The Danish Atrial Fibrillation Registry: A Multidisciplinary National Pragmatic Initiative for Monitoring and Supporting Quality of Care Based on Data Retrieved from Administrative Registries

IF 3.4 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Clinical Epidemiology Pub Date : 2023-12-22 DOI:10.2147/clep.s443473

Lars Frost, Albert Marni Joensen, Ulla Dam-Schmidt, Ina Qvist, Margit Brinck, Axel Brandes, Ulla Davidsen, Ole Dyg Pedersen, Dorte Damgaard, Inge Mølgaard, Robert Bedsted, Anders Damgaard Møller Schlünsen, Miriam Grijota Chousa, Julie Andersen, Asger Roer Pedersen, Søren Paaske Johnsen, Nicklas Vinter

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Abstract

Aim: The Danish Atrial Fibrillation (AF) Registry monitors and supports improvement of quality of care for all AF patients in Denmark. This report describes the registry’s administrative and organizational structure, data sources, data flow, data analyses, annual reporting, and feedback between the registry, clinicians, and the administrative system. We also report the selection process of the quality indicators and the temporal trends in results from 2017– 2021.
Methods and Results: The Danish AF Registry aims for complete registration and monitoring of care for all patients diagnosed with AF in Denmark. Administrative registries provide data on contacts to general practice, contacts to private cardiology practice, hospital contacts, medication prescriptions, updated vital status information, and biochemical test results. The Danish Stroke Registry provides information on stroke events. From 2017 to 2021, the proportion with a reported echocardiography among incident AF patients increased from 39.9% (95% CI: 39.3– 40.6) to 82.6% (95% CI: 82.1– 83.1). The initiation of oral anticoagulant therapy among patients with incident AF and a CHA₂DS₂-VASc score of ≥ 1 in men and ≥ 2 in women increased from 85.3% (95% CI: 84.6– 85.9) to 90.4% (95% CI: 89.9– 91.0). The 1-year and 2-year persistence increased from 85.2% (95% CI: 84.5– 85.9) to 88.7% (95% CI: 88.0– 89.3), and from 85.4% (95% CI: 84.7– 86.2) to 88.2% (95% CI: 87.5– 88.8), respectively. The 1-year risk of ischemic stroke among prevalent patients with AF decreased from 0.88% (95% CI: 0.83– 0.93) to 0.71% (95% CI: 0.66– 0.75). Variation in clinical performance between the five administrative Danish regions was reduced.
Conclusion: Continuous nationwide monitoring of quality indicators for AF originating from administrative registries is feasible and supportive of improvements of quality of care.

Keywords: atrial fibrillation, quality indicators, quality of care

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丹麦心房颤动登记：基于从行政登记处获取的数据监测和支持医疗质量的多学科国家实用计划

目的：丹麦心房颤动（AF）登记处监控并支持丹麦所有心房颤动患者医疗质量的改善。本报告介绍了登记处的行政和组织结构、数据来源、数据流、数据分析、年度报告以及登记处、临床医生和行政系统之间的反馈。我们还报告了质量指标的选择过程以及 2017-2021 年间结果的时间趋势：丹麦房颤登记处旨在对丹麦所有被诊断为房颤的患者进行完整的登记和护理监测。行政登记处提供的数据包括与全科医生的联系、与私人心脏病医生的联系、与医院的联系、药物处方、最新生命状态信息和生化检验结果。丹麦卒中登记处提供有关卒中事件的信息。从 2017 年到 2021 年，房颤事件患者中报告过超声心动图的比例从 39.9%（95% CI：39.3- 40.6）增加到 82.6%（95% CI：82.1- 83.1）。发生房颤且 CHA2DS2-VASc 评分男性≥1 分、女性≥2 分的患者开始口服抗凝疗法的比例从 85.3% (95% CI: 84.6- 85.9) 增加到 90.4% (95% CI: 89.9- 91.0)。1 年和 2 年的持续率分别从 85.2% (95% CI: 84.5- 85.9) 增加到 88.7% (95% CI: 88.0- 89.3)，以及从 85.4% (95% CI: 84.7- 86.2) 增加到 88.2% (95% CI: 87.5- 88.8)。心房颤动患者发生缺血性中风的 1 年风险从 0.88% (95% CI: 0.83- 0.93) 降至 0.71% (95% CI: 0.66- 0.75)。丹麦五个行政区域之间的临床表现差异有所减少：关键词：心房颤动；质量指标；医疗质量

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来源期刊

Clinical Epidemiology Medicine-Epidemiology

CiteScore

6.30

自引率

5.10%

发文量

169

审稿时长

16 weeks

期刊介绍： Clinical Epidemiology is an international, peer reviewed, open access journal. Clinical Epidemiology focuses on the application of epidemiological principles and questions relating to patients and clinical care in terms of prevention, diagnosis, prognosis, and treatment. Clinical Epidemiology welcomes papers covering these topics in form of original research and systematic reviews. Clinical Epidemiology has a special interest in international electronic medical patient records and other routine health care data, especially as applied to safety of medical interventions, clinical utility of diagnostic procedures, understanding short- and long-term clinical course of diseases, clinical epidemiological and biostatistical methods, and systematic reviews. When considering submission of a paper utilizing publicly-available data, authors should ensure that such studies add significantly to the body of knowledge and that they use appropriate validated methods for identifying health outcomes. The journal has launched special series describing existing data sources for clinical epidemiology, international health care systems and validation studies of algorithms based on databases and registries.