Leveraging Clinical Digitized Data to Understand Temporal Characteristics and Outcomes of Acute Myocardial Infarctions at a Tertiary Care Medical Centre in Pakistan from 1988–2018 – Methods and Results
Background and Objective: Few data exist on trends in acute myocardial infarction (AMI) patterns spanning recent epidemiological shifts in low middle-income countries (LMICs). To understand temporal disease patterns of AMI characteristics and outcomes between 1988–2018, we used digitized legacy clin...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Ubiquity Press
2022-08-01
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| Series: | Global Heart |
| Subjects: | |
| Online Access: | https://globalheartjournal.com/articles/1147 |
| _version_ | 1828143804964667392 |
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| author | Zainab Samad Ali Aahil Noorali Awais Farhad Safia Awan Nada Qaiser Qureshi Minaz Mawani Mushyada Ali Laiba Masood Ghufran Adnan Linda K. Shaw Fahim Haider Jafary Salim S. Virani Eric J. Velazquez Zulfiqar Bhutta Gerald S. Bloomfield Javed Tai |
| author_facet | Zainab Samad Ali Aahil Noorali Awais Farhad Safia Awan Nada Qaiser Qureshi Minaz Mawani Mushyada Ali Laiba Masood Ghufran Adnan Linda K. Shaw Fahim Haider Jafary Salim S. Virani Eric J. Velazquez Zulfiqar Bhutta Gerald S. Bloomfield Javed Tai |
| author_sort | Zainab Samad |
| collection | DOAJ |
| description | Background and Objective: Few data exist on trends in acute myocardial infarction (AMI) patterns spanning recent epidemiological shifts in low middle-income countries (LMICs). To understand temporal disease patterns of AMI characteristics and outcomes between 1988–2018, we used digitized legacy clinical data at a large tertiary care centre in Pakistan. Methods: We reviewed digital health information capture systems maintained across the Aga Khan University Hospital and obtained structured elements to create a master dataset. We included index admissions of patients >18 years that were discharged between January 1, 1988, and December 31, 2018, with a primary discharge diagnosis of AMI (using ICD-9 diagnoses). The outcome evaluated was in-hospital mortality. Clinical characteristics derived from the electronic database were validated against chart review in a random sample of cases ('k' 0.53–1.00). Results: The final population consisted of 14,601 patients of which 30.6% (n = 4,470) were female, 52.4% (n = 7,651) had ST elevation MI and 47.6% (n = 6,950) had non-ST elevation MI. The median (IQR) age at presentation was 61 (52–70) years. Overall unadjusted in-hospital mortality was 10.3%. Across the time period, increasing trends were noted for the following characteristics: age, proportion of women, prevalence of hypertension, diabetes, proportion with NSTEMI (all ptrend < 0.001). In-hospital mortality rates declined significantly between 1988–1997 and 2008–2018 (13.8% to 9.2%, p < 0.001). Conclusions: The patterns of AMI have changed over the last three decades with a concomitant decline in in-hospital mortality at a tertiary care centre in Pakistan. Clinical digitized data presents a unique opportunity for gaining insights into disease patterns in LMICs. |
| first_indexed | 2024-04-11T20:05:47Z |
| format | Article |
| id | doaj.art-5ae3b1d724014fa289a23fad1d4546ae |
| institution | Directory Open Access Journal |
| issn | 2211-8179 |
| language | English |
| last_indexed | 2024-04-11T20:05:47Z |
| publishDate | 2022-08-01 |
| publisher | Ubiquity Press |
| record_format | Article |
| series | Global Heart |
| spelling | doaj.art-5ae3b1d724014fa289a23fad1d4546ae2022-12-22T04:05:20ZengUbiquity PressGlobal Heart2211-81792022-08-0117110.5334/gh.1147965Leveraging Clinical Digitized Data to Understand Temporal Characteristics and Outcomes of Acute Myocardial Infarctions at a Tertiary Care Medical Centre in Pakistan from 1988–2018 – Methods and ResultsZainab Samad0Ali Aahil Noorali1Awais Farhad2Safia Awan3Nada Qaiser Qureshi4Minaz Mawani5Mushyada Ali6Laiba Masood7Ghufran Adnan8Linda K. Shaw9Fahim Haider Jafary10Salim S. Virani11Eric J. Velazquez12Zulfiqar Bhutta13Gerald S. Bloomfield14Javed Tai15Department of Medicine, Aga Khan University, Karachi, PK; Division of Cardiology, Department of Medicine, Duke University, Duke Global Health Institute, Duke Clinical Research Institute, Durham, NCDepartment of Medicine, Aga Khan University, KarachiDepartment of Medicine, Aga Khan University, KarachiDepartment of Medicine, Aga Khan University, KarachiDepartment of Medicine, Aga Khan University, KarachiDepartment of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GeorgiaDepartment of Medicine, Aga Khan University, KarachiDepartment of Medicine, Aga Khan University, KarachiDepartment of Medicine, Aga Khan University, KarachiIndependent Biostatistical ConsultantDepartment of Cardiology, Tan Tock Seng HospitalDivision of Cardiology, Department of Medicine, Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Centre, Houston TXSection of Cardiology, Department of Medicine, Yale School of Medicine, Yale University, New Haven, COInstitute of Global Health and Development, Aga Khan University, KarachiDivision of Cardiology, Department of Medicine, Duke University, Duke Global Health Institute, Duke Clinical Research Institute, Durham, NCDepartment of Medicine, Aga Khan University, KarachiBackground and Objective: Few data exist on trends in acute myocardial infarction (AMI) patterns spanning recent epidemiological shifts in low middle-income countries (LMICs). To understand temporal disease patterns of AMI characteristics and outcomes between 1988–2018, we used digitized legacy clinical data at a large tertiary care centre in Pakistan. Methods: We reviewed digital health information capture systems maintained across the Aga Khan University Hospital and obtained structured elements to create a master dataset. We included index admissions of patients >18 years that were discharged between January 1, 1988, and December 31, 2018, with a primary discharge diagnosis of AMI (using ICD-9 diagnoses). The outcome evaluated was in-hospital mortality. Clinical characteristics derived from the electronic database were validated against chart review in a random sample of cases ('k' 0.53–1.00). Results: The final population consisted of 14,601 patients of which 30.6% (n = 4,470) were female, 52.4% (n = 7,651) had ST elevation MI and 47.6% (n = 6,950) had non-ST elevation MI. The median (IQR) age at presentation was 61 (52–70) years. Overall unadjusted in-hospital mortality was 10.3%. Across the time period, increasing trends were noted for the following characteristics: age, proportion of women, prevalence of hypertension, diabetes, proportion with NSTEMI (all ptrend < 0.001). In-hospital mortality rates declined significantly between 1988–1997 and 2008–2018 (13.8% to 9.2%, p < 0.001). Conclusions: The patterns of AMI have changed over the last three decades with a concomitant decline in in-hospital mortality at a tertiary care centre in Pakistan. Clinical digitized data presents a unique opportunity for gaining insights into disease patterns in LMICs.https://globalheartjournal.com/articles/1147myocardial infarctionelectronic health recordshealth care outcome assessmentquality of health carerisk factors |
| spellingShingle | Zainab Samad Ali Aahil Noorali Awais Farhad Safia Awan Nada Qaiser Qureshi Minaz Mawani Mushyada Ali Laiba Masood Ghufran Adnan Linda K. Shaw Fahim Haider Jafary Salim S. Virani Eric J. Velazquez Zulfiqar Bhutta Gerald S. Bloomfield Javed Tai Leveraging Clinical Digitized Data to Understand Temporal Characteristics and Outcomes of Acute Myocardial Infarctions at a Tertiary Care Medical Centre in Pakistan from 1988–2018 – Methods and Results Global Heart myocardial infarction electronic health records health care outcome assessment quality of health care risk factors |
| title | Leveraging Clinical Digitized Data to Understand Temporal Characteristics and Outcomes of Acute Myocardial Infarctions at a Tertiary Care Medical Centre in Pakistan from 1988–2018 – Methods and Results |
| title_full | Leveraging Clinical Digitized Data to Understand Temporal Characteristics and Outcomes of Acute Myocardial Infarctions at a Tertiary Care Medical Centre in Pakistan from 1988–2018 – Methods and Results |
| title_fullStr | Leveraging Clinical Digitized Data to Understand Temporal Characteristics and Outcomes of Acute Myocardial Infarctions at a Tertiary Care Medical Centre in Pakistan from 1988–2018 – Methods and Results |
| title_full_unstemmed | Leveraging Clinical Digitized Data to Understand Temporal Characteristics and Outcomes of Acute Myocardial Infarctions at a Tertiary Care Medical Centre in Pakistan from 1988–2018 – Methods and Results |
| title_short | Leveraging Clinical Digitized Data to Understand Temporal Characteristics and Outcomes of Acute Myocardial Infarctions at a Tertiary Care Medical Centre in Pakistan from 1988–2018 – Methods and Results |
| title_sort | leveraging clinical digitized data to understand temporal characteristics and outcomes of acute myocardial infarctions at a tertiary care medical centre in pakistan from 1988 2018 methods and results |
| topic | myocardial infarction electronic health records health care outcome assessment quality of health care risk factors |
| url | https://globalheartjournal.com/articles/1147 |
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