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Using big data from health records from four countries to evaluate chronic disease outcomes: a study in 114 364 survivors of myocardial infarction
Farr Institute of Health Informatics Research, University College London, London, UK.
Statisticon AB, Uppsala, Sweden.
Retrospective Observational Studies, Evidera, Lexington, MA, USA.
University of Bordeaux, Bordeaux, France.
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2016 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aims To assess the international validity of using hospital record data to compare long-term outcomes in heart attack survivors.

Methods and results We used samples of national, ongoing, unselected record sources to assess three outcomes: cause death; a composite of myocardial infarction (MI), stroke, and all-cause death; and hospitalized bleeding. Patients aged 65 years and older entered the study 1 year following the most recent discharge for acute MI in 2002–11 [n = 54 841 (Sweden), 53 909 (USA), 4653 (England), and 961 (France)]. Across each of the four countries, we found consistent associations with 12 baseline prognostic factors and each of the three outcomes. In each country, we observed high 3-year crude cumulative risks of all-cause death (from 19.6% [England] to 30.2% [USA]); the composite of MI, stroke, or death [from 26.0% (France) to 36.2% (USA)]; and hospitalized bleeding [from 3.1% (France) to 5.3% (USA)]. After adjustments for baseline risk factors, risks were similar across all countries [relative risks (RRs) compared with Sweden not statistically significant], but higher in the USA for all-cause death [RR USA vs. Sweden, 1.14 (95% confidence interval 1.04–1.26)] and hospitalized bleeding [RR USA vs. Sweden, 1.54 (1.21–1.96)].

Conclusion The validity of using hospital record data is supported by the consistency of estimates across four countries of a high adjusted risk of death, further MI, and stroke in the chronic phase after MI. The possibility that adjusted risks of mortality and bleeding are higher in the USA warrants further study.

Place, publisher, year, edition, pages
Oxford University Press, 2016.
Keyword [en]
Acute myocardial infarction, Co-morbidities, Healthcare systems, International comparison, Long-term outcomes, EHR
National Category
Cardiac and Cardiovascular Systems
URN: urn:nbn:se:liu:diva-130050DOI: 10.1093/ehjqcco/qcw004OAI: diva2:946796
Available from: 2016-07-06 Created: 2016-07-06 Last updated: 2016-07-27Bibliographically approved

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Janzon, Magnus
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Department of Medical and Health SciencesFaculty of Medicine and Health SciencesDepartment of Cardiology in Linköping
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