使用关联的健康数据集,英国普通人群的急性心肌梗死(AMI)病例确定得到了改善。因为慢性肾脏病(CKD)患者的护理途径因疾病严重程度而发生变化,与普通人群相比,这些人的AMI病例确定可能有所不同。我们的目的是在两个二级护理数据集中确定CKD严重程度与AMI病例确定之间的关联,以及相同数据集之间估计的肾小球滤过率(eGFR)的一致性。
我们采用队列研究设计。CKD患者的初级保健记录或CKD的危险因素,使用国家CKD审计(2015-2017)确定,与心肌缺血国家审计项目(MINAP,2007-2017年)和医院事件统计(HES,2007-2017)二级保健登记。在任何一个MINAP中都有AMI记录的人,HES或两者都包括在研究队列中。CKD状态使用eGFR定义,来自初级保健记录的最新血清肌酐值。中重度CKD定义为eGFR<60mL/min/1.73m2,轻度CKD或有CKD风险的定义为eGFR≥60mL/min/1.73m2或eGFR缺失。CKD阶段分为(1)在CKD的风险和阶段1-2(eGFR缺失或≥60mL/min/1.73m2),(2)阶段3a(eGFR45-59mL/min/1.73m2),(3)阶段3b(eGFR为30-44mL/min/1.73m2)和(4)阶段4-5(eGFR<30mL/min/1.73m2)。
我们确定了6748个AMI:MINAP和HES记录了23%,66%仅在HES和11%仅在MINAP。与有CKD风险或轻度CKD的人相比,中重度CKD患者的AMI更有可能在MINAP和HES中记录(42%vs11%,分别),或仅MINAP(22%对5%),并且不太可能仅在HES中记录(36%对84%)。仅在HES或MINAP中记录有AMI的人在住院期间的死亡几率与两者中记录的人相比增加(分别为校正OR1.61,95%CI1.32至1.96和OR1.60,95%CI1.26至2.04)。AMI入院时(MINAP)和初级保健中的eGFR之间的协议较差(κ(K)0.42,SE0.012)。
在MINAP和HES中,AMI病例的确定都不完整,与CKD严重程度相关。
Acute myocardial infarction (AMI)
case ascertainment improves for the UK general population using linked health data sets. Because care pathways for people with chronic kidney disease (CKD) change based on disease severity, AMI
case ascertainment for these people may differ compared with the general population. We aimed to determine the association between CKD severity and AMI
case ascertainment in two secondary care data sets, and the agreement in estimated glomerular filtration rate (eGFR) between the same data sets.
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 Project (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 eGFR, derived from the most recent serum creatinine value recorded in primary care. Moderate-severe CKD was defined as eGFR <60 mL/min/1.73 m2, and mild CKD or at risk of CKD was defined as eGFR ≥60 mL/min/1.73 m2 or eGFR missing. CKD stages were grouped as (1) At risk of CKD and Stages 1-2 (eGFR missing or ≥60 mL/min/1.73 m2), (2) Stage 3a (eGFR 45-59 mL/min/1.73 m2), (3) Stage 3b (eGFR 30-44 mL/min/1.73 m2) and (4) Stages 4-5 (eGFR <30 mL/min/1.73 m2).
We identified 6748 AMIs: 23% were recorded in both MINAP and HES, 66% in HES only and 11% in MINAP only. Compared with 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 with those recorded in both (adjusted OR 1.61, 95% CI 1.32 to 1.96 and OR 1.60, 95% CI 1.26 to 2.04, respectively). Agreement between eGFR at AMI admission (MINAP) and in primary care was poor (kappa (K) 0.42, SE 0.012).
AMI case ascertainment is incomplete in both MINAP and HES, and is associated with CKD severity.