Background
Methods
Patient recruitment for the feasibility study
Formal consensus to identify important changes in management (and the subgroups of patients to which these referred)
Identifying the patient subgroups defined through formal consensus
Identifying CMR exposure
Identifying the key clinical “events” that reflected the important changes in management
Statistical analysis
Results
Hospital A (n = 758) | Hospital B (n = 272) | Hospital C (n = 316) | Hospital D (n = 309) | Total (n = 1655) | |
---|---|---|---|---|---|
PPCI | 651 (86%) | 246 (90%) | 291 (92%) | 279 (90%) | 1467 (89%) |
MVD | 361 (48%) | 138 (51%) | 169 (53%) | 58 (19%) | 726 (44%) |
LV thrombus after PPCI | 1 (0.13%) | 0 | 0 | 0 | 1 (0.06%) |
Unobstructed coronary arteries | 107 (14%) | 26 (10%) | 25 (8%) | 30 (10%) | 188 (11%) |
OHCA | 57 (8%) | 22 (8%) | 16 (5%) | 14 (5%) | 109 (7%) |
Identifying changes in management in hospital episode statistics data
Important change in management resulting from CMRa | Patient subgroup | Data source | ICD-10 diagnosis codes and OPCS procedure codes (up to 12 months after the index admission) |
---|---|---|---|
New diagnosis (non-ischaemic) | Unobstructed coronary arteries OHCA | HES / PEDW admitted patient care data | Any record of the following: − Takotsubo cardiomyopathy (I42.8 AND F43.8) − Myocarditis (I51.4) − Pericarditis (I30 OR I31.0 OR I31.1 OR I31.9 OR I32.0 OR I32.1 OR I32.8 OR I01.0 OR I02.0 OR I09.2) − Endocarditis (I33.9) − Coronary spasm (I20.1) |
Changes in medication | PPCI MVD LV thrombus after PPCI Unobstructed coronary arteries OHCA | Not available | Not available |
Additional diagnostic tests | PPCI MVD LV thrombus after PPCI Unobstructed coronary arteries OHCA | HES / PEDW admitted patient care data and outpatient care data | Any record of the following: − Echocardiography (K58.5 OR U20.1 OR U20.2 OR U20.3 OR U20.4 OR U20.5) − Single photon emission computed tomography (SPECT) (U21.4) − Positron emission tomography (PET) scans (U10.4 OR U21.3 OR U36.2) − Intravascular ultrasound (IVUS) (K51.2 OR L726) − Pressure wire ((K63.4 OR K63.5 OR K63.6) AND K51.8 AND Y44.2 AND Y53) − Radionuclide angiocardiography (U10.5) − Computed tomography angiography (U10.2) |
Implantation of devices | PPCI OHCA | HES / PEDW admitted patient care data | Any record of the following: − Cardiac resynchronization therapy (CRT) (K60.7 OR K61.7 OR K59.6) − Implantable cardioverter defibrillator (ICD) (K59 OR K72) |
Revascularisation (PCI or CABG) within 3 months | MVD | HES / PEDW admitted patient care data | Any record of the following (up to 3 months after the index admission): − PCI (K49 OR K50 OR K75) − CABG (K40 OR K41 OR K42 OR K43 OR K44 OR K45 OR K46) |
Frequency of cardiology outpatient appointments | PPCI MVD LV thrombus after PPCI Unobstructed coronary arteries OHCA | HES / PEDW outpatient care data | Rate of outpatient visit attended (count of visits divided by follow-up time) where the treatment speciality in which the consultant responsible was working during the period of care was Cardiology (code = 320). |
Important changes in management by CMR status and in CMR / non CMR centres
Number of events (%) identified in HES / PEDW up to 12 months after the index admission and number of days (median and IQR) until the first event after the index admission | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Patient subgroup | New diagnoses (e.g. Takotsubo, myocarditis, pericarditis, endocarditis, coronary spasm) | Changes in medication | Additional diagnostic tests (ECHO, SPECT, PET, IVUS, pressure-wire, radionuclide angiocardiography, CT angiography) | Implantation of devices (CRT or ICD) | Revascularisation (PCI or CABG) within 3 months | Cardiology outpatient appointments (median, IQR) | |||||
No. of events | No. of days | No. of events | No. of days | No. of events | No. of days | No. of events | No. of days | No. of events | No. of days | ||
PPCI | No data available | N/A | |||||||||
CMR (n = 152) | 0 | – | 16 (11%) | 107 (50, 240) | 0 | – | 2 (1, 3) | 64 (34, 99) | |||
No CMR (n = 1312) | 10 (1%) | 16 (8, 20) | 129 (10%) | 74 (27, 171) | 6 (0.5%) | 147 (48, 171) | 1 (1, 2) | 55 (33, 95) | |||
MVD | |||||||||||
CMR (n = 104) | 0 | – | 11 (11%) | 85 (50, 221) | 0 | – | 11 (11%) | 99 (50, 180) | 2 (1, 3) | 76 (52, 116) | |
No CMR (n = 622) | 4 (1%) | 13 (8, 110) | 61 (10%) | 62 (24, 130) | 4 (1%) | 147 (84, 169) | 64 (10%) | 66 (39, 122) | 1 (1, 2) | 57 (33, 95) | |
LV thrombus after PPCI | N/A | ||||||||||
CMR (n = 1) | 0 | – | 0 | – | 0 | – | 3 (3, 3) | 66 (66, 66) | |||
No CMR (n = 0) | 0 | – | 0 | – | 0 | – | – | – | |||
Unobstructed coronary arteries | |||||||||||
CMR (n = 35) | 1 (3%) | 358 (358, 358) | 6 (17%) | 93 (58, 140) | 1 (3%) | 78 (78, 78) | 2 (1, 3) | 67 (52, 121) | |||
No CMR (n = 139) | 1 (1%) | 180 (180, 180) | 12 (9%) | 123 (78, 284) | 3 (2%) | 245 (71, 262) | 1 (0, 2) | 67 (44, 106) | |||
OHCA | |||||||||||
CMR (n = 14) | 0 | – | 2 (14%) | 110 (79, 141) | 0 | – | 1 (1, 3) | 65 (61, 104) | |||
No CMR (n = 95) | 1 (1%) | 48 (48, 48) | 10 (11%) | 62 (48, 93) | 5 (5%) | 126 (71, 167) | 1 (1, 2) | 64 (41, 99) |
Number of events (%) identified in HES / PEDW up to 12 months after the index admission and number of days (median and IQR) until first event after the index admission | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Patient subgroup | New diagnoses (e.g. Takotsubo, myocarditis, pericarditis, endocarditis, coronary spasm) | Changes in medication | Additional diagnostic tests (ECHO, SPECT, PET, IVUS, pressure-wire, radionuclide angiocardiography, CT angiography) | Implantation of devices (CRT or ICD) | Revascularisation (PCI or CABG) within 3 months | Cardiology outpatient appointments (median, IQR) | |||||
No. of events | No. of days | No. of events | No. of days | No. of events | No. of days | No. of events | No. of days | No. of events | No. of days | ||
PPCI | No data available | N/A | |||||||||
CMR centres (n = 897) | 6 (1%) | 14 (8, 17) | 112 (12%) | 79 (33, 205) | 5 (1%) | 167 (126, 171) | 2 (1, 3) | 46 (30, 81) | |||
Non CMR centres (n = 567) | 4 (1%) | 20 (14, 34) | 33 (6%) | 45 (24, 116) | 1 (0.2%) | 48 (48, 48) | 1 (0, 1) | 90 (57, 126) | |||
MVD | |||||||||||
CMR centres (n = 499) | 4 (1%) | 13 (8, 110) | 61 (12%) | 69 (32, 159) | 4 (1%) | 147 (84, 169) | 53 (11%) | 71 (41, 151) | 2 (1, 3) | 52 (32, 87) | |
Non CMR centres (n = 227) | 0 | – | 11 (5%) | 59 (15, 122) | 0 | – | 22 (10%) | 63 (43, 88) | 1 (0, 1) | 95 (68, 136) | |
LV thrombus after PPCI | N/A | ||||||||||
CMR centres (n = 1) | 0 | – | 0 | – | 0 | – | 3 (3, 3) | 66 (66, 66) | |||
Non CMR centres (n = 0) | – | – | – | – | – | – | – | – | |||
Unobstructed coronary arteries | |||||||||||
CMR centres (n = 133) | 2 (2%) | 269 (180, 358) | 16 (12%) | 103 (68, 205) | 4 (3%) | 162 (75, 254) | 1 (0, 2) | 65 (46, 103) | |||
Non CMR centres (n = 41) | 0 | – | 2 (5%) | 184 (69, 299) | 0 | – | 0 (0, 1) | 89 (54, 133) | |||
OHCA | |||||||||||
CMR centres (n = 79) | 0 | – | 9 (11%) | 79 (62, 141) | 4 (5%) | 147 (99, 169) | 2 (1,3) | 63 (42, 95) | |||
Non CMR centres (n = 30) | 1 (3%) | 48 (48, 48) | 3 (10%) | 48 (5, 74) | 1 (3%) | 48 (48, 48) | 1 (0,1) | 86 (52, 105) |