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Variation Between Hospitals in Short-term Mortality After Acute Coronary Syndromes: A CALIBER Study

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ClinicalTrials.gov Identifier: NCT01111071
Recruitment Status : Completed
First Posted : April 27, 2010
Last Update Posted : May 12, 2016
Sponsor:
Collaborators:
Barts & The London NHS Trust
Queen Mary University of London
University of Bristol
Yale University
Information provided by (Responsible Party):
Julie George, University College, London

Study Description
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Brief Summary:
We seek to investigate whether hospitals in England and Wales vary in their rate of mortality following admission for heart attack or unstable angina, the extent of such variation, whether discharge diagnosis affects the extent of variation, and whether such variation has changed over time. Furthermore, we will investigate what individual- or hospital-level factors explain variation in mortality between hospitals.

Condition or disease
Acute Coronary Syndrome

Detailed Description:

Several studies have looked at between-hospital variation in mortality following myocardial infarction but have lacked patient-level data. Those with individual-level data have been limited by:

  • use of in-hospital mortality as an outcome measure, which can be affected by length of stay,
  • restriction to patients aged 65 and over, or otherwise selected patients, and
  • patient-level explanatory factors lacking clinical detail, particularly medications given in hospital.

MINAP patient-level data allow the investigation of hospital variation in mortality (in-hospital and 30-day) in a group of unselected patients, taking into account clinical details such as medication use in hospital, as well as features of the hospitals providing care. The proposed study will establish the extent of variation between hospitals in England and Wales, whether this varies by ACS diagnosis, whether the variation has reduced over time and finally which patient-level or hospital-level factors explain any variation found.

A statistical analytic protocol for this study, dated 15.4.2010, is available on request.

This study is part of the CALIBER (Cardiovascular disease research using linked bespoke studies and electronic records) programme funded over 5 years from the NIHR and Wellcome Trust. The central theme of the CALIBER research is linkage of the Myocardial Ischaemia National Audit Project (MINAP) with primary care (GPRD) and other resources. The overarching aim of CALIBER is to better understand the aetiology and prognosis of specific coronary phenotypes across a range of causal domains, particularly where electronic records provide a contribution beyond traditional studies. CALIBER has received both Ethics approval (ref 09/H0810/16) and ECC approval (ref ECC 2-06(b)/2009 CALIBER dataset).

Study Design
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Study Type : Observational
Actual Enrollment : 316648 participants
Time Perspective: Prospective
Official Title: Variation Between Hospitals in Short-term Mortality After Acute Coronary Syndromes: A CALIBER Study
Study Start Date : April 2010
Actual Primary Completion Date : September 2014
Actual Study Completion Date : December 2014

Resource links provided by the National Library of Medicine


Groups and Cohorts
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Group/Cohort
STEMI
patients with discharge diagnosis of ST elevation myocardial infarction
nSTEMI
patients with discharge diagnosis of non ST elevation myocardial infarction
unstable angina
patients with discharge diagnosis of unstable angina


Outcome Measures
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Primary Outcome Measures :
  1. all-cause 30-day mortality [ Time Frame: 30 day ]
    all-cause 30-day mortality following hospitalisation for acute coronary syndrome


Secondary Outcome Measures :
  1. all-cause in-hospital mortality [ Time Frame: length of hospital stay ]
    all-cause in-hospital mortality following hospitalisation for acute coronary syndrome


Eligibility Criteria
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Ages Eligible for Study:   30 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Patients admitted with acute coronary syndrome to acute hospitals in England and Wales participating in the Myocardial Ischaemia National Audit Project (MINAP)
Criteria

Inclusion Criteria:

  • admitted between January 2003 to June 2009 (or latest date data available)

Exclusion Criteria:

  • admitted to hospital with fewer than 25 admissions in given year
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01111071


Locations
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United Kingdom
Epidemiology and Public Health, University College London
London, United Kingdom, WC1E 6BT
Sponsors and Collaborators
University College, London
Barts & The London NHS Trust
Queen Mary University of London
University of Bristol
Yale University
Investigators
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Principal Investigator: Julie L George, MSc University College, London
More Information
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Additional Information:

Publications:

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Responsible Party: Julie George, NIHR Doctoral Fellow, University College, London
ClinicalTrials.gov Identifier: NCT01111071    
Other Study ID Numbers: CALIBER-09-03
RP-PG-0407-10314 ( Other Grant/Funding Number: National Institute of Health Research (UK) )
First Posted: April 27, 2010    Key Record Dates
Last Update Posted: May 12, 2016
Last Verified: May 2016
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Plan Description: permissions to use anonymised data from data owners do not allow further sharing.
Keywords provided by Julie George, University College, London:
hospital variation
30 day mortality
in hospital mortality
acute coronary syndrome
 myocardial infarction
unstable angina
hospital performance
trends
Additional relevant MeSH terms:
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Acute Coronary Syndrome
Syndrome
Disease
Pathologic Processes
 Myocardial Ischemia
Heart Diseases
Cardiovascular Diseases
Vascular Diseases