Monitoring acute coronary syndrome using national hospital data: an information paper on trends and issues

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Release Date: 22 Dec 2011
Author: AIHW

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Acute coronary syndrome (ACS) refers to the spectrum of acute coronary artery diseases spanning acute myocardial infarction (AMI) and unstable angina (UA). They are sudden, severe and life-threatening events. This report reviews the current algorithm for monitoring the incidence of ACS in Australia, presenting a detailed analysis of hospitalisations for AMI and UA. It also presents a range of alternative algorithms for the estimation of ACS incidence. Further work is required to validate these algorithms.

ISBN: 978-1-74249-273-5
Cat. no: CVD 57
Pages: 136

Preliminary material
- Contents
- Acknowledgments
- Abbreviations
- Summary
Body section
- 1 Introduction
  - 1.1 Background
  - 1.2 Objectives
  - 1.3 Structure of report
- 2 Background
  - 2.1 What do we mean by acute coronary syndrome (ACS)?
    - Acute myocardial infarction
    - What is unstable angina?
  - 2.2 Why monitor ACS events on a national level?
  - 2.3 How do we currently monitor ACS events?
  - 2.4 Why review the current method of estimating ACS events?
- 3 Data sources, codes and methods
  - 3.1 National Hospital Morbidity Database
    - Diagnosis codes for ACS events
  - 3.2 National Mortality Database
  - 3.3 Statistical methods
- 4 Issues that impact on monitoring ACS events using national hospital data
  - 4.1 Changes to coding and coding standards
  - 4.2 Changes in diagnostic tests
  - 4.3 Changes in clinical practice
  - 4.4 Monitoring ACS rather than acute myocardial infarction
- 5 Trends in hospitalisations for ACS
  - 5.1 Overview
    - Trends in acute myocardial infarction hospitalisations
      - Age and sex
      - Type of acute myocardial infarction
    - Trends in unstable angina hospitalisations
      - Age and sex
    - Trends in chest pain hospitalisations
  - 5.2 Length of stay
    - Length of stay for acute myocardial infarction hospitalisations
    - Length of stay for unstable angina hospitalisations
    - Length of stay for chest pain hospitalisations
  - 5.3 Urgency of admission
  - 5.4 Transfers
    - Transfers to another acute care hospital
      - Acute myocardial infarction
      - Unstable angina
      - Chest pain
    - Transfers from another acute care hospital
      - Acute myocardial infarction
      - Unstable angina
      - Chest pain
  - 5.5 ACS hospitalisations ending in death
  - 5.6 Region of hospital
    - Transfers by region
    - Length of stay by region
    - Length of stay for transfers by region
  - 5.7 Procedures for ACS events
    - By length of stay
    - Transfers
    - Trends in procedure use
- 6 Deaths
- 7 Alternative algorithms
  - 7.1 Options for consideration
  - 7.2 ACS events
  - 7.3 Case-fatality
  - 7.4 Main points to note from the alternative algorithms
- 8 Discussion and recommendations
  - Monitoring ACS events at a national level
  - The impact of change on national hospital data
  - Trends in deaths that affect the estimation of fatal ACS events
  - Alternative algorithms for estimating ACS events and case-fatality rates from existing administrative data
  - Further work required
End matter
- Appendix A: ICD-10-AM and ACHI codes
  - ICD-10-AM (6th edition) codes for AMI and unstable angina (UA)
    - I21 Acute myocardial infarction (AMI)
    - I22 Subsequent myocardial infarction
  - ACHI (ICD-10-AM 6th edition) codes for cardiac procedures
- Appendix B: Statistical methods
  - Rates
  - Age-standardised rates
    - Direct age-standardisation
    - Population for standardisation
  - Totals
- Appendix C: Detailed tables
  - Overview
  - Length of stay
  - Urgency of admission
  - Transfers
  - Deaths in hospital
  - Remoteness of hospital
  - Procedures
  - Deaths
- Glossary
- References
- List of tables
- List of figures

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