Introduction
Among the causes of mortality in Russia, as in most developed countries, the first position is occupied by the cardiovascular diseases (CVD) [1]. CVD have caused 50.1% cases of total mortality in 2014 in Russia [1]. In some countries with a comparable economic level, the mortality rate is lower and life expectancy is higher than that in Russia [2]. It may be caused by different reasons, including an insufficient quality of healthcare.
In various countries, there are a number of registries that include patients with main chronic CVD, such as hypertension (Htn) [3-12], coronary artery disease (CAD) [9, 13-18], and chronic heart failure (CHF) [15, 16, 19-23]. The main goal of registries is to fill the gap between probative data of randomized controlled trials and real clinical practice [24]. The registries can also be the basis for epidemiologic studies, original studies, risk modeling, etc.
The registry is an ideal tool for studying the real clinical practice, especially when it is necessary to improve the quality of healthcare [25]. Registries of CVD can be useful for increasing the management efficiency in the healthcare system [25]. The problem of improving the quality control methods of providing healthcare to patients is very relevant [8, 26, 27], including for Russia [28]. In real practice, the use of existing Russian healthcare standards is often accompanied by various difficulties, for example, inadequate management and funding of healthcare, low patients’ compliance, and lack of qualified specialists, necessary equipment, and drugs [28-30].
The first Russian registry of Htn was created in 2006 and has been used successfully up to 2012 inclusive. The main results of this registry were published in Russian scientific journals [31-35]. In 2012, the novel registry, named the Russian Registry of Hypertension, Coronary Artery Disease, and Chronic Heart Failure (RusR-Htn-CAD-CHF), was created, which replaced the first registry of Htn. The goal of the novel registry was to collect information about the patients with one or several of the following chronic CVD: Htn, CAD, and CHF.
The aim of this paper is to describe the objectives and design of the RusR-Htn-CAD-CHF. Presented results may be interesting to a wide audience because the RusR-Htn-CAD-CHF is currently the largest registry of Russian patients with Htn, CAD, and CHF.
Description of RusR-Htn-CAD-CHF
Objectives
The main objectives of RusR-Htn-CAD-CHF are the following:
- to create the Russian national database containing information on healthcare delivered to patients with Htn and/or CAD and/or CHF in primary care and specialized healthcare;
- to obtain the data on the demographic, clinical, and laboratorial characteristics of patients with Htn and/or CAD and/or CHF in the Russian healthcare;
- to identify the national features of associations between the characteristics of evaluated chronic CVD (Htn, CAD, and CHF) and clinical outcomes, including quality of primary care and specialized healthcare;
- to propose a practical guide for improving the quality and efficiency of healthcare in each health facilities participating in the RusR-Htn-CAD-CHF.
Developers
The Russian Cardiology Research and Production Complex (Moscow, Russia) was responsible for the development of the RusR-Htn-CAD-CHF and centralized the data analysis at a federal level. The RusR-Htn-CAD-CHF was established in 2011–2012 by researchers, cardiologists, and IT specialists from the Saratov Research Institute of Cardiology (Saratov, Russia). The current support of the RusR-Htn-CAD-CHF is carried out by the staff of both the above-mentioned organizations.
Participation
Participation in the RusR-Htn-CAD-CHF is voluntary and free of charge. Any health facility that provides primary care for patients with Htn, CAD, and CHF can participate in the Registry by sending a request to the technical support staff. Starting from 2013, many health facilities from different regions of Russia were invited to take part in the RusR-Htn-CAD-CHF by the Russian Cardiology Research and Production Complex (Moscow, Russia). Up to 2016, 69 healthcare units (from small rural polyclinics to large regional dispensaries) from 18 regions of Russia participated in the RusR-Htn-CAD-CHF. However, the contribution of regions to data collection of the RusR-Htn-CAD-CHF is nonuniform. The major part of participants of the RusR-Htn-CAD-CHF is from the Ivanovo region. Ivanovo region is a main participant which is now owned by a majority of patient data in database. Ivanovo region is a region in the Central Federal District of Russia. According to official data of Federal State Statistics Service of Russian Federation (http://www.gks.ru), the population of Ivanovo region was 1,036,900 people (44.9% male) in January 2015. It is 2.7% of population of the Central Federal District of Russia, and 0.7% of total Russian population (http://www.gks.ru). The main demographic characteristics of Ivanovo region are the following: the proportion of adult people is 84.4% (vs 82.4% in all-Russia), mean age of inhabitants is 41.5 years (vs 39.5 years in all-Russia), the proportion of urban people is 81.2% (vs 74.0% in all-Russia), and cardiovascular mortality among total population is 0.64% (vs 0.65% in all-Russia).
Now, 4.2% (36,424 people) of adult population (875,513 people) of Ivanovo region are registered in the RusR-Htn-CAD-CHF. In other regions of Russia, the using of RusR-Htn-CAD-CHF is only at the beginning.
Design of RusR-Htn-CAD-CHF
The RusR-Htn-CAD-CHF is a retrospective, continuous, nationwide, web-based registry operating online (URL: http://62.117.81.44/Register/login.aspx). The design of RusR-Htn-CAD-CHF is based on the national and international clinical guidelines on diagnostics and treatment of Htn, CAD, and CHF [36-42].
Access to the Registry is given to registered members. Each user has a unique identification number and password to log into the database. The web forms are designed to be interactive. They limit or exclude certain options in order to avoid the entry of conflicting or spurious data. Wherever possible, the data are entered by selection from “drop-down” lists in order to minimize the number of keyboard errors. The purpose of all the above-mentioned measures is to maximize the accuracy of data.
he web interface of RusR-Htn-CAD-CHF contains 9 web forms with the following titles:
- Personal data of patients;
- Past history;
- Results of physical examination at visit;
- Results of instrumental examinations;
- Results of laboratory tests;
- Non-pharmacologic treatment;
- Drug treatment;
- Invasive treatment;
- Diagnosis and its codes according to the International Classification of Diseases 10 (ICD-10).
Each web form can be saved unlimited number of times with different dates that allows accumulating the information about the dynamics of clinical parameters of patients over time.
Patients
The RusR-Htn-CAD-CHF enrolls patients with Htn and/or CAD and/or CHF receiving primary healthcare in Russia. The enrollment of patients started in January 2013 and is continued up to the present day.
Inclusion criteria comprise established diagnosis of Htn and/or CAD and/or CHF in patients’ medical card, and age ≥18 years. The RusR-Htn-CAD-CHF has no any exclusion criteria.
Data elements
The key data elements and definitions of RusR-Htn-CAD-CHF database were developed using ACCF/AHA 2011 Key Data Elements and Definitions of the Base Cardiovascular Vocabulary for Electronic Health Records [43] and national and international clinical guidelines on diagnostics and treatment of Htn, CAD, and CHF [36-42].
Data on patients’ demographics, clinical characteristics, non-pharmacologic and drug treatment, and invasive intervention are collected. The key data elements of RusR-Htn-CAD-CHF database are presented in Appendix A. The list of data elements recommended to filling depends on the diagnosis (Htn, CAD, or CHF) (see Appendix A).
For each included patient, the web form (see Design of RusR-Htn-CAD-CHF) can be saved multiple times with different dates signed by user according to the dates in patients’ medical card.
Data collection
The health facilities participating in the RusR-Htn-CAD-CHF were asked to include all patients following inclusion criteria treated for Htn, CAD, and CHF. For each included patient, new data may be added to the database annually in the case of necessity. Thus, the RusR-Htn-CAD-CHF can be used not only for the retrospective study, but also for the prospective evaluation (observation). Several health facilities can enter data on the same patient, if they provided him medical care at the same time or sequentially. The source of patients’ data is the patient medical card and/or the hospital chart. Тhe design of RusR-Htn-CAD-CHF does not allow to study of mortality in patients with chronic CVD.
In each center, one or several physicians were trained to log the data of patients into the Registry. To help these physicians, a detailed user manual was developed [44]. This user manual is available on the RusR-Htn-CAD-CHF website.
Currently, the RusR-Htn-CAD-CHF contains the data on more than 41,000 patients with one or several chronic CVD (Htn, CAD, and CHF) who were followed-up in 2013-2015. As for the proportion of chronic CVD presentations included in the Registry since 2013, we have only an approximate estimation. For example, the main participant (Ivanovo region) owns 36,424 patients in the registry. That is about 4.2% of the total number of adults in this region. In other regions, this proportion is even smaller.
The health facilities are interested in accurate data collection because these data are analyzed further by experts separately for each center and used on site for healthcare quality management.
Data security
Some of the main features of database and web security issues should be mentioned briefly. As it is mentioned above, all users are assigned a unique username/password combination that is used to log on to the RusR-Htn-CAD-CHF. In this way, all transactions are recorded automatically in the web server’s log.
All the data are pseudonymously entered into a web-based database protected by a password on a safe server of the Russian Cardiology Research and Production Complex (Moscow, Russia) using SSL connections. Subject identification is possible only at the local study site and participating centers are exclusively able to review and modify the patient data. The data on patients with chronic CVD can be added to the RusR-Htn-CAD-CHF and can be changed, but cannot be removed. The transmitted data are stored in the central database on the central server at the Russian Cardiology Research and Production Complex (Moscow, Russia).
The purpose of all the above-mentioned measures is to ensure the confidentiality of data.
Ethical aspects
The study protocol including patient information and consent forms has been reviewed and approved by the Ethics Commission of the Russian Cardiology Research and Production Complex (Moscow, Russia).
All patients must give informed consent before inclusion of their personal and clinical data in the RusR-Htn-CAD-CHF. The standard informed consent form is available on the RusR-Htn-CAD-CHF website. Patients gave their informed consent during their first visit to health facilities in the period of inclusion.
Personal data are coded automatically when entered into the registry. Names, addresses and other data which allows identification of a patient do not stored on the central server. Patients’ personal data are available only for staff of a healthcare facility where patients are treated.
The appropriate measures are used to guarantee maximal data confidentiality.
Data analysis
Within the RusR-Htn-CAD-CHF, an analytical module was created for the assessment of guidelines implementation in patients with Htn, CAD, and CHF. The main aim of this analytical module is to implement the system analysis of clinical cases to achieve the clinical result (for example, to achieve the target blood pressure in patients with Htn).
In the RusR-Htn-CAD-CHF, the completeness of clinical guidelines performance in real healthcare is evaluated using the developed clinical indicators, which are calculated automatically by using the database query for a required cohort of patients (in primary care facilities, in regions of Russia, or in all-Russia). These indicators were developed on the basis of national and European guidelines using the ACCF/AHA methodology for the development of quality measures for cardiovascular technology [45]. The details of clinical indicators are presented in Appendix C.
Based on the presented clinical indicators, the quality of care in patients with chronic CVD could be compared among Russian healthcare units. This approach allows not only evaluation of the quality of care in a particular unit based on clinical guidelines, but also allows comparative evaluation of health facilities in a city, region or the whole Russia.
Discussion
Registries of diseases allow collecting data from large populations of patients. Currently, the use of RusR-Htn-CAD-CHF is local. Only one region (Ivanovo region) uses the Registry systematically. In other regions of Russia, we have only the first results of RusR-Htn-CAD-CHF using. However, these results can be employed for the evaluation of quality of healthcare in health facilities participating in the project [46-50]. The first results of RusR-Htn-CAD-CHF caused debate among some Russian cardiologists. Some authors reported their comments and suggestions to improving this Registry [51]. Heterogeneity of quality and efficiency of secondary prevention of CVD in different regions of Russia (according to 2014 report [47]) shows relevant improvement of healthcare in these regions based on using the RusR-Htn-CAD-CHF [52]. According to S.V. Balashov [52], similar approach can be used also for primary cardiovascular prevention, which is also an urgent problem for the Russian cardiology. There is evidence of the successful use of RusR-Htn-CAD-CHF for healthcare quality control in a certain clinic [53, 54]. The basic principle of clinical indicators of RusR-Htn-CAD-CHF (see Appendix C) is the following: the quality indicator must contribute to the achievement of clinical outcome.
Since the RusR-Htn-CAD-CHF uses key data elements and definitions recommended by the American College of Cardiology and American Heart Association, the results of our study have the potential to be used for cross-country comparison of different registries in other European countries and the USA.
Currently, the data filling of RusR-Htn-CAD-CHF faced some difficulties. The use of RusR-Htn-CAD-CHF in practical healthcare meets the problem of reorganizing the workload of staff in health facilities providing care for patients with chronic CVD. Untrained users may have some difficulties with the use of RusR-Htn-CAD-CHF. To solve this problem we developed a user manual [44].
Due to the first Russian registry of Htn (2006-2012), it became possible to trace for several years the level of implementation of clinical guidelines among Russian patients with Htn. It was found out that the level of guidelines implementation is low, compared to economically developed countries [34, 35, 55, 56]. In 2008, only 22% of hypertensive patients had the goal blood pressure and/or satisfactory quality of healthcare [32]. It has been shown that primary care physicians do not conduct correction of cardiovascular risk factors and diagnosis of lesions of target organs and/or associated clinical conditions, which leads to an underestimation of cardiovascular risk and inadequate choice of treatment tactics in patients with Htn [32, 34]. In 2007, 64% of hypertensive patients had medicinal purposes in medical card [34]. At the same time, assigned antihypertensive therapy is fully consistent with the clinical status in 6.5% of total patients with Htn [34].
One of the reasons of low guidelines implementation is a set of current healthcare indicators powered by the Russian Ministry of Health. These indicators are solely organizational. They are used to calculate the average cost of treatment of a typical patient. These indices are not associated with the clinical objectives of treatment [28]. Such dissonance is a major problem in the transition of the Russian healthcare system to higher quality level. Novel registry (the RusR-Htn-CAD-CHF) will provide an objective view not only on patients with Htn, but also on patients with CAD and CHF. In the future, the RusR-Htn-CAD-CHF may provide the basis for implementing local initiatives, such as “pay for performance”. Similar projects were implemented in the US and UK [57-59].
In recent years, the attention to primary and secondary prevention of chronic CVD significantly increased in Russia and other countries [60-64]. Some authors have shown that coronary revascularization was often performed unnecessarily from the clinical point of view [65]. It is known that Russian patients with CAD are characterized by more severe clinical status compared with the same patients from other economically developed countries [66, 67]. However, the percitaneous coronary intervention (PCI) is carried out less frequently in these patients in Russia [66-68]. Soon, criteria of assessment of needs and appropriateness of coronary revascularization [69] will be added to analytical apparatus of the RusR-Htn-CAD-CHF. It is important for modern healthcare in Russia, taking into account the lack of probative data on the necessity and appropriateness of using the coronary revascularization in CAD patients in Russia. Our systematic search in database of Russian Science Citation Index gave no results.
The RusR-Htn-CAD-CHF may be also used as a basis for improving the quality of primary and secondary prevention of chronic CVD. Some Russian health facilities are already using the RusR-Htn-CAD-CHF for the assessment of quality of cardiovascular primary prevention [53].
In Russia, there are other registries of patients with Htn (RECVASA registry, local registries in Tomsk region, Tyumen region, and some other regions) [70-72], CAD (PROGNOS CHD registry and RECVASA registry) [73, 74], and CHF (RIF-CHF registry and Russian Hospital Chronic Heart Failure Registry) [75, 76]. But the RusR-Htn-CAD-CHF is currently the largest registry of Russian patients with chronic CVD.
Currently, the RusR-Htn-CAD-CHF is focused on primary care in Russia. But in the near future, we plan to expand this registry to covering secondary care facilities.
Conclusion
The RusR-Htn-CAD-CHF is a perspective project for healthcare quality assessment in patients with Htn, CAD, and CHF, living in Russia. This registry can be used for dynamic monitoring and improving the quality of primary care (and secondary care in near future) in Russia. Additionally, the RusR-Htn-CAD-CHF can be used for different epidemiologic studies in Russian patients with Htn, CAD, and CHF.
Acknowledgments
We thank all the participants of RusR-Htn-CAD-CHF. This Registry is funded by the Russian Ministry of Health as a part of the Health National Project.
Conflict of interest
None declared. The Russian Ministry of Health was not involved in the collection, analysis, and interpretation of data, in the manuscript preparation, or in making the decision to submit the paper. The authors have not received any financial support for the preparation of this paper.
- The demographic yearbook of Russia. 2015. Federal State Statistical Service (Rosstat). Moscow, 2015; 176 p. Russian
- Regions of Russia. Social and economy indices – 2011. Federal State Statistical Service (Rosstat). Moscow, 2011; 155 p. Russian
- Silber S, Richartz BM, Goss F, Haerer W, Glowatzki M, Schmieder RE. Care of hypertensive patients seen by cardiologists: results of the Snapshot Hypertension Registry. Dtsch Med Wochenschr 2007; 132: 2430-2435. German. http://dx.doi.org/10.1055/s-2007-991668.
- Ho PM, Zeng C, Tavel HM, Selby JV, O'Connor PJ, Margolis KL, Magid DJ. Trends in first-line therapy for hypertension in the Cardiovascular Research Network Hypertension Registry, 2002-2007. Arch Intern Med 2010; 170: 912-913. http://dx.doi.org/10.1001/archinternmed.2010.102.
- Choi SW, Kim MK, Han SW, Han SH, Lee BK, Lee SU, et al. Apparent treatment-resistant hypertension among elderly Korean hypertensives: an insight from the HIT registry. J Hum Hypertens 2014; 28: 201-205. https://doi.org/10.1038/jhh.2013.76.
- Kiss I, Kékes E. Hungarian Hypertension Registry. Orv Hetil 2014; 155: 764-768. Hungarian. https://doi.org/10.1556/OH.2014.29924.
- Michalska M, Rysz J, Pencina MJ, Zdrojewski T, Banach M. The knowledge and awareness of hypertension among patients with hypertension in central Poland: a pilot registry. Angiology 2014; 65: 525-532. https://doi.org/10.1177/0003319713489166.
- Zeymer U, Dechend R, Riemer T, Kaiser E, Senges J, Pittrow D, et al. 1-Year outcomes of hypertension management in 13,000 outpatients under practice conditions: prospective 3A registry. Int J Cardiol 2014; 176: 589-594. https://doi.org/10.1016/j.ijcard.2014.07.089.
- Masoudkabir F, Poorhosseini H, Vasheghani-Farahani A, Hakki E, Roayaei P, Kassaian SE. Synergistic effect of hypertension with diabetes mellitus and gender on severity of coronary atherosclerosis: Findings from Tehran Heart Center registry. ARYA Atheroscler 2015; 11: 317-322. https://www.ncbi.nlm.nih.gov/pubmed/26862339.
- Schmieder RE, Gitt AK, Koch C, Bramlage P, Ouarrak T, Tschöpe D; DIALOGUE study group. Achievement of individualized treatment targets in patients with comorbid type-2 diabetes and hypertension: 6 months results of the DIALOGUE registry. BMC Endocr Disord 2015; 15: 23. https://doi.org/10.1186/s12902-015-0020-7.
- Schmieder RE, Potthoff SA, Bramlage P, Baumgart P, Mahfoud F, Buhck H, et al. Patients with newly diagnosed hypertension treated with the renin angiotensin receptor blocker azilsartan medoxomil vs angiotensin-converting enzyme inhibitors: the prospective EARLY Registry. J Clin Hypertens (Greenwich) 2015; 17: 947-953. https://doi.org/10.1111/jch.12603.
- Choi SI, Kim SK, Park S, Kim JH, Ihm SH, Kim GI, et al. Prevalence of resistant hypertension and associated factors for blood pressure control status with optimal medical therapy using Korean ambulatory blood pressure monitoring registry data. Clin Hypertens 2016; 22: 8. https://doi.org/10.1186/s40885-016-0045-x.
- Brand E, Pavenstädt H, Schmieder RE, Engelbertz C, Fobker M, Pinnschmidt HO, et al. The Coronary Artery Disease and Renal Failure (CAD-REF) registry: trial design, methods, and aims. Eur J Prev Cardiol 2015; 22: 1056-1065. https://doi.org/10.1016/j.ahj.2013.06.010.
- Ferrari R, Ford I, Greenlaw N, Tardif JC, Tendera M, Abergel H, et al. Geographical variations in the prevalence and management of cardiovascular risk factors in outpatients with CAD: Data from the contemporary CLARIFY registry. Eur J Prev Cardiol 2015; 22: 1056-1065. https://doi.org/10.1177/2047487314547652.
- Virani SS, Maddox TM, Chan PS, Tang F, Akeroyd JM, Risch SA, et al. Provider type and quality of outpatient cardiovascular disease care: insights from the NCDR PINNACLE Registry. J Am Coll Cardiol 2015; 66: 1803-1812. https://doi.org/10.1016/j.jacc.2015.08.017.
- Fleming LM, Jones P, Chan PS, Andrei AC, Maddox TM, Farmer SA. Relationship of provider and practice volume to performance measure adherence for coronary artery disease, heart failure, and atrial fibrillation: results from the national cardiovascular data registry. Circ Cardiovasc Qual Outcomes 2016; 9: 48-54. https://doi.org/10.1161/CIRCOUTCOMES.115.002159 9.
- Kim HL, Kim MA, Shim WJ, Park SM, Kim YH, Na JO, et al. Reproductive factors predicting angiographic obstructive coronary artery disease: The KoRean wOmen'S Chest Pain rEgistry (KoROSE). J Womens Health (Larchmt) 2016; 25: 443-448. https://doi.org/10.1089/jwh.2015.5381.
- Roleder T, Smolka G, Podolecka E, Chudek J, Dworowy S, Żelazowska K, et al. Outcomes of biodegradable polymer sirolimus-eluting PROLIM stent in patients with coronary artery disease. Results of 12-month follow-up of prospective registry. Kardiol Pol 2016; 74: 411-417. https://doi.org/10.5603/KP.a2015.0208.
- Shirato K, Shiba N, Shimokawa H. Chronic heart failure analysis and registry in the Tohoku district: the CHART study. Nihon Rinsho 2007; 65, Suppl 4: 74-78. Japanese. https://www.ncbi.nlm.nih.gov/ pubmed/17511069.
- AlHabib KF, Elasfar AA, AlBackr H, AlFaleh H, Hersi A, AlShaer F, et al. Design and preliminary results of the heart function assessment registry trial in Saudi Arabia (HEARTS) in patients with acute and chronic heart failure. Eur J Heart Fail 2011; 13: 1178-1184. https://doi.org/10.1093/eurjhf/hfr111.
- Grundtvig M, Gullestad L, Hole T, Flønæs B, Westheim A. Characteristics, implementation of evidence-based management and outcome in patients with chronic heart failure: results from the Norwegian heart failure registry. Eur J Cardiovasc Nurs 2011; 10: 44-49. https://doi.org/10.1016/j.ejcnurse.2010.04.001.
- Berg J, Lindgren P, Mejhert M, Edner M, Dahlström U, Kahan T. Determinants of utility based on the EuroQol five-dimensional questionnaire in patients with chronic heart failure and their change over time: results from the Swedish Heart Failure Registry. Value Health 2015; 18: 439-448. https://doi.org/10.1016/j.jval.2015.02.003.
- Arzt M, Woehrle H, Oldenburg O, Graml A, Suling A, Erdmann E, et al. Prevalence and predictors of sleep-disordered breathing in patients with stable chronic heart failure: the SchlaHF Registry. JACC Heart Fail 2016; 4: 116-125. https://doi.org/10.1016/j.jchf.2015.09.014.
- Gitt AK, Bueno H, Danchin N, Fox K, Hochadel M, Kearney P, et al. The role of cardiac registries in evidence-based medicine. Eur Heart J 2010; 31: 525-529. https://doi.org/10.1093/eurheartj/ehp596.
- Posnenkova OM, Kiselev AR, Gridnev VI, Popova YV, Shvartz VA. View on the problem of managing of medical care quality. Oman Med J 2012; 27: 261-262. https://doi.org/10.5001/omj.2012.63.
- Kenny SJ, Smith PJ, Goldschmid MG, Newman JM, Herman WH. Survey of physician practice behaviors related to diabetes mellitus in the U.S.: Physician adherence to consensus recommendations. Diabetes Care 1993; 16: 1507-1510. https://doi.org/10.2337/diacare.16.11.1507.
- Stockwell DH, Madhavan S, Cohen H, Gibson G, Alderman MH. The determinants of hypertension awareness, treatment, and control in an insured population. Am J Public Health 1994; 84: 1768-1774. https://www.ncbi.nlm.nih.gov/pubmed/7977915.
- Kiselev AR, Posnenkova OM, Gridnev VI. Capabilities, limitations and perspectives of Russian standards of medical care and process approach using clinical indicators for evaluation medical care quality. Cardio-IT 2014; 1: 0205. Russian. https://doi.org/10.15275/cardioit.2014.0205.
- Sazanova GYu, Parkhomenko AA, Abyzova NV, Razdevilova OP, Voyteshak AA. Sociological analysis of the implementation of healthcare standards among patients with cardiovascular diseases. Bulletin of Medical Internet Conferences 2013; 3: 1126. Russian
- Obukhova ОV, Bazarova IN, Gavrilenko ОYu. Problems in implementation of medical and economic standards in medical facilities providing inpatient medical care. Social Aspects of Population Health 2008; 7(3): 6. Russian
- Evstifeyeva SE, Oshchepkova EV, Gridnev VI, Dovgalevsky PYa. An innovative method for controlling the quality of medical care to patients with arterial hypertension in primary health care facilities. Zdravookhranenie Rossiyskoy Federatsii 2009; (6): 17-20. Russian
- Oshchepkova EV, Evstifeyeva SE, Gridnev VI, Dovgalevsky PYa. The quality of examination and treatment of patients with arterial hypertension in primary health care facilities (the data from the Registry for Arterial Hypertension). Kardiologicheskij Vestnik 2009; 4(2): 54-58. Russian
- Oshchepkova EV, Lazareva NV, Balygin MM, Gridnev VI, Dovgalevsky PYa.The monitoring of measures to prevent and treat essential hypertension and its complications. Zdravookhranenie Rossiyskoy Federatsii 2011; (2): 7-11. Russian
- Posnenkova OM, Kiselev AR, Gridnev VI, Shvartz VA, Dovgalevsky PYa, Oschepkova EV. Pharmacotherapy quality in patients with arterial hypertension observed in primary care practice. Hypertension register data. Rational Pharmacother Card 2011; 7: 725-732. Russian. http://dx.doi.org/10.20996/1819-6446-2011-7-6-725-732.
- Posnenkova OM, Kiselev AR, Gridnev VI, Schwartz VA, Dovgalevskyi PYa, Oshchepkova EV. Blood pressure control in primary care patients with arterial hypertension: analysing the Hypertension Register data. Cardiovascular Therapy and Prevention 2012; 11(3): 4-11. Russian
- National guidelines for diagnosis and treatment of stable angina. Cardiovascular Therapy and Prevention 2008; 7(6), Suppl. 4. Russian
- Chazova IE, Ratova LG, Boytsov SA, Nebieridze DV, Karpov YuA, Belousov YuB, et al. Diagnosis and treatment of hypertension (Guidelines of Russian Society of Hypertension and Russian Society of Cardiology). Sistemnye Gipertenzii 2010; (3): 5-26. Russian
- Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2012; 126: e354-e471. https://doi.org/10.1161/CIR.0b013e3182776f83.
- McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012; 33: 1787-1847. https://doi.org/10.1093/eurheartj/ehs104.
- Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension. Eur Heart J 2013; 34: 2159-2219. https://doi.org/10.1093/eurheartj/eht151.
- Mareev VYu, Ageev FT, Arutyunov GP, Koroteev AV, Mareev YuV, Ovchinnikov AG, et al. National guidelines for diagnosis and treatment of CHF (fourth revision). Zhurnal Serdechnaya Nedostatochnost' 2013; 14: 379-472. Russian
- Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, et al. ESC guidelines on the management of stable coronary artery disease. Eur Heart J 2013; 34: 2949-3003. https://doi.org/10.1093/eurheartj/eht296.
- Weintraub WS, Karlsberg RP, Tcheng JE, Boris JR, Buxton AE, Dove JT, et al. ACCF/AHA 2011 Key data elements and definitions of a base cardiovascular vocabulary for electronic health records: a report of the American College of Cardiology Foundation/ American Heart Association Task Force on Clinical Data Standards. Circulation 2011; 124: 103-123. https://doi.org/10.1161/CIR.0b013e31821ccf71.
- Oshchepkova EV, Dovgalevsky PYa, Gridnev VI, Posnenkova OM, Kiselev AR, Dmitriev VA, et al. User guide of Russian registry of patients with arterial hypertension, coronary artery disease and chronic heart failure. Cardio-IT 2014; 1: 0204. Russian. https://doi.org/10.15275/cardioit.2014.0204.
- Bonow RO, Douglas PS, Buxton AE, Cohen DJ, Curtis JP, Delong E, et al. ACCF/AHA methodology for the development of quality measures for cardiovascular technology: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures. Circulation 2011; 124: 1483-1502. https://doi.org/10.1161/CIR.0b013e31822935fc.
- Posnenkova OM, Kiselev AR, Korotin AS, Genkal EN, Gridnev VI, Dovgalevsky PYa. Public report on quality of care delivered to patients with stable coronary artery disease and chronic heart failure in 2013: the data from Saratov Registry of coronary artery disease and chronic heart failure. Cardio-IT 2014; 1: 0402. Russian. https://doi.org/10.15275/cardioit.2014.0402.
- Posnenkova OM, Korotin AS, Kiselev AR, Gridnev VI, Belova OA, Rachkova SA, et al. Performance of recommended measures on risk factors control in patients with hypertension, coronary artery disease and chronic heart failure: the data from 2014 Russian registry. Cardio-IT 2015; 2: e0102. Russian. https://doi.org/10.15275/cardioit.2015.0102.
- Korotin AS, Posnenkova OM, Kiselev AR, Genkal EN, Gridnev VI, Dovgalevsky PYa, Oshchepkova EV. Implementation of recommended measures in patients with stable coronary artery disease: the data from 2014 Russian registry. Cardio-IT 2015; 2: e0103. Russian. https://doi.org/10.15275/cardioit.2015.0103.
- Korotin AS, Posnenkova OM, Kiselev AR, Gridnev VI, Dovgalevsky PYa, Oshchepkova EV. Implementation of recommended measures in patients with chronic heart failure: the data from 2014 Russian registry. Cardio-IT 2015; 2: e0104. Russian. https://doi.org/10.15275/cardioit.2015.0104.
- Oshchepkova EV, Lazareva NV, Satlykova DF, Tereshchenko SN. The first results of the Russian Register of Chronic Heart Failure. Kardiologiia 2015; 55(5): 22-28. Russian. https://www.ncbi.nlm.nih.gov/pubmed/26615620.
- Erlikh AD. Russian registries of cardiovascular diseases: from existing problems to perspectives. Cardio-IT 2016; 3: e0402. https://doi.org/10.15275/cardioit.2016.0402.
- Balashov SV. On the question about relevance of quality assessment in the system of of cardiovascular prevention. Bulletin of Medical Internet Conferences 2015; 5: 1111-1112. Russian
- Balashov SV, Balashova ME, Popova YuV. Assessment of health care quality among penitentiary employees with hypertension in the Saratov region. Saratov Journal of Medical Scientific Research 2015; 11: 275-279. Russian
- Gerasimov SN, Alexandrova IN. Potential of a registry in evaluation of treatment of patients with essential hypertension in primary care (using the example of polyclinic located in Saratov region). Cardio-IT 2015; 2: e0403. Russian. https://doi.org/10.15275/cardioit.2015.0403.
- Oshchepkova EV. Five-year results of implementation of the federal target program Prevention and Treatment of Arterial Hypertension in Russian Federation (2002-2006). Ter Arkh 2007; 79(9): 25-30. Russian. https://www.ncbi.nlm.nih.gov/pubmed/18038582.
- Chazova IE, Oshchepkova EV. Results of implementation of a hypertension control program in Russia in 2002-2012. Ter Arkh 2013; 85(1): 4-10. Russian. https://www.ncbi.nlm.nih.gov/pubmed/23536938.
- Peterson LA, Woodard LD, Urech D, Daw C, Sookanan S. Does pay-for-performance improve the quality of health care? Ann Intern Med 2006; 145: 265-272. https://doi.org/10.7326/0003-4819-145-4-200608150-00006.
- Peterson LA, Woodard LD, Henderson LM, Urech TH, Pietz K. Will hypertension performance measures used for pay-for-performance programs penalize those who care for medically complex patients? Circulation 2009; 119: 2978-2985. https://doi.org/10.1161/CIRCULATIONAHA.108.836544.
- Serumaga B, Ross-Degnan D, Avery AJ, Elliott RA, Majumdar SR, Zhang F, Soumerai SB. Effect of pay for performance on the managamant and outcomes of hypertension in the United Kingdom: interrupted time series study. BMJ 2011; 342: d108. https://doi.org/10.1136/bmj.d108.
- Kalinina AM, Kondrat'eva NV, Shapovalova VP, Kontsevaia AV, Gambarian MG, Ryzhov VM, Ryzhova TV. Estimating the need for primary prevention of cardiovascular diseases in the medical and sanitary unit of an industrial enterprise. Profilakticheskaia Meditsina 2013; 16(3): 8-13. Russian
- Klochkov VA. Current trends in the fight with cardiovascular risk factors. Fundamental Research 2013; (7-1): 213-217. Russian
- Olimov NKh, Mamedov MN, Deev AD. Primary and secondary prevention of cardio-vascular diseases: main directions of a national multicenter study in Tajikistan. Kardiologiia 2013; 53(4): 45-48. Russian. https://www.ncbi.nlm.nih.gov/pubmed/23952952.
- Kalinina AM. Multifactor primary prevention of ischemic heart disease in middle-aged men and its efficacy (10-year follow-up). Rational Pharmacother Card 2014; 10: 6-17. Russian. https://doi.org/10.20996/1819-6446-2014-10-1-6-17.
- Leshchenko IZh. Organization of primary and secondary prevention of cardiovascular diseases in the diagnostic center. Medicine and Education in Siberia 2014; (2): 23. Russian
- Stergiopoulos K, Boden WE, Hartigan P, Möbius-Winkler S, Hambrecht R, Hueb W, et al. Percutaneous coronary intervention outcomes in patients with stable obstructive coronary artery disease and myocardial ischemia: A collaborative meta-analysis of contemporary randomized clinical trials. JAMA Intern Med 2014;174: 232-240. https://doi.org/10.1001/jamainternmed.2013.12855.
- Boytsov SA, Yakushin SS, Martsevich SYu, Lukyanov MM, Nikulina NN, Zagrebelny AV, et al. Outpatient register of cardiovascular diseases in the Ryazan region (RECVASA): principal tasks, experience of development and first results. Rational Pharmacother Card 2013; 9: 4–14. Russian. https://doi.org/10.20996/1819-6446-2013-9-1-4-14.
- Shalnova SA, Oganov RG, Steg PhG, Ford I. Coronary artery disease in Russia: today’s reality evidenced by the international CLARIFY Registry. Kardiologiia 2013; 53(8): 28–33. Russian. https://www.ncbi.nlm.nih.gov/pubmed/24087997.
- Tolpygina SN, Martsevich SYu, Gofman EA, Malysheva AM, Polyanskaya YuN, Deev AD. Developing a register of outcomes of chronic coronary heart disease: CHD PROGNOSIS Study. Cardiovascular Therapy and Prevention 2013; 12(1): 32–39. Russian. https://doi.org/10.15829/1728-8800-2013-1-32-39.
- Genkal EN, Posnenkova OM, Kiselev AR, Korotin AS, Gridnev VI, Dovgalevsky PYa. Perspectives of anatomical and clinical criteria use in revascularization of patients with stable coronary artery disease. Saratov Journal of Medical Scientific Research 2015; 11: 280-286. Russian
- Kobyakova OS, Nesvetailo NYa, Yefimova YeV, Boikov VA. The electronic register patients with hypertensia in Tomsk Region. Bulletin of Siberian Medicine 2012; 11(3): 154-159. Russian. https://doi.org/10.20538/1682-0363-2012-3-154-159.
- Zagrebelnyy AV, Martsevich SYu, Loukianov MM, Pravkina EA, Vorobyev AN, Yakushin SS, Boytsov SA. Quality assessment of antihypertensive therapy in patients with arterial hypertension without concomitant cardiovascular diseases as a part of outpatient RECVASA register. Rational Pharmacother Card 2014; 10: 378-383. Russian. https://doi.org/10.20996/1819-6446-2014-10-4-378-383.
- Efanov AY, Medvedeva IV, Sholomov IF, Efanova SA, Andrianova IA. Chronic non-infectious diseases register and ambulatory surveillance features of patients with arterial hypertension in Tyumen region. Medical Science and Education of Ural 2015; 16(4): 102-109. Russian
- Tolpygina SN, Martsevich SYu, Gofman EA, Deev AD. Prognostic value of instrumental diagnostics in chronic coronary heart disease. Data from “PROGNOS CHD”. Cardiovascular Therapy and Prevention 2014; 13(4): 29-35. Russian. https://doi.org/10.15829/1728-8800-2014-4-29-35.
- Boytsov SA, Lukyanov MM, Yakushin SS, Martsevich SY, Vorobyev AN, Zagrebelny AV, et al. The outpatient based registry RECVASA: prospective follow-up data, risk evluation and outcomes in cardiovascular patients. Cardiovascular Therapy and Prevention 2015; 14(1): 53-62. Russian. https://doi.org/10.15829/1728-8800-2015-1-53-62.
- Sitnikova MYu, Lyasnikova EA, Yurchenko AV, Trukshina MA, Libis RA, Kondratenko VY, et al. Results of Russian hospital chronic heart failure registry in three subjects of Russian Federation. Kardiologiia 2015; 55(10): 5-13. Russian. https://www.ncbi.nlm.nih.gov/pubmed/28294788.
- Tereshchenko SN, Zhirov IV, Romanova NV, Osmolovskaya YF, Golitsyn SP. The first Russian register of patients with chronic heart failure and atrial fibrillation (RIF-CHF): study design. Rational Pharmacother Card 2015; 11: 577-581. Russian. https://doi.org/10.20996/1819-6446-2015-11-6-577-581.
Received 10 March 2017, Revised 12 April 2017, Accepted 25 April 2017
© 2017, Gridnev V.I., Kiselev A.R., Posnenkova O.M., Popova Yu.V., Lazareva N.V., Belova O.A., Romanchuk S.V., Prokhorov M.D., Dovgalevsky P.Ya., Oshchepkova E.V.
© 2017, Russian Open Medical Journal
Correspondence to Vladimir I. Gridnev. Address: Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, 112, Bolshaya Kazachya str., Saratov, 410012, Russia. Email: gridnev@cardio-it.ru.
Appendix A. Key data elements of the database of RusR-Htn-CAD-CHF
|
Code |
Recommended diagnosis |
Title of key data element |
Type of element |
Format of data |
|---|---|---|---|---|
|
1 |
|
Personal data of patients |
||
|
1.1 |
Htn, CAD, CHF |
Surname |
Text |
Any text |
|
1.2 |
Htn, CAD, CHF |
First name |
Text |
Any text |
|
1.3 |
Htn, CAD, CHF |
Middle name |
Text |
Any text |
|
1.4 |
Htn, CAD, CHF |
Sex |
Binary |
Male Female |
|
1.5 |
Htn, CAD, CHF |
Date of birth |
Date |
DD.MM.YYYY |
|
1.6 |
Htn, CAD, CHF |
Date of registration in the RusR-Htn-CAD-CHF |
Date |
DD.MM.YYYY |
|
1.7 |
Htn, CAD, CHF |
Address |
Text |
Any text |
|
1.8 |
Htn, CAD, CHF |
Phone (one or more) |
Text |
Any text |
|
1.9 |
Htn, CAD, CHF |
Number of pension insurance certificate |
Text |
Any text |
|
1.10 |
Htn, CAD, CHF |
Number of health insurance policy |
Text |
Any text |
|
1.11 |
Htn, CAD, CHF |
Social category |
Categorical (one of list) |
Working Pensioner Disabled Other Unknown |
|
1.12 |
Htn, CAD, CHF |
Education |
Categorical (one of list) |
Primary Average Specialized secondary Incomplete higher Higher Unknown |
|
1.13 |
Htn, CAD, CHF |
Type of work |
Categorical (one of list) |
Physical Mental Not working Unknown |
|
2 |
|
Past history |
||
|
2.1 |
Htn, CAD |
Family history of coronary artery disease |
Categorical (one of list) |
Yes No Unknown |
|
2.2 |
Htn |
Family history of hypertension |
Categorical (one of list) |
Yes No Unknown |
|
2.3 |
Htn, CAD, CHF |
Smoking |
Categorical (one of list) |
Current smoker: <1 cigarettes/day Current smoker: 1-9 cigarettes/day Current smoker: 10-19 cigarettes/day Current smoker: 20-39 cigarettes/day Current smoker: ≥40 cigarettes/day Former smoker Never smoked Unknown |
|
2.4 |
Htn, CAD, CHF |
Alcohol consumption |
Categorical (one of list) |
Alcohol drinking: <20 g/day Alcohol drinking: 20-59 g/day Alcohol drinking: 60-139 g/day Alcohol drinking: 140-179 g/day Alcohol drinking: ≥180 g/day No alcohol drinking Unknown |
|
2.5 |
Htn, CAD, CHF |
The level of physical activity in lifestyle |
Categorical (one of list) |
Low Medium High Unknown |
|
2.6 |
Htn, CAD, CHF |
Balanced diet |
Categorical (one of list) |
Yes No Unknown |
|
2.7 |
CHF |
Inpatient treatment for cardiovascular diseases |
Date of admission, Discharge date |
DD.MM.YYYY, DD.MM.YYYY |
|
3 |
|
Results of physical examination at the visit |
|
|
|
3.1 |
Htn, CAD |
SBP, first measurement at visit |
Numeric |
000 mmHg Unknown |
|
3.2 |
Htn, CAD |
DBP, first measurement at the visit |
Numeric |
000 mmHg Unknown |
|
3.3 |
Htn, CAD |
SBP, second measurement at the visit |
Numeric |
000 mmHg Unknown |
|
3.4 |
Htn, CAD |
DBP, second measurement at the visit |
Numeric |
000 mmHg Unknown |
|
3.5 |
CAD, CHF |
Heart rate at the visit |
Numeric |
000 beats/min Unknown |
|
3.6 |
CAD, CHF |
Palpation |
Categorical (multiple choose) |
Bilateral ankle swelling Ripple of jugular veins Hepatojugular reflux Hepatomegalia |
|
3.7 |
CAD, CHF |
Auscultation |
Categorical (multiple choose) |
Rattling in the lower lung Rattling on all lung fields The third tone in heart beat |
|
3.8 |
Htn, CAD |
Height |
Numeric |
000 cm Unknown |
|
3.9 |
Htn, CAD |
Weight |
Numeric |
000 kg Unknown |
|
3.10 |
Htn, CAD |
Waist circumference |
Numeric |
000 cm Unknown |
|
3.11 |
CAD |
Complaints of chest pain or its equivalent |
Categorical (one of list) |
Yes No Unknown |
|
3.12 |
CAD |
Characteristics of chest pain or its equivalent |
Categorical (multiple choose) |
Symptom has characteristic features and duration for chest pain Chest pain or its equivalent arises during physical exertion or emotional stress Chest pain or its equivalent passes alone and/or after taking nitroglycerin Not applicable (if in element 3.11 it was selected “No” or “Unknown”) |
|
3.13 |
CAD |
The level of physical activity associated with chest pain or its equivalent |
Categorical (one of list) |
Usual daily physical activity does not cause chest pain or its equivalent Slight limitation of usual physical activity Significant limitation of usual physical activity Inability to perform any physical activity because of chest pain or its equivalent Unknown Not applicable (if in element 3.11 it was selected “No” or “Unknown”) |
|
3.14 |
CAD, CHF |
Complaint of dyspnea |
Categorical (one of list) |
Yes No Unknown |
|
3.15 |
CAD, CHF |
Characteristics of dyspnea (прим.: если в пункте «Жалобы на одышку» выбран «Имеется») |
Categorical (multiple choose) |
Paroxysmal nocturnal dyspnea Dyspnea during usual physical activity Dyspnea during walking on level ground Dyspnea when climbing (uphill, stairs) Dyspnea at rest Orthopnoea Nocturnal cough Unknown Not applicable (if in element 3.14 it was selected “No” or “Unknown”) |
|
4 |
|
Results of instrumental examinations |
||
|
4.1 |
Htn |
24-hour ambulatory blood pressure monitoring |
Categorical (one of list) |
Yes No |
|
4.1.1 |
Htn |
24-hour SBP |
Numeric |
000 mmHg Unknown |
|
4.1.2 |
Htn |
24-hour DBP |
Numeric |
000 mmHg Unknown |
|
4.1.3 |
Htn |
Daytime SBP |
Numeric |
000 mmHg Unknown |
|
4.1.4 |
Htn |
Daytime DBP |
Numeric |
000 mmHg Unknown |
|
4.1.5 |
Htn |
Number of daytime measurements |
Numeric |
00 Unknown |
|
4.2.1 |
Htn |
Self-monitoring SBP (mean) |
Numeric |
000 mmHg Unknown |
|
4.2.2 |
Htn |
Self-monitoring DBP (mean) |
Numeric |
000 mmHg Unknown |
|
4.2.3 |
Htn |
Duration of self-monitoring blood pressure |
Numeric |
00 days Unknown |
|
4.3 |
Htn, CAD, CHF |
Echocardiography |
Categorical (one of list) |
Yes No |
|
4.3.1 |
Htn |
Left ventricular mass index |
Numeric |
000 g/m2 Unknown |
|
4.3.2 |
CAD, CHF |
LVEF |
Numeric |
00 % Unknown |
|
4.3.3 |
CHF |
Left ventricular diastolic dysfunction |
Categorical (one of list) |
Yes No Unknown |
|
4.3.4 |
CAD |
Local contractility disorders |
Categorical (one of list) |
Yes No Unknown |
|
4.3.5 |
CHF |
Pulmonary hypertension |
Categorical (one of list) |
Yes No Unknown |
|
4.4.1 |
Htn, CAD, CHF |
ECG: conclusion |
Categorical (multiple choose) |
Left ventricular hypertrophy Signs of Q-wave myocardial infarction Signs of non-Q-wave myocardial infarction Tachyarrhythmia Atrioventricular block: 2 or 3 degree Atrial fibrillation or atrial flutter Other violations Normal Unknown |
|
4.4.2 |
Htn |
Sokolow-Lyon index |
Numeric |
00 mm Unknown |
|
4.4.3 |
Htn |
Cornell product criteria |
Numeric |
0000 mm*ms Unknown |
|
4.5.1 |
Htn |
Duplex ultrasound: Intima media thickness |
Numeric |
0.0 mm Unknown |
|
4.5.2 |
Htn |
Duplex ultrasound: Atherosclerotic plaque in great arteries |
Categorical (one of list) |
Yes No Unknown |
|
4.5.3 |
Htn |
Carotid–femoral pulse wave velocity |
Numeric |
00.0 m/s Unknown |
|
4.5.4 |
Htn |
Ankle-brachial index |
Numeric |
0.0 Unknown |
|
4.6 |
CAD, CHF |
Chest X-ray |
Categorical (multiple choose) |
Cardiomegaly Pleurisy Pulmonary vascular congestion or pulmonary edema None of the above Unknown |
|
4.7 |
Htn |
Fundus examination by ophthalmologist |
Categorical (one of list) |
Hypertensive retinopathy Other Unknown |
|
4.8 |
Htn, CHF |
Consulting with cardiologist |
Categorical (one of list) |
Yes No |
|
4.9 |
CAD |
ECG during exercise |
Categorical (one of list) |
Yes No |
|
4.9.1 |
CAD |
Results of ECG during exercise |
Categorical (one of list) |
Positive Negative Uncertain Unknown Not applicable (if in element 4.9 it was selected “No”) |
|
4.9.2 |
CAD |
ECG during exercise: The load duration |
Numeric |
00.0 minutes Unknown Not applicable (if in element 4.9 it was selected “No”) |
|
4.9.3 |
CAD |
ECG during exercise: Maximal deviation of ST segment |
Numeric |
00.0 mm Unknown Not applicable (if in element 4.9 it was selected “No”) |
|
4.9.4 |
CAD |
ECG during exercise: Features of chest pain |
Categorical (one of list) |
No angina Angina occurs, but does not stop exercise test Angina causes to stop the test Unknown Not applicable (if in element 4.9 it was selected “No”) |
|
4.9.5 |
CAD |
ECG during exercise: METs |
Numeric |
00.0 METs Unknown Not applicable (if in element 4.9 it was selected “No”) |
|
4.9.6 |
CAD |
Contraindications for exercise test |
Categorical (one of list) |
Yes Unknown Not applicable (if in element 4.9 it was selected “Yes”) |
|
4.10.1 |
CAD |
Physical stress echocardiography: Minimal LVEF |
Numeric |
00 % Unknown |
|
4.10.2 |
CAD |
Physical stress echocardiography: Stress-induced violations of local contractility |
Categorical (one of list) |
Yes No Unknown |
|
4.11 |
CAD |
Dobutamine stress echocardiography: Stress-induced violations of local contractility |
Categorical (one of list) |
Yes No Unknown |
|
4.12 |
CAD |
Perfusion scintigraphy: Irreversible perfusion defect |
Categorical (one of list) |
Yes No Unknown |
|
4.13.1 |
CAD |
Computerized tomography: Agatston score |
Numeric |
000 HU Unknown |
|
4.13.2 |
CAD |
Results of coronary computed tomography angiography |
Categorical (multiple choose) |
Yes (Additional dataset is presented in Appendix B) Unknown |
|
4.14 |
CAD |
Results of coronary angiography |
Categorical (multiple choose) |
Yes (Additional dataset is presented in Appendix B) Unknown |
|
5 |
|
Results of laboratory tests |
||
|
5.1 |
Htn, CAD |
Blood glucose |
Numeric |
00.0 mmol/L 000 mg/dL Unknown |
|
5.2 |
Htn, CAD |
Glucose tolerance test: Blood glucose via 2 hours after glucose load |
Numeric |
00.0 mmol/L 000 mg/dL Unknown |
|
5.3 |
Htn, CAD |
Hemoglobin A1c |
Numeric |
00.0 % Unknown |
|
5.4 |
Htn, CAD |
Total cholesterol |
Numeric |
00.0 mmol/L 000 mg/dL Unknown |
|
5.5 |
Htn, CAD |
Triglycerides |
Numeric |
00.0 mmol/L 000 mg/dL Unknown |
|
5.6 |
Htn, CAD |
Low-density lipoprotein |
Numeric |
00.0 mmol/L 000 mg/dL Unknown |
|
5.7 |
Htn, CAD |
High-density lipoprotein |
Numeric |
00.0 mmol/L 000 mg/dL Unknown |
|
5.8 |
Htn, CHF |
Creatinine |
Numeric |
000 micromoles/L 0.00 mg/dL Unknown |
|
5.9 |
Htn |
Serum urea |
Numeric |
00.00 mmol/L Unknown |
|
5.10 |
Htn |
Uric acid |
Numeric |
000.0 µmol/L Unknown |
|
5.11 |
CHF |
B-type natriuretic peptide (PNB) |
Numeric |
000 Pg/ml 000 Pmol/ml |
|
5.12 |
CHF |
N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) |
Numeric |
0000 Pg/ml 000 Pmol/ml |
|
5.13 |
Htn, CAD, CHF |
Serum potassium |
Numeric |
000.0 mmol/L Unknown |
|
5.14 |
CHF |
Serum sodium |
Numeric |
000.0 mmol/L Unknown |
|
5.15 |
CHF |
Serum chloride |
Numeric |
000.0 mmol/L Unknown |
|
5.16 |
CAD |
Hemoglobin |
Numeric |
000 g/L Unknown |
|
5.17 |
Htn |
Urine protein |
Numeric |
0.000 g/L Unknown |
|
5.18 |
Htn |
24-hour urine protein |
Numeric |
000.0 mg/day Unknown |
|
5.19 |
Htn |
Albumin/creatinine ratio in urine |
Numeric |
00 mg/g 0.0 mg/mmol |
|
6 |
|
Non-pharmacologic treatment |
||
|
6.1 |
Htn |
Subject who was trained in the School for hypertensive patients |
Categorical (one of list) |
Yes Unknown |
|
6.2 |
CHF |
Subject who was trained in the School for patients with CHF |
Categorical (one of list) |
Yes Unknown |
|
6.3 |
Htn, CAD, CHF |
Patient who received advice on the rational consumption of alcohol |
Categorical (one of list) |
Yes Unknown |
|
6.4 |
Htn, CAD, CHF |
Patient who received advice on smoking cessation |
Categorical (one of list) |
Yes Unknown |
|
6.5 |
Htn, CAD, CHF |
Patient who received advice on rational physical activity |
Categorical (one of list) |
Yes Unknown |
|
6.6 |
Htn, CAD, CHF |
Patient who received advice on rational diet |
Categorical (one of list) |
Yes Unknown |
|
6.7 |
Htn, CAD, CHF |
Patient who received advice on weight normalization |
Categorical (one of list) |
Yes Unknown |
|
7 |
|
Drug treatment |
||
|
7.1.1 |
Htn, CAD, CHF |
ACE-Is |
Categorical (one of list) |
Yes No |
|
7.1.2 |
Htn, CHF |
Adverse reactions to ACE-Is and/or idiosyncrasy |
Categorical (one of list) |
Yes Unknown |
|
7.1.3 |
Htn, CAD, CHF |
Angioedema |
Categorical (one of list) |
Yes Unknown Not applicable (if in element 7.1.2 it was selected “Unknown”) |
|
7.2.1 |
Htn, CAD, CHF |
ARBs |
Categorical (one of list) |
Yes No |
|
7.2.2 |
Htn, CHF |
Adverse reactions to ARBs and/or idiosyncrasy |
Categorical (one of list) |
Yes Unknown |
|
7.3 |
Htn |
Direct renin inhibitors |
Categorical (one of list) |
Yes No |
|
7.4.1 |
Htn, CAD, CHF |
Beta-blockers |
Categorical (one of list) |
Yes No |
|
7.4.2 |
Htn, CAD, CHF |
Adverse reactions to beta-blockers and/or idiosyncrasy |
Categorical (one of list) |
Yes Unknown |
|
7.5.1 |
Htn, CAD |
Dihydropyridine CCBs |
Categorical (one of list) |
Yes No |
|
7.5.2 |
Htn, CAD |
Non-dihydropyridine CCBs |
Categorical (one of list) |
Yes No |
|
7.5.3 |
Htn, CAD |
Adverse reactions to CCBs and/or idiosyncrasy |
Categorical (one of list) |
Yes Unknown |
|
7.6.1 |
Htn, CHF |
Thiazide diuretics |
Categorical (one of list) |
Yes No |
|
7.6.2 |
Htn, CHF |
Potassium-sparing diuretics |
Categorical (one of list) |
Yes No |
|
7.6.3 |
Htn, CHF |
Loop diuretics |
Categorical (one of list) |
Yes No |
|
7.6.4 |
Htn, CHF |
Adverse reactions to diuretics and/or idiosyncrasy |
Categorical (one of list) |
Yes Unknown |
|
7.7 |
Htn |
Alpha-blockers |
Categorical (one of list) |
Yes No |
|
7.8 |
Htn |
Imidazoline receptor agonists |
Categorical (one of list) |
Yes No |
|
7.9 |
Htn |
Other antihypertensive drugs |
Categorical (one of list) |
Yes No |
|
7.10.1 |
CAD, CHF |
Statins |
Categorical (one of list) |
Yes No |
|
7.10.2 |
CAD, CHF |
Adverse reactions to statins and/or idiosyncrasy |
Categorical (one of list) |
Yes Unknown |
|
7.11.1 |
Htn, CAD, CHF |
Aspirin |
Categorical (one of list) |
Yes No |
|
7.11.2 |
Htn, CHF |
Adverse reactions to aspirin and/or idiosyncrasy |
Categorical (one of list) |
Yes Unknown |
|
7.12.1 |
Htn, CAD, CHF |
Indirect-acting anticoagulants |
Categorical (one of list) |
Yes No |
|
7.12.2 |
Htn, CHF |
Adverse reactions to indirect-acting anticoagulants and/or idiosyncrasy |
Categorical (one of list) |
Yes Unknown |
|
7.13.1 |
CAD |
Clopidogrel |
Categorical (one of list) |
Yes No |
|
7.13.2 |
CAD |
Adverse reactions to clopidogrel and/or idiosyncrasy |
Categorical (one of list) |
Yes Unknown |
|
7.14.1 |
CAD, CHF |
Short-acting nitrates |
Categorical (one of list) |
Yes No |
|
7.14.2 |
CAD, CHF |
Adverse reactions to short-acting nitrates and/or idiosyncrasy |
Categorical (one of list) |
Yes Unknown |
|
7.14.3 |
CAD, CHF |
Long-acting nitrates |
Categorical (one of list) |
Yes No |
|
7.14.4 |
CAD, CHF |
Adverse reactions to long-acting nitrates and/or idiosyncrasy |
Categorical (one of list) |
Yes Unknown |
|
7.14.5 |
CAD |
Number of nitroglycerin tablets per week |
Numeric |
00 tablets/week |
|
7.15 |
CHF |
Hydralazine |
Categorical (one of list) |
Yes No |
|
7.16 |
CHF |
Digoxin |
Categorical (one of list) |
Yes No |
|
8 |
|
Invasive treatment |
||
|
8.1.1 |
Htn, CAD |
PCI |
Categorical (one of list) |
Yes No |
|
8.1.2 |
CAD |
Results of PCI: residual stenosis |
Categorical (multiple choose) |
Yes (Additional dataset is presented in Appendix B) Unknown |
|
8.1.3 |
CAD |
Contraindications for PCI |
Categorical (one of list) |
Yes Unknown |
|
8.1.4 |
CAD |
Number of stents |
Numeric |
0 Unknown |
|
8.1.5 |
CAD |
Type of stents |
Categorical (one of list) |
With drug-coated Uncovered Unknown |
|
8.2 |
Htn, CAD |
Surgical coronary revascularization |
Categorical (one of list) |
Yes No |
|
9 |
|
Diagnosis and its codes according to the International Classification of Diseases 10 (ICD-10) |
||
|
9.1.1 |
Htn, CAD |
Stable angina (I20.8) |
Categorical (one of list) |
Yes No |
|
9.1.2 |
CAD |
Angina functional class according to the Canadian Cardiovascular Society grading of angina pectoris |
Categorical (one of list) |
I class II class III class IV class Unknown |
|
9.2 |
Htn, CAD, CHF |
Old myocardial infarction (I25.2) |
Categorical (one of list) |
Yes No |
|
9.3 |
CAD |
Other forms of chronic ischemic heart disease (I25.0, I25.1, I25.3, I25.4, I25.5, I25.6, I25.8, I25.9) |
Categorical (one of list) |
Yes No |
|
9.4 |
Htn, CAD |
Essential (primary) hypertension (I10) |
Categorical (one of list) |
Yes No |
|
9.5.1 |
Htn |
Renovascular hypertension (I15.0) |
Categorical (one of list) |
Yes No |
|
9.5.2 |
Htn, CAD |
Bilateral renal artery stenosis |
Categorical (one of list) |
Yes No |
|
9.6 |
Htn |
Other secondary hypertension (I15.1, I15.2, I15.8, I15.9) |
Categorical (one of list) |
Yes No |
|
9.7.1 |
Htn, CAD, CHF |
CHF (I50) |
Categorical (one of list) |
Yes No |
|
9.7.2 |
CAD, CHF |
Functional class of CHF according to the New York Heart Association Functional Classification |
Categorical (one of list) |
I class II class III class IV class Unknown |
|
9.8 |
Htn |
Cerebral infarction (I63) |
Categorical (one of list) |
Yes No |
|
9.9 |
Htn |
Intracerebral haemorrhage (I60, I61, I62) |
Categorical (one of list) |
Yes No |
|
9.10 |
Htn |
Stroke, not specified as haemorrhage or infarction (I64) |
Categorical (one of list) |
Yes No |
|
9.11 |
Htn |
Atherosclerotic peripheral arterial disease (I70) |
Categorical (one of list) |
Yes No |
|
9.12 |
Htn |
Transient cerebral ischaemic attacks and related syndromes (G45) |
Categorical (one of list) |
Yes No |
|
9.13 |
Htn |
Discirculatory encephalopathy (I65, I66, I67.2, I67.3, I67.4, I67.8, F01, I69) |
Categorical (one of list) |
Yes No |
|
9.14 |
Htn |
Dissecting aortic aneurysm (I71.0) |
Categorical (one of list) |
Yes No |
|
9.15 |
Htn, CAD |
Diabetes mellitus (E10-E14) |
Categorical (one of list) |
Yes No |
|
9.16.1 |
Htn, CAD, CHF |
Chronic lower respiratory diseases (J40-J47) |
Categorical (one of list) |
Yes No |
|
9.16.2 |
Htn, CAD |
Asthma (J45) |
Categorical (one of list) |
Yes No |
|
9.17 |
Htn |
Gout (M10) |
Categorical (one of list) |
Yes No |
|
9.18 |
Htn, CAD |
Pregnancy |
Categorical (one of list) |
Yes No Not applicable (if in element 1.4 it was selected “Male”) |
|
9.19 |
CHF |
Cirrhosis of liver (K74.3-K74.6) |
Categorical (one of list) |
Yes No |
|
9.20 |
CAD |
Other deseases provoking or aggravating ischemia |
Categorical (one of list) |
Yes No |
|
9.21 |
CAD |
Other deseases provoking, aggravating, or simulating chest pain |
Categorical (one of list) |
Yes No |
Data elements, preferred to fill in patients with Htn and/or CAD and/or CHF, signed in column “Recommended diagnosis”.
DD.MM.YYYY is day, month and year. ACE-Is, angiotensin converting enzyme inhibitors; ARBs, angiotensin II receptor blockers; CAD, coronary artery disease; CCBs, calcium channel blockers; CHF, chronic heart failure; DBP, diastolic blood pressure; ECG, electrocardiogram; Htn, hypertension; HU, Hounsfield units; LVEF, left ventricle ejection fraction; METs, metabolic equivalents of task; PCI, percitaneous coronary intervention; SBP, systolic blood pressure.
Appendix B. Addition data elements for coronary anatomy used in the RusR-Htn-CAD-CHF
|
Segments |
Title |
Stenosis or residual stenosis |
TIMI |
|
Segment 1 |
Proximal part of right coronary artery |
00 % |
0 |
|
Segment 2 |
Middle part of right coronary artery |
00 % |
0 |
|
Segment 3 |
Middle part of right coronary artery |
00 % |
0 |
|
Segment 4 |
Posterior descending (interventricular) artery |
00 % |
0 |
|
Segment 5 |
Trunk of left coronary artery |
00 % |
0 |
|
Segment 6 |
Proximal part of anterior descending (interventricular) artery |
00 % |
0 |
|
Segment 7 |
Middle part of anterior descending (interventricular) artery |
00 % |
0 |
|
Segment 8 |
Middle part of anterior descending (interventricular) artery |
00 % |
0 |
|
Segment 9 |
First diagonal branch |
00 % |
0 |
|
Segment 10 |
Second diagonal branch |
00 % |
0 |
|
Segment 11 |
Proximal part of circumflex artery |
00 % |
0 |
|
Segment 12 |
First blunt marginal branch |
00 % |
0 |
|
Segment 13 |
Middle part of circumflex artery |
00 % |
0 |
|
Segment 14 |
Other blunt segments |
00 % |
0 |
|
Segment 15 |
Right posterolateral segment and branches |
00 % |
0 |
|
|
Bypass |
00 % |
0 |
Appendix С. Clinical indicators for assessment of quality of healthcare in patients with Htn, CAD, and CHF
|
Title of indicators |
Definitions |
|---|---|
|
Control of cardiovascular risk factors |
|
|
1. BP control |
Numerator: [Patients with Htn and/or CAD and/or CHF who have last BP <140/90 mmHg] AND [Patients with Htn and/or CAD and/or CHF who have last BP is ≥140/90 mmHg under treatment with 2 or more antihypertensive drugs]. Denominator: Patients with Htn and/or CAD and/or CHF. Exclusion criteria: i) There are no data on BP at the last 12 months. ii) Secondary hypertension. |
|
1A. Target BP is reached |
Numerator: Patients with Htn and/or CAD and/or CHF who have last BP <140/90 mmHg. Denominator: Patients with Htn and/or CAD and/or CHF. Exclusion criteria: i) There are no data on BP at the last 12 months. ii) Secondary hypertension. |
|
1B. Target BP is not reached, but assigned 2 or more antihypertensive drugs |
Numerator: Patients with Htn and/or CAD and/or CHF who have last BP is ≥140/90 mmHg under treatment with 2 or more antihypertensive drugs. Denominator: Patients with Htn and/or CAD and/or CHF. Exclusion criteria: i) There are no data on BP at the last 12 months. ii) Secondary hypertension. |
|
2. Control of physical activity |
Numerator: [Patients with AH and/or CAD and/or CHF with optimal physical activity] AND [Patients with AH and/or CAD and/or CHF with low physical activity who received advice to increase physical activity]. Denominator: Patients with AH and/or CAD and/or CHF. Exclusion criterion: There are no data on physical activity at the last 12 months. |
|
2A. The proportion of patients with optimal physical activity |
Numerator: Patients with Htn and/or CAD and/or CHF with optimal physical activity. Denominator: Patients with Htn and/or CAD and/or CHF. Exclusion criterion: There are no data on physical activity at the last 12 months. |
|
2B. The proportion of patients with low physical activity who received advice to increase physical activity |
Numerator: Patients with Htn and/or CAD and/or CHF with low physical activity who received advice to increase physical activity. Denominator: Patients with Htn and/or CAD and/or CHF. Exclusion criterion: There are no data on physical activity at the last 12 months. |
|
3. Smoking control |
Numerator: [Non-smoking patients with Htn and/or CAD and/or CHF] AND [Smoking patients with Htn and/or CAD and/or CHF who received advice to smoking cessation]. Denominator: Patients with Htn and/or CAD and/or CHF. Exclusion criterion: There are no data on smoking (or non-smoking) at the last 12 months. |
|
3A. The proportion of non-smoking patients |
Numerator: Non-smoking patients with Htn and/or CAD and/or CHF. Denominator: Patients with Htn and/or CAD and/or CHF. Exclusion criterion: There are no data on smoking (or non-smoking) at the last 12 months. |
|
3B. The proportion of smoking patients who received advice to smoking cessation |
Numerator: Smoking patients with AH and/or CAD and/or CHF who received advice to smoking cessation. Denominator: Patients with AH and/or CAD and/or CHF. Exclusion criterion: There are no data on smoking (or non-smoking) at the last 12 months. |
|
4. Body mass control |
Numerator: [Patients with Htn and/or CAD and/or CHF who have normal body mass] AND [Patients with Htn and/or CAD and/or CHF who have excess body mass and received advice to mass loss]. Denominator: Patients with Htn and/or CAD and/or CHF. Exclusion criterion: There are no data on body mass at the last 12 months. |
|
4A. The proportion of patients with normal body mass |
Numerator: Patients with Htn and/or CAD and/or CHF who have normal body mass. Denominator: Patients with Htn and/or CAD and/or CHF. Exclusion criteria: There are no data on body mass at the last 12 months. |
|
4B. The proportion of patients with excess body mass who received advice to mass loss |
Numerator: Patients with Htn and/or CAD and/or CHF who have excess body mass and received advice to mass loss. Denominator: Patients with Htn and/or CAD and/or CHF. Exclusion criterion: There are no data on body mass at the last 12 months. |
|
5. Diet control |
Numerator: [Patients with Htn and/or CAD and/or CHF who observe a balanced diet] AND [Patients with Htn and/or CAD and/or CHF with have unhealthy diet and received advice to improve diet]. Denominator: Patients with Htn and/or CAD and/or CHF. Exclusion criterion: There are no data on compliance with a balanced diet at the last 12 months. |
|
5A. The proportion of patients with balanced diet |
Numerator: Patients with Htn and/or CAD and/or CHF who observe a balanced diet. Denominator: Patients with Htn and/or CAD and/or CHF. Exclusion criterion: There are no data on compliance with a balanced diet at the last 12 months. |
|
5B. The proportion of patients with unhealthy diet who received advice to improve diet |
Numerator: Patients with Htn and/or CAD and/or CHF with have unhealthy diet and received advice to improve diet. Denominator: Patients with Htn and/or CAD and/or CHF. Exclusion criterion: There are no data on compliance with a balanced diet at the last 12 months. |
|
6. Blood cholesterol control |
Numerator: Patients with Htn and/or CAD and/or CHF who have blood cholesterol <190 mg/dL and LDL <115 mg/dL during last 12 months. Denominator: Patients with Htn and/or CAD and/or CHF. Exclusion criterion: There are no data on blood cholesterol and/or LDL at the last 12 months. |
|
6A. The proportion of patients with CAD and LDL <100 mg/dL during last 12 months |
Numerator: Patients with CAD who have LDL <100 mg/dL during last 12 months. Denominator: Patients with CAD. Exclusion criterion: There are no data on LDL at the last 12 months. |
|
Healthcare in patients with CAD |
|
|
1. The proportion of patients with CAD who received antiplatelet agents |
Numerator: Patients CAD who received antiplatelet agents (aspirin or clopidogrel) at the last visit during last 12 months. Denominator: Patients with CAD. Exclusion criterion: Contraindications to aspirin and clopidogrel. |
|
2. The proportion of patients with CAD who received statin medication |
Numerator: Patients with CAD who received statin medication during last 12 months. Denominator: Patients with CAD. Exclusion criterion: Contraindications to statin medication. |
|
2A. The proportion of patients with CAD and LDL >100 mg/dL who received statin medication |
Numerator: Patients with CAD and last level of LDL >100 mg/dL who received statin medication during last 12 months. Denominator: Patients with CAD. Exclusion criteria: i) Contraindications to statin medication. ii) There are no data on LDL at the last 12 months. |
|
3. The proportion of patients with CAD who received beta-blockers |
Numerator: Patients with CAD who received beta-blockers during last 12 months. Denominator: Patients with CAD. Exclusion criterion: Absolute contraindications to beta-blockers. |
|
3A. The proportion of patients with old myocardial infarction who received beta-blockers |
Numerator: Patients with old myocardial infarction who received beta-blockers during last 12 months. Denominator: Patients with old myocardial infarction. Exclusion criterion: Absolute contraindications to beta-blockers. |
|
3B. The proportion of patients with CAD and LVEF <40% who received beta-blockers |
Numerator: Patients with CAD and LVEF <40% who received beta-blockers during last 12 months. Denominator: Patients with CAD and LVEF <40%. Exclusion criterion: Absolute contraindications to beta-blockers. |
|
4. The proportion of patients with CAD who received ACE-Is or ARBs |
Numerator: Patients with CAD who received ACE-Is or ARB during last 12 months. Denominator: Patients with CAD. Exclusion criterion: Absolute contraindications to ACE-Is and ARBs. |
|
4A. The proportion of patients with CAD and diabetes mellitus who received ACE-Is or ARBs |
Numerator: Patients with CAD and diabetes mellitus who received ACE-Is or ARB during last 12 months. Denominator: Patients with CAD and diabetes mellitus. Exclusion criterion: Absolute contraindications to ACE-Is and ARBs. |
|
4B. The proportion of patients with CAD and LVEF <40% who received ACE-Is or ARBs |
Numerator: Patients with CAD and LVEF <40% who received ACE-Is and ARBs during last 12 months. Denominator: Patients with CAD and LVEF <40%. Exclusion criterion: Absolute contraindications to ACE-Is and ARBs. |
|
Healthcare in patients with CHF |
|
|
1. Assessment of LVEF in patients with CHF |
Numerator: Patients with CHF who have at least one measurement of LVEF during last 12 months. Denominator: Patients with CHF. Exclusion criterion: none. |
|
2. The proportion of patients with CHF who received ACE-Is or ARBs |
Numerator: Patients with CHF who received ACE-Is or ARB during last 12 months. Denominator: Patients with CHF. Exclusion criterion: Absolute contraindications to ACE-Is and ARBs. |
|
2A. The proportion of patients with CHF and LVEF <40% who received ACE-Is or ARBs |
Numerator: Patients with CHF and LVEF <40% who received ACE-Is and ARBs during last 12 months. Denominator: Patients with CHF and LVEF <40%. Exclusion criterion: Absolute contraindications to ACE-Is and ARBs. |
|
3. The proportion of patients with CHF who received beta-blockers |
Numerator: Patients with CHF who received beta-blockers during last 12 months. Denominator: Patients with CHF. Exclusion criterion: Absolute contraindications to beta-blockers. |
|
3A. The proportion of patients with CHF and LVEF <40% who received beta-blockers |
Numerator: Patients with CHF and LVEF <40% who received beta-blockers during last 12 months. Denominator: Patients with CHF and LVEF <40%. Exclusion criterion: Absolute contraindications to beta-blockers. |
|
4. The proportion of patients with CHF and atrial fibrillation (or atrial flutter) who received indirect-acting anticoagulants |
Numerator: Patients with CHF and atrial fibrillation (or atrial flutter) who received indirect-acting anticoagulants during last 12 months. Denominator: Patients with CHF and atrial fibrillation (or atrial flutter). Exclusion criterion: Contraindications to indirect-acting anticoagulants. |
|
5. The proportion of subjects who were trained in the School for patients with CHF |
Numerator: Patients with CHF who were trained in the School for patients with CHF. Denominator: Patients with CHF. Exclusion criterion: none. |
ACE-Is, angiotensin converting enzyme inhibitors; ARBs, angiotensin II receptor blockers; BP, blood pressure; CAD, coronary artery disease; CHF, chronic heart failure; LDL, low-density lipoprotein; LVEF, left nentricular ejection fraction; Htn, hypertension.
