Using Big Data from Health Records from Four Countries to Evaluate Chronic Disease Outcomes: a Study in 114 364 Survivors of Myocardial Infarction

Overview

Journal Eur Heart J Qual Care Clin Outcomes

Publisher Oxford University Press

Specialty Cardiology & Vascular Diseases

Date 2018 Feb 24

PMID 29474617

Citations 46

Authors

Eleni Rapsomaniki

Marcus Thuresson

Erru Yang

Patrick Blin

Phillip Hunt

Sheng-Chia Chung

Dimitris Stogiannis

Mar Pujades-Rodriguez

Adam Timmis

Spiros C Denaxas

Nicolas Danchin

Michael Stokes

Florence Thomas-Delecourt

Cathy Emmas

Pal Hasvold

Em Jennings

Saga Johansson

David J Cohen

Tomas Jernberg

Nicholas Moore

Magnus Janzon

Harry Hemingway

Affiliations

Soon will be listed here.

Abstract

Aims: To assess the international validity of using hospital record data to compare long-term outcomes in heart attack survivors.

Methods And Results: We used samples of national, ongoing, unselected record sources to assess three outcomes: cause death; a composite of myocardial infarction (MI), stroke, and all-cause death; and hospitalized bleeding. Patients aged 65 years and older entered the study 1 year following the most recent discharge for acute MI in 2002-11 [n = 54 841 (Sweden), 53 909 (USA), 4653 (England), and 961 (France)]. Across each of the four countries, we found consistent associations with 12 baseline prognostic factors and each of the three outcomes. In each country, we observed high 3-year crude cumulative risks of all-cause death (from 19.6% [England] to 30.2% [USA]); the composite of MI, stroke, or death [from 26.0% (France) to 36.2% (USA)]; and hospitalized bleeding [from 3.1% (France) to 5.3% (USA)]. After adjustments for baseline risk factors, risks were similar across all countries [relative risks (RRs) compared with Sweden not statistically significant], but higher in the USA for all-cause death [RR USA vs. Sweden, 1.14 (95% confidence interval 1.04-1.26)] and hospitalized bleeding [RR USA vs. Sweden, 1.54 (1.21-1.96)].

Conclusion: The validity of using hospital record data is supported by the consistency of estimates across four countries of a high adjusted risk of death, further MI, and stroke in the chronic phase after MI. The possibility that adjusted risks of mortality and bleeding are higher in the USA warrants further study.

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