Objectives and design of Russian Registry of Hypertension, Coronary Artery Disease, and Chronic Heart Failure

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Vladimir I. Gridnev, Anton R. Kiselev, Olga M. Posnenkova, Yulia V. Popova, Natalya V. Lazareva, Olga A. Belova, Svetlana V. Romanchuk, Mikhail D. Prokhorov, Pavel Ya. Dovgalevsky, Elena V. Oshchepkova
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e0201
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Abstract: 
Introduction ― Among the causes of mortality in Russia, as in most developed countries, the first position is occupied by the cardiovascular diseases (CVD). It may be caused by different reasons, including an insufficient quality of healthcare. Methods ― The Russian Registry of Hypertension, Coronary Artery Disease, and Chronic Heart Failure (RusR-Htn-CAD-CHF) is a retrospective, continuous, nationwide, web-based registry of patients with the following chronic CVD: hypertension (Htn), coronary artery disease (CAD) and chronic heart failure (CHF). Participation in the RusR-Htn-CAD-CHF is voluntary. Any health facilities that provide primary healthcare to patients with one or several of the evaluated chronic CVD (Htn, CAD, and CHF) can take part in the RusR-Htn-CAD-CHF. The RusR-Htn-CAD-CHF enrolls patients who underwent care in Russian health facilities from January 2013 to the present day. Key data elements and methods of data analysis in the RusR-Htn-CAD-CHF are presented in this paper. Results ― Up to 2016, 69 healthcare units (from small rural clinics to large regional dispensaries) from 18 regions of Russia participated in the RusR-Htn-CAD-CHF. Currently, the database contains data on more than 41,000 patients with one or several chronic CVD (Htn, CAD, and CHF) who were followed-up from 2013 to current day. However, the contribution of regions to data collection of the RusR-Htn-CAD-CHF is nonuniform. In database, the major part of participants (88.7%) is from the Ivanovo region. Current statement of promotion of RusR-Htn-CAD-CHF, some problems, and first advances are considered in the present paper. Conclusion ― The RusR-Htn-CAD-CHF is a novel project for the Russian healthcare. It has good prospects for the assessment of healthcare quality in Russian patients with Htn, CAD, and CHF.
Cite as: 
Gridnev VI, Kiselev AR, Posnenkova OM, Popova YuV, Lazareva NV, Belova OA, Romanchuk SV, Prokhorov MD, Dovgalevsky PYa, Oshchepkova EV. Objectives and design of Russian Registry of Hypertension, Coronary Artery Disease, and Chronic Heart Failure. Russian Open Medical Journal 2017; 6: e0201.

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.

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About the Authors: 

Vladimir I. Gridnev – MD, DSc, Head of Department of New Cardiological Informational Technologies, Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, Saratov, Russia. http://orcid.org/0000-0001-6807-7934.
Anton R. Kiselev – MD, DSc, Leading Researcher, Department of New Cardiological Informational Technologies, Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, Saratov, Russia. http://orcid.org/0000-0003-3967-3950.
Olga M. Posnenkova – MD, DSc, Senior Researcher, Department of New Cardiological Informational Technologies, Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, Saratov, Russia. http://orcid.org/0000-0001-5311-005X.
Yulia V. Popova – MD, PhD, Researcher, Department of New Cardiological Informational Technologies, Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, Saratov, Russia. http://orcid.org/0000-0002-2402-7588.
Natalya V. Lazareva – MD, PhD, Senior Researcher, Department of Registries of Cardiovascular Diseases, Russian Cardiology Research and Production Complex, Moscow, Russia.
Olga A. Belova – Chief physician, Ivanovo Regional Cardiology Dispensary, Ivanovo, Russia.
Svetlana V. Romanchuk – MD, PhD, Director of Healthcare Department of Ivanovo Region, Ivanovo, Russia.
Mikhail D. Prokhorov – DSc, Head of Laboratory of Nonlinear Dynamics Modelling, Saratov Branch of the Institute of Radio Engineering and Electronics of Russian Academy of Sciences, Saratov, Russia. http://orcid.org/0000-0003-4069-9410.
Pavel Ya. Dovgalevsky – MD, DSc, Professor, Director of Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, Saratov, Russia. http://orcid.org/0000-0001-6846-6219.
Elena V. Oshchepkova – MD, DSc, Professor, Head of Department of Registries of Cardiovascular Diseases, Russian Cardiology Research and Production Complex, Moscow, Russia.

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.

DOI: 
10.15275/rusomj.2017.0201