Diapositiva 1

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Electronic discharge summary (Epi-Cardio,
Epicrisis Computada) as a tool for a prospective
multicentric registry of CCU patients. A
GEDIC-ARIAM collaboration EPI-CARDIO registry
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INTRODUCTION
BACKGROUND

• What is EPI-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

OBJECTIVES
TOOL
NETWORK
FEASIBILITY
RESULTS
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INTRODUCTION
BACKGROUND

• 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.

OBJECTIVES
TOOL
NETWORK
FEASIBILITY
RESULTS
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INTRODUCTION

• Short term objectives
• 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

BACKGROUND
OBJECTIVES
TOOL
NETWORK
FEASIBILITY
RESULTS
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INTRODUCTION

• 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

BACKGROUND
OBJECTIVES
TOOL
NETWORK
FEASIBILITY
RESULTS
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INTRODUCTION

• Long term objectives
• To assess educational interventions with the
  objective of improving the quality of medical
  care and to evaluate the clinical impact of these
  interventions
• To share and to compare information with
  registries of another regions

BACKGROUND
OBJECTIVES
TOOL
NETWORK
FEASIBILITY
RESULTS
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INTRODUCTION

• The software was developed over a database with
• Access format (.MDB)
• Functions and utilities
• Permanent data base of admitted patients
• Printed institutional discharge report
• Copies for patient chart, patient and treating
  physician
• Send by e-mail to coordinating centre the data,
  for the generation of institutional and registry
  reports.
• Special forms for more frequent pathologies, with
  the objective of evaluate practics and uses, and
  measure the rate of fulfillment of the guidelines
  

BACKGROUND
OBJECTIVES
TOOL
NETWORK
FEASIBILITY
RESULTS
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INTRODUCTION
Main screen of the software
BACKGROUND
OBJECTIVES
TOOL/FORMAT
NETWORK
FEASIBILITY
RESULTS
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Discharge report generated automatically
INTRODUCTION
BACKGROUND
OBJECTIVES
TOOL
NETWORK
FEASIBILITY
RESULTS
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• Network operation

INTRODUCTION
Main Database
BACKGROUND
Processing
Coordinating center
OBJECTIVES
Send
Send of Individual and global reports
TOOL
EPICARDIO Centers
Backup Avoid missing data
DATA BASE
NETWORK
Charge data of patients and generate discharge
report
Patient
Clinical record
Physician
FEASIBILITY
RESULTS
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INTRODUTCION

• FEASIBILITY of the project (after
  1 y.)
• Based on
• Quick incorporation of centres
• Shortening administrative work time (estimated
  time lt10
• minutes)
• Utility of individual and global reports
• Active participation of investigators in research
  projects
• 12.000 (twelve thousands) patients included in 12
  months

BACKGROUND
OBJECTIVES
TOOL
NETWORK
FEASIBILITY
RESULTS
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Brief review of results Showing the power of
the tool
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• Present of the registry
• Total Institutions (using the tool)
• 70 centers
• Active Institutions (sharing the core
  registry)
• 42 centers

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Patients included (linear progression)
months
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Distribution of EPI-CARDIO Centers in Argentina
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Diagnosis at discharge
n 11634
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Acute coronary syndromes whith ST elevation
601 patients with full available data
included Incidence 5,2 of total
admissions Mortality 7,82
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Reperfusion strategies
Rep. strategy
(45 out of time window)
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Acute coronary syndroms without ST elevation
Were included (complete data) 1091
patients Mortality 2,29
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Invasive strategy
n1091
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Heart failure
Were included 1299 pacients with heart failure.
Mortality 5,79
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Heart failure
Procedures

• Mechanical ventilatory assistance 7
• Swan-Ganz 5
• Non invasive
• ventilation 3,1
• Diuretics (cont.
• IV infusion) 26,3
• IV inotropics 21,6

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Cardiovascular surgery

n 558
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Conclusions

• 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.

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• Limitations
• Selection bias predominant incorporation of
  institutions from urban centres, with less
  incorporation of periferic institutions.
• Some degree of under-registry of dead patients,
  due to double function of the software as
  registry and discharge report.

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Epi-cardio/ARIAM collaboration

• We share with ARIAM group his web database
• Epi-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.

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Latino-ARIAM web page
Tools for reports generation
Database
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Example of immediate statistic reports of
Latino-ARIAM website
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Conclusions

• Epi-cardio was quickly included in the clinical
  practice in a growing number of institutions.
• 2) To share information in a network allows to
  get permanent epidemological data of acute
  cardiovascular pathology.
• Future
• The progressive difusion of Epi-Cardio could be
  an economic solution for the continuous
  evaluation of the cardiologic practice in
  Argentina. Latino-ARIAM collaboration alows as to
  extend the registry to other countries and
  communities.