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...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Ubiquity Press
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9389955/ https://www.ncbi.nlm.nih.gov/pubmed/36051315 http://dx.doi.org/10.5334/gh.1147 |
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author | Samad, Zainab Noorali, Ali Aahil Farhad, Awais Awan, Safia Qureshi, Nada Qaiser Mawani, Minaz Ali, Mushyada Masood, Laiba Adnan, Ghufran Shaw, Linda K. Jafary, Fahim Haider Virani, Salim S. Velazquez, Eric J. Bhutta, Zulfiqar Bloomfield, Gerald S. Tai, Javed |
author_facet | Samad, Zainab Noorali, Ali Aahil Farhad, Awais Awan, Safia Qureshi, Nada Qaiser Mawani, Minaz Ali, Mushyada Masood, Laiba Adnan, Ghufran Shaw, Linda K. Jafary, Fahim Haider Virani, Salim S. Velazquez, Eric J. Bhutta, Zulfiqar Bloomfield, Gerald S. Tai, Javed |
author_sort | Samad, Zainab |
collection | PubMed |
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 p(trend) < 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. |
format | Online Article Text |
id | pubmed-9389955 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Ubiquity Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-93899552022-08-31 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 Samad, Zainab Noorali, Ali Aahil Farhad, Awais Awan, Safia Qureshi, Nada Qaiser Mawani, Minaz Ali, Mushyada Masood, Laiba Adnan, Ghufran Shaw, Linda K. Jafary, Fahim Haider Virani, Salim S. Velazquez, Eric J. Bhutta, Zulfiqar Bloomfield, Gerald S. Tai, Javed Glob Heart Original Research 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 p(trend) < 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. Ubiquity Press 2022-08-18 /pmc/articles/PMC9389955/ /pubmed/36051315 http://dx.doi.org/10.5334/gh.1147 Text en Copyright: © 2022 The Author(s) https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Original Research Samad, Zainab Noorali, Ali Aahil Farhad, Awais Awan, Safia Qureshi, Nada Qaiser Mawani, Minaz Ali, Mushyada Masood, Laiba Adnan, Ghufran Shaw, Linda K. Jafary, Fahim Haider Virani, Salim S. Velazquez, Eric J. Bhutta, Zulfiqar Bloomfield, Gerald S. Tai, Javed 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 | 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 | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9389955/ https://www.ncbi.nlm.nih.gov/pubmed/36051315 http://dx.doi.org/10.5334/gh.1147 |
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