NHLBI Workshop
Data Needs for Cardiovascular Events, Management, and Outcomes
Acute Coronary Syndromes - Dr. Harlan Krumholz
Various data-collection systems for acute myocardial infarction (AMI) currently exist, including local surveillance
projects, federal agency projects, and other large organizations. There is a
generally decreasing trend in coronary heart disease deaths, as observed by the Framingham Heart
Study, the Minnesota Heart Survey, the Worcester Heart Attack Study, and in
Olmsted County. Dr. Krumholz showed trends in AMI incidence as per the Worcester Heart Attack Study; this study has also
provided data on trends in case-fatality, drug treatment, and use of invasive
procedures following AMI. He then described the Cooperative Cardiovascular
Project (CCP), a CMS initiative to improve the quality of care for Medicare
beneficiaries with AMI. Using the databases of Medicare beneficiaries with AMI
in four states (AL, CT, IA, and WI), medical records of more than 200,000 Medicare
hospitalizations for AMI were evaluated. During 1992-2001, there was an
increasing percentage of older people, female, and skilled nursing facility
residents who had AMI. The burden of comorbidities among AMI patients has also
increased. Other interesting CCP data presented included the adjusted 1-year
mortality and changes in clinical presentation of AMI.
Dr. Krumholz indicated that presently no national
surveillance system exists for AMI. Even with the currently available AMI data several
important pieces are missing, including health status/functional status
information, treatment from the patient perspective, and a concerted national
strategy for surveillance. Specific data needs for AMI include national
incidence data, patient profiles, treatment patterns, safety information, and
outcomes. He also raised the need for complementary data that will provide
insight about the changing epidemiology and performance in promoting the safety,
effectiveness, equity, efficiency, timeliness and patient-centeredness of the
U.S. health care system. He discussed the importance of optimizing existing
data as well as obtaining new data, supporting creative local efforts, and
moving toward coordinated national projects. Finally, he posed some fundamental
questions for the group to consider: What do we need to know, and how well do we
need to know it? What percent of our total health care budget should be
informing us about the health and outcomes of our population?
Back to Workshop Agenda
|
HOME
Department of Health
and Human Services
National
Institutes of Health
National Heart, Lung, and Blood
Institute