemia National Audit Programme (MINAP, 2007-2017) and Hospital Episode Statistics (HES, 2007-2017) secondary care registries. People with an AMI recorded in either MINAP, HES, or both were included in the study cohort. CKD status was defined using estimated glomerular filtration rate (eGFR), derived from the most recent serum creatinine value recorded in primary care. Moderate-severe CKD was defined as eGFR<60mL/min/1.73m2, and mild CKD or at risk of CKD was defined as eGFR≥60mL/min/1.73m2 or eGFR missing. CKD stages were grouped as (1) At risk of CKD & Stages 1-2 (eGFR missing or ≥60mL/min/1.73m2), (2) Stage 3a (eGFR 45-59mL/min/1.73m2), (3) Stage 3b (eGFR 30-44mL/min/1.73m2), and (4) Stages 4-5 (eGFR<30mL/min/1.73m2).
Results
We identified 6,748 AMIs: 23% were recorded in both MINAP and HES, 66% in HES only and 11% in MINAP only. Compared to people at risk of CKD or with mild CKD, AMIs in people with moderate-severe CKD were more likely to be recorded in both MINAP and HES (42% vs. 11% respectively), or MINAP only (22% vs. 5%), and less likely to be recorded in HES only (36% vs. 84%). People with AMIs recorded in HES only or MINAP only had increased odds of death during hospitalisation compared to those recorded in both (adjusted odds ratio (OR) 1.61, 95% confidence interval (CI) 1.32-1.96 and OR 1.60, 95% CI 1.26-2.04, respectively). Agreement between eGFR at AMI admission (MINAP) and in primary care was poor (kappa (K) 0.42, standard error (SE) 0.012).
Conclusions
AMI case ascertainment is incomplete in both MINAP and HES, and is associated with CKD severity.
Acute myocardial infarction (AMI) case ascertainment improves for the UK general population using linked health datasets. Because care pathways for people with chronic kidney disease (CKD) change based on disease severity, AMI case ascertainment for these people may differ compared to the general population. We aimed to determine the association between CKD severity and AMI case ascertainment in two secondary care datasets, and the agreement in estimated glomerular filtration rate (eGFR) between the same datasets.
Methods
We used a cohort study design. Primary care records for people with CKD or risk factors for CKD, identified using the National CKD Audit (2015-2017), were linked to the Myocardial Ischaemia National Audit Programme (MINAP, 2007-2017) and Hospital Episode Statistics (HES, 2007-2017) secondary care registries. People with an AMI recorded in either MINAP, HES, or both were included in the study cohort. CKD status was defined using estimated glomerular filtration rate (eGFR), derived from the most recent serum creatinine value recorded in primary care. Moderate-severe CKD was defined as eGFR<60mL/min/1.73m2, and mild CKD or at risk of CKD was defined as eGFR≥60mL/min/1.73m2 or eGFR missing. CKD stages were grouped as (1) At risk of CKD & Stages 1-2 (eGFR missing or ≥60mL/min/1.73m2), (2) Stage 3a (eGFR 45-59mL/min/1.73m2), (3) Stage 3b (eGFR 30-44mL/min/1.73m2), and (4) Stages 4-5 (eGFR<30mL/min/1.73m2).
Results
We identified 6,748 AMIs: 23% were recorded in both MINAP and HES, 66% in HES only and 11% in MINAP only. Compared to people at risk of CKD or with mild CKD, AMIs in people with moderate-severe CKD were more likely to be recorded in both MINAP and HES (42% vs. 11% respectively), or MINAP only (22% vs. 5%), and less likely to be recorded in HES only (36% vs. 84%). People with AMIs recorded in HES only or MINAP only had increased odds of death during hospitalisation compared to those recorded in both (adjusted odds ratio (OR) 1.61, 95% confidence interval (CI) 1.32-1.96 and OR 1.60, 95% CI 1.26-2.04, respectively). Agreement between eGFR at AMI admission (MINAP) and in primary care was poor (kappa (K) 0.42, standard error (SE) 0.012).
Conclusions
AMI case ascertainment is incomplete in both MINAP and HES, and is associated with CKD severity.
| Original language | English |
|---|---|
| Article number | e057909 |
| Pages (from-to) | e057909 |
| Journal | BMJ Open |
| Volume | 12 |
| Issue number | 3 |
| Early online date | 28 Mar 2022 |
| DOIs | |
| Publication status | E-pub ahead of print - 28 Mar 2022 |
Bibliographical note
Publisher Copyright:© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.
Keywords
- chronic kidney disease
- myocardial infarction
- outcomes
- CASE ASCERTAINMENT
- revascularisation