Abstract
AimsTo assess the recording and accuracy of acute myocardial infarction (AMI) hospital admissions between two electronic health record databases within an English cancer population over time and understand the factors that affect case-ascertainment.Methods and resultsWe identified 112 502 hospital admissions for AMI in England 2010–2017 from the Myocardial Ischaemia National Audit Project (MINAP) disease registry and hospital episode statistics (HES) for 95 509 patients with a previous cancer diagnosis up to 15 years prior to admission. Cancer diagnoses were identified from the National Cancer Registration Dataset (NCRD). We calculated the percentage of AMI admissions captured by each source and examined patient characteristics associated with source of ascertainment. Survival analysis assessed whether differences in survival between case-ascertainment sources could be explained by patient characteristics. A total of 57 265 (50.9%) AMI admissions in patients with a prior diagnosis of cancer were captured in both MINAP and HES. Patients captured in both sources were younger, more likely to have ST-segment elevation myocardial infarction and had better prognosis, with lower mortality rates up to 9 years after AMI admission compared with patients captured in only one source. The percentage of admissions captured in both data sources improved over time. Cancer characteristics (site, stage, and grade) had little effect on how AMI was captured.ConclusionMINAP and HES define different populations of patients with AMI. However, cancer characteristics do not substantially impact on case-ascertainment. These findings support a strategy of using multiple linked data sources for observational cardio-oncological research into AMI.
Highlights
Multimorbid patients make up the majority of hospital admissions and account for significant secondary care healthcare costs but are frequently excluded from clinical trials [1,2,3]
Through linkage of the National Cancer Registration Dataset (NCRD) [11] with both Myocardial Ischaemia National Audit Project (MINAP) and hospital episode statistics (HES) we investigate firstly, whether individual or multiple data resources are required for the ascertainment of acute myocardial infarction (AMI) in cancer patients, secondly whether cancer characteristics impact on ascertainment of AMI and thirdly to investigate the differences in characteristics and survival of cancer patients with AMI captured by MINAP, HES or both data sources
Between 2010 and 2017 we identified 112,502 hospital admissions for AMI across MINAP and HES for 95,509 patients who had had a previous cancer diagnosis up to 15 years prior to the admission
Summary
Multimorbid patients make up the majority of hospital admissions and account for significant secondary care healthcare costs but are frequently excluded from clinical trials [1,2,3]. Previous researchers studying MINAP records prior to 2009, found that only around half of patients with at least one record of non-fatal AMI were captured in MINAP when compared with AMI capture in hospital episode statistics (HES) data (routinely collected secondary care data coded by non-clinical coding clerks), and primary care data from the Clinical Practice Research Datalink (CPRD) [8]. This may partly be due to incomplete hospital-level case-ascertainment and likely arises because MINAP is targeted primarily to capture AMI caused by atherothrombotic coronary artery disease or Type I AMI [9]
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