Impact of chronic kidney disease on case ascertainment for hospitalised acute myocardial infarction: an English cohort study
Objectives 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...
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BMJ Publishing Group
2022-03-01
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| Online Access: | https://bmjopen.bmj.com/content/12/3/e057909.full |
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| author | Jemima Scott Fergus Caskey Dorothea Nitsch David Adlam Clive Weston Spiros Denaxas John Deanfield Mark De Belder Michael Sweeting Lucy Teece Patrick Bidulka Udaya Udayaraj |
| author_facet | Jemima Scott Fergus Caskey Dorothea Nitsch David Adlam Clive Weston Spiros Denaxas John Deanfield Mark De Belder Michael Sweeting Lucy Teece Patrick Bidulka Udaya Udayaraj |
| author_sort | Jemima Scott |
| collection | DOAJ |
| description | Objectives 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.Methods 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).Results 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).Conclusions AMI case ascertainment is incomplete in both MINAP and HES, and is associated with CKD severity. |
| format | Article |
| id | doaj-art-a38336473fbb4fa0a7bf5a2b5cd42a83 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-03-01 |
| publisher | BMJ Publishing Group |
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| spelling | doaj-art-a38336473fbb4fa0a7bf5a2b5cd42a832025-08-20T01:48:11ZengBMJ Publishing GroupBMJ Open2044-60552022-03-0112310.1136/bmjopen-2021-057909Impact of chronic kidney disease on case ascertainment for hospitalised acute myocardial infarction: an English cohort studyJemima Scott0Fergus Caskey1Dorothea Nitsch2David Adlam3Clive Weston4Spiros Denaxas5John Deanfield6Mark De Belder7Michael Sweeting8Lucy Teece9Patrick Bidulka10Udaya Udayaraj11North Bristol NHS Trust, Southmead Hospital, Bristol, UKDepartment of Medicine, University of Bristol Faculty of Medicine and Dentistry, Bristol, UKDepartment of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UKDepartment of Cardiovascular Sciences, University of Leicester, Leicester, UKconsultant cardiologistInstitute of Health Informatics, University College London, London, UKInstitute of Cardiovascular Sciences, University College London, London, UK5University of Leicester & Karolinska Institutet2 Department of Public Health and Primary Care, Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, UKDepartment of Population Health Sciences, University of Leicester, Leicester, UK1 London School of Hygiene & Tropical Medicine, London, UKOxford Kidney Unit, Churchill Hospital, Oxford, Oxfordshire, UKObjectives 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.Methods 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).Results 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).Conclusions AMI case ascertainment is incomplete in both MINAP and HES, and is associated with CKD severity.https://bmjopen.bmj.com/content/12/3/e057909.full |
| spellingShingle | Jemima Scott Fergus Caskey Dorothea Nitsch David Adlam Clive Weston Spiros Denaxas John Deanfield Mark De Belder Michael Sweeting Lucy Teece Patrick Bidulka Udaya Udayaraj Impact of chronic kidney disease on case ascertainment for hospitalised acute myocardial infarction: an English cohort study BMJ Open |
| title | Impact of chronic kidney disease on case ascertainment for hospitalised acute myocardial infarction: an English cohort study |
| title_full | Impact of chronic kidney disease on case ascertainment for hospitalised acute myocardial infarction: an English cohort study |
| title_fullStr | Impact of chronic kidney disease on case ascertainment for hospitalised acute myocardial infarction: an English cohort study |
| title_full_unstemmed | Impact of chronic kidney disease on case ascertainment for hospitalised acute myocardial infarction: an English cohort study |
| title_short | Impact of chronic kidney disease on case ascertainment for hospitalised acute myocardial infarction: an English cohort study |
| title_sort | impact of chronic kidney disease on case ascertainment for hospitalised acute myocardial infarction an english cohort study |
| url | https://bmjopen.bmj.com/content/12/3/e057909.full |
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