Abstract 169: A Retrospective Cardiovascular Disease Registry to Inform Community Prevention

Abstract

Background: Cardiovascular disease (CVD) registries are essential to planning, implementation, and evaluation of clinical and public health practice. Registries primarily enroll patients seeking medical care and poor, socially isolated and medically underserved populations are not well represented, distorting the magnitude of the problem and mischaracterizing victims. Lincoln Project investigators contend a retrospective CVD victim registry, created from a well-documented cohort of all-cause Out of Hospital Premature Death (OHPND) victims, dominated by cardiovascular deaths, will accurately identify, describe and locate CVD victims and drive intervention strategies targeting CVD risk factors in the community. Objective: To establish a comprehensive retrospective CVD registry from a cohort of OHPND victims in rural Eastern North Carolina. Methods: All deaths (12,665) for 2014 from 29 counties in Eastern North Carolina (Population 1.5M) were electronically filtered. 1122 cases of OHPND (18-74 years old, natural causes, that died out of the hospital) were identified. Cancer deaths were excluded. Medical records from clinical providers, Emergency Medical Services (EMS) and the Medical Examiner (ME) were procured. Cases were mapped using victim’s residence address and matched with Census data to determine socioeconomic status. All available medical records and reports of OHPND victims were reviewed by a group of 3 cardiologists to determine inclusion in CVD registry per internally designed protocol. Results: Death registration data was acquired for all 1122 OHPND subjects. Medical provider records were available for 71.9% (807/1122) of victims; we captured EMS records on the date of death for 67.2% (755) of victims and all EMS encounter data for three years prior to death on 89.2% (I1001)of decedents. Report of Medical Examiner was available on all (39%) ME cases. No medical records were available for 124 subjects. Of 998 OHPND subjects with available medical records, 659 (66%) met the criteria for inclusion in CVD registry. Of CVD registrants, 66.1% (435/659) had coronary artery disease, 72% (475) hypertension, and 55.2% (364) had diabetes mellitus. Heart failure accounted for 19.3% (127) of registry deaths; resuscitation was attempted on 27.9% (184) of victims, no ROSC was recorded in cases where ressucitation was attempted. GPS mapping of residence addresses shows CVD victims cluster in low socioeconomic areas. Conclusion: A CVD registry, created from a data-rich cohort of OHPND victims, will identify high-risk communities and illuminate common antecedents and modifiable CVD risk factors. Intensive community preventative health care efforts can be initiated to minimize the undue burden of CVD on rural populations.