The myocardial ischaemia national audit project (MINAP)

Department of Epidemiology and Population Health, Non-communicable Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, UK.
Heart (British Cardiac Society) (Impact Factor: 5.6). 08/2010; 96(16):1264-7. DOI: 10.1136/hrt.2009.192328
Source: PubMed


AIMS OF MINAP: To audit the quality of care of patients with acute coronary syndrome and provide a resource for academic research. QUALITY OF CARE INTERVENTIONS: Feedback to hospitals, ambulance services and cardiac networks regarding benchmarking of performance against national standards and targets. SETTING: All 230 acute hospitals in England and Wales. Years: 2000-present. POPULATION: Consecutive patients, unconsented. Current number of records: 735 000. STARTPOINTS: Any acute coronary syndrome, including non-ST-elevation myocardial infarction, ST-elevation myocardial infarction and unstable angina. BASELINE DATA: 123 fields covering demographic factors, co-morbid conditions and treatment in hospital. No blood resource. DATA CAPTURE: Manual entry by clerks, nurses or doctors onto Lotus Notes; non-financial incentives at hospital level. DATA QUALITY: Hospitals perform an annual data validation study, where data are re-entered from the case notes in 20 randomly selected records that are held on the server. In 2008 data were >90% complete for 20 key fields, with >80% completeness for all but four of the remaining fields. ENDPOINTS AND LINKAGES TO OTHER DATA: All-cause mortality is obtained through linkage with Office for National Statistics. No other linkages exist at present. ACCESS TO DATA: Available for research and audit by application to the MINAP Academic Group.

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Available from: Clive Weston, Oct 02, 2015
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    • "As part of the CALIBER research programme (Cardiovascular disease research using Linked Bespoke studies and Electronic health Records),17 the records of patients in the Myocardial Ischaemia National Audit Project (MINAP, the national registry of acute coronary syndrome18), and Hospital Episode Statistics (HES, hospital discharge data set19) were linked to longitudinal electronic health records from primary care in the General Practice Research Database (GPRD20) and to Office for National Statistics (ONS21) cause-specific mortality data (for details, see Supplementary material online, Table S2). Linkage was performed by a trusted third party and was based on National Health Service (NHS) number, date of birth, gender and postcode. "
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    ABSTRACT: Background Ischaemia in different arterial territories before acute myocardial infarction (AMI) may influence post-AMI outcomes. No studies have evaluated prospectively collected information on ischaemia and its effect on short- and long-term coronary mortality. The objective of this study was to compare patients with and without prospectively measured ischaemic presentations before AMI in terms of infarct characteristics and coronary mortality. Methods and results As part of the CALIBER programme, we linked data from primary care, hospital admissions, the national acute coronary syndrome registry and cause-specific mortality to identify patients with first AMI (n = 16,439). We analysed time from AMI to coronary mortality (n = 5283 deaths) using Cox regression (median 2.6 years follow-up), comparing patients with and without recent ischaemic presentations. Patients with ischaemic presentations in the 90 days before AMI experienced lower coronary mortality in the first 7 days after AMI compared with those with no prior ischaemic presentations, after adjusting for age, sex, smoking, diabetes, blood pressure and cardiovascular medications [HR: 0.64 (95% CI: 0.57–0.73) P < 0.001], but subsequent mortality was higher [HR: 1.42 (1.13–1.77) P = 0.001]. Patients with ischaemic presentations closer in time to AMI had the lowest seven day mortality (P-trend = 0.001). Conclusion In the first large prospective study of ischaemic presentations prior to AMI, we have shown that those occurring closest to AMI are associated with lower short-term coronary mortality following AMI, which could represent a natural ischaemic preconditioning effect, observed in a clinical setting. Clinical trials registration identifier NCT01604486.
    European Heart Journal 07/2014; 35(35). DOI:10.1093/eurheartj/ehu286 · 15.20 Impact Factor
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    • "CALIBER is a database of linked routinely collected electronic health records from England (16), comprising data from primary care (Clinical Practice Research Datalink) (18), hospital admissions (19), the national registry of acute coronary syndromes (20), and the national death registry. "
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    ABSTRACT: Multivariate imputation by chained equations (MICE) is commonly used for imputing missing data in epidemiologic research. The "true" imputation model may contain nonlinearities which are not included in default imputation models. Random forest imputation is a machine learning technique which can accommodate nonlinearities and interactions and does not require a particular regression model to be specified. We compared parametric MICE with a random forest-based MICE algorithm in 2 simulation studies. The first study used 1,000 random samples of 2,000 persons drawn from the 10,128 stable angina patients in the CALIBER database (Cardiovascular Disease Research using Linked Bespoke Studies and Electronic Records; 2001-2010) with complete data on all covariates. Variables were artificially made "missing at random," and the bias and efficiency of parameter estimates obtained using different imputation methods were compared. Both MICE methods produced unbiased estimates of (log) hazard ratios, but random forest was more efficient and produced narrower confidence intervals. The second study used simulated data in which the partially observed variable depended on the fully observed variables in a nonlinear way. Parameter estimates were less biased using random forest MICE, and confidence interval coverage was better. This suggests that random forest imputation may be useful for imputing complex epidemiologic data sets in which some patients have missing data.
    American journal of epidemiology 03/2014; 179(6):764-74. DOI:10.1093/aje/kwt312 · 5.23 Impact Factor
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    • "The cohort consisted of patients admitted to hospital for acute coronary syndrome (ACS) identified through MINAP22–24 who resided in England and Wales at the time of admission. We included patients with a final diagnosis (at discharge) of ST elevation MI (STEMI) and non-ST elevation MI (non-STEMI) between 1 January 2004 and 31 March 2007. "
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    ABSTRACT: AimsThe aim of this study was to determine (i) whether long-term exposure to air pollution was associated with all-cause mortality using the Myocardial Ischaemia National Audit Project (MINAP) data for England and Wales, and (ii) the extent to which exposure to air pollution contributed to socioeconomic inequalities in prognosis.Methods and resultsRecords of patients admitted to hospital with acute coronary syndrome (ACS) in MINAP collected under the National Institute for Cardiovascular Outcomes Research were linked to modelled annual average air pollution concentrations for 2004-10. Hazard ratios for mortality starting 28 days after admission were estimated using Cox proportional hazards models. Among the 154 204 patients included in the cohort, the average follow-up was 3.7 years and there were 39 863 deaths. Mortality rates were higher for individuals exposed to higher levels of particles with a diameter of ≤2.5 µm (PM(2.5); PM, particulate matter): the fully adjusted hazard ratio for a 10 µg/m(3) increase in PM(2.5) was 1.20 (95% CI 1.04-1.38). No associations were observed for larger particles or oxides of nitrogen. Air pollution explained socioeconomic inequalities in survival to only a small extent.Conclusion Mortality from all causes was higher among individuals with greater exposure to PM(2.5) in survivors of hospital admission for ACS in England and Wales. Despite higher exposure to PM(2.5) among those from more deprived areas, such exposure was a minor contribution to the socioeconomic inequalities in prognosis following ACS. Our findings add to the evidence of mortality associated with long-term exposure to fine particles.
    European Heart Journal 02/2013; 34(17). DOI:10.1093/eurheartj/ehs480 · 15.20 Impact Factor
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