Www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation Electronic discharge summary (Epi-Cardio, Epicrisis Computada) as a tool for.

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EPI-CARDIOEPI-CARDIO Multicentric Network of Clinical Evaluation

Electronic discharge summary (Epi-Cardio, Epicrisis Computada) Electronic discharge summary (Epi-Cardio, Epicrisis Computada) as a tool for a prospective multicentric registry of CCU patients.as a tool for a prospective multicentric registry of CCU patients.

AA GEDIC-ARIAM collaboration GEDIC-ARIAM collaboration

EPI-CARDIO registryEPI-CARDIO registry



What is EPI-CARDIOEPI-CARDIO?

Is an independent research project, conformed

by a collaborative network of cardiovascular

acute care units that share a multicentric registry

of cardiovascular acute pathology

OBJECTIVESOBJECTIVES

TOOLTOOL

NETWORKNETWORK

BACKGROUNDBACKGROUND

INTRODUCTIONINTRODUCTION

FEASIBILITYFEASIBILITY

RESULTSRESULTS



• In Argentina there is a lack of communitary

prospective surveys of patients admitted to CCU

• The electronic case report form for in-hospital patients is restricted to a few academic institutions.

• The challenge was to develop a low cost tool to be a part of the routine practice and simultaneously to keep good quality information about in-hospital evolution and medical strategies of acute cardiovascular disease.


TOOLTOOL

NETWORKNETWORK




RESULTSRESULTS



Short term objectives Short term objectives

1) To provide an electronic discharge letter software without costs to institutions with CCU to:

a) registre in a database all patients admitted in cardiovascular care units b) generate a complete discharge report-letter

2) To build a multicentric registry of acute cardiovascular patologhy

3) To keep an active interaction with all the institutions of the network

TOOLTOOL

NETWORKNETWORK





RESULTSRESULTS



Medium term objectives Medium term objectives

1) To explore indicators of quality of care in critical care units

2) To measure and to improve the rate of use of drugs recomended by the guidelines for acute cardiovascular pathology

TOOLTOOL

NETWORKNETWORK





RESULTSRESULTS



Long term objectives Long term objectives

1) To assess educational interventions with the objective of improving the quality of medical care and to evaluate the clinical impact of these interventions

2) To share and to compare information with registries of another regions

TOOLTOOL

NETWORKNETWORK





RESULTSRESULTS



The software was developed over a database with Access ® format (.MDB)

Functions and utilities:Functions and utilities:

1) Permanent data base of admitted patients

2) Printed institutional discharge report

3) Copies for patient chart, patient and treating physician

4) Send by e-mail to coordinating centre the data, for the generation of institutional and registry reports.

5) Special forms for more frequent pathologies, with the objective of evaluate practics and uses, and measure the rate of fulfillment of the guidelines


NETWORKNETWORK



TOOLTOOL


RESULTSRESULTS




NETWORKNETWORK



TOOL/FORMATTOOL/FORMAT


RESULTSRESULTS

Main screen of the software




NETWORKNETWORK



TOOLTOOL


RESULTSRESULTS

Discharge report generated automatically



Network operationNetwork operation

PatientClinical recordPhysician

BackupAvoid missing data

Send

EPICARDIOCenters

Coordinating center Processing

Send ofIndividual

andglobalreports

DATABASE

Main Database





RESULTSRESULTS

TOOLTOOL

NETWORKNETWORK Charge data of patients and generate discharge report




TOOLTOOL


INTRODUTCIONINTRODUTCION

RESULTSRESULTS


NETWORKNETWORK

FEASIBILITY of the project (after 1 y.)FEASIBILITY of the project (after 1 y.)

Based onBased on

• Quick incorporation of centres

• Shortening administrative work time (estimated time <10

minutes)

• Utility of individual and global reports

• Active participation of investigators in research projects

• 12.000 (twelve thousands) patients included in 12 months



Brief review of resultsBrief review of results

Showing the power of the tool



Present of the registryPresent of the registry

Total Institutions: (using the tool)70 centers

Active Institutions: (sharing the core registry)42 centers



Patients included Patients included (linear progression)(linear progression)

1578

5104

7993

11634

0

2000

4000

6000

8000

10000

12000

14000

3 6 9 12 months



Distribution of Distribution of EPI-CARDIOEPI-CARDIOCenters in Centers in ArgentinaArgentina



Diagnosis at dischargeDiagnosis at discharge

Angina14%

M. Infarction9%

NC CH.Pain6%

Cath. Lab Proc.11%

Heart. F11%

Arrhythmias13%

CVSurg6%

Syncope3%

PM. ICD4%

Non C Diag4%

Other19%

Angina14%

M. Infarction9%

NC CH.Pain6%

Cath. Lab Proc.11%

Heart. F11%

Arrhythmias13%

CVSurg6%

Syncope3%

PM. ICD4%

Non C Diag4%

Other19%

n: 11634



Acute coronary syndromes Acute coronary syndromes whith ST elevationwhith ST elevation

601 patients with full available data included601 patients with full available data included

Incidence: 5,2% of total admissionsIncidence: 5,2% of total admissions

Mortality 7,82%Mortality 7,82%



Reperfusion strategiesReperfusion strategies

69%31%

No reperfusion Reperfusion

69%31%

No reperfusion Reperfusion

TBL 28%

rescue PTCA 8%

primary PTCA 64%

TBL 28%

rescue PTCA 8%

primary PTCA 64%

(45% out of time window)(45% out of time window)

Rep. strategy



Acute coronary syndroms Acute coronary syndroms without ST elevationwithout ST elevation

Were included (complete data) 1091 patientsWere included (complete data) 1091 patients

Mortality 2,29%Mortality 2,29%



Invasive strategyInvasive strategy

Medical therapy

48%

No int23%

Angioplasty26%

Bypass 3%

Medical therapy

48%

No int23%

Angioplasty26%

Bypass 3%IS 52%IS 52%

n:1091



Heart failureHeart failure

33,00%

67,00% Diastolic

Systolic

33,00%

67,00% Diastolic

Systolic

0%

5%

10%

15%

20%

25%

30%

Causes of admission

Progression of d

Exc. Salt intake

Susp. Medication

Infection

Arhythmia

0%

5%

10%

15%

20%

25%

30%

Causes of admission

Progression of d

Exc. Salt intake

Susp. Medication

Infection

Arhythmia

11%

Total HF

11%

Total HF

Were included 1299 pacients with heart failure. Mortality 5,79%



Heart failureHeart failure

• Mechanical ventilatory Mechanical ventilatory assistanceassistance 7 % 7 %

• Swan-Ganz Swan-Ganz 5 % 5 %• Non invasive Non invasive • ventilationventilation 3,1% 3,1%• Diuretics (cont. Diuretics (cont. • IV infusion) 26,3%IV infusion) 26,3%• IV inotropics 21,6%IV inotropics 21,6%

Dopamine-Dobutamine

27%

Dobutamine 35%

Milrinone 0%

Dopamine 24%

Another comb 12%

Levosimendan 2%

Dopamine-Dobutamine

27%

Dobutamine 35%

Milrinone 0%

Dopamine 24%

Another comb 12%

Levosimendan 2%

Procedures



Cardiovascular surgeryCardiovascular surgery

Bypass 57%Valvular

24%

Combined 10%

Other 9%

Bypass 57%Valvular

24%

Combined 10%

Other 9%

4,5

2,5

6,8

11

0

2

4

6

8

10

12

Mortality

Total Bypass

Valvular Combined

4,5

2,5

6,8

11

0

2

4

6

8

10

12

Mortality

Total Bypass

Valvular Combinedn: 558

%



ConclusionsConclusions

EPI-CARDIO allows:

• To establish in a continuous way the incidence of pathology admitted in coronary units.

• To evaluate in-hospital evolution and associated procedures.

• To know diagnostic and therapeutic uses in the “real world”.

EPI-CARDIO allows:

• To establish in a continuous way the incidence of pathology admitted in coronary units.

• To evaluate in-hospital evolution and associated procedures.

• To know diagnostic and therapeutic uses in the “real world”.



LimitationsLimitations

Selection bias: predominant incorporation of institutions Selection bias: predominant incorporation of institutions from urban centres, with less incorporation of periferic from urban centres, with less incorporation of periferic institutions.institutions.

Some degree of under-registry of dead patients, due to Some degree of under-registry of dead patients, due to double function of the software as registry and double function of the software as registry and “discharge report”.“discharge report”.



Epi-cardio/ARIAM collaboration

We share with ARIAM group his web databaseEpi-cardio investigators can:

•generate immediate reports of his own data through LATINO-ARIAM website

•compare it with other institutions, regions and countries, initially Argentina and Spain.



Latino-ARIAM web page

DatabaseTools for reportsgeneration



Example of immediate statistic reports of Latino-ARIAM website



ConclusionsConclusions

1)1) Epi-cardio was quickly included in the clinical Epi-cardio was quickly included in the clinical practice in a growing number of institutions. practice in a growing number of institutions.

2) To share information in a network allows to get 2) To share information in a network allows to get permanent epidemological data of acute permanent epidemological data of acute cardiovascular pathology. cardiovascular pathology.

FutureFuture

The progressive difusion of Epi-Cardio could be an The progressive difusion of Epi-Cardio could be an economic solution for the continuous evaluation of economic solution for the continuous evaluation of the cardiologic practice in Argentina. Latino-ARIAM the cardiologic practice in Argentina. Latino-ARIAM collaboration alows as to extend the registry to other collaboration alows as to extend the registry to other countries and countries and communitiescommunities..

Www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation Electronic discharge summary (Epi-Cardio, Epicrisis Computada) as a tool for.

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