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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?