The collection of acute coronary syndrome core data (ACS-Data) is a voluntary data collection with individual hospitals or health service areas developing collection methods and policies appropriate for their service.
Acute coronary syndromes reflect the spectrum of coronary artery disease resulting in acute myocardial ischaemia, and span unstable angina, non-ST segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI). Clinically these diagnoses encompass a wide variation in risk, require complex and time urgent risk stratification and represent a large social and economic burden.
The definitions used in this data set specification are designed to underpin the data collected by health professionals in their day-to-day acute care practice. They relate to the realities of an acute clinical consultation for patients presenting with chest pain/ discomfort and the need to correctly identify, evaluate and manage patients at increased risk of a coronary event.
The data elements specified in this metadata set provide a framework for:
promoting the delivery of evidenced-based acute coronary syndrome management care to patients;
facilitating the ongoing improvement in the quality and safety of acute coronary syndrome management in acute care settings in Australia and New Zealand;
improving the epidemiological and public health understanding of this syndrome; and
supporting acute care services as they develop information systems to complement the above.
This is particularly important as the scientific evidence supporting the development of the data elements within the ACS data set specification indicate that accurate identification of the evolving myocardial infarction patient or the high/intermediate risk patient leading to the implementation of the appropriate management pathway impacts on the patient's outcome. Having a nationally recognised set of definitions in relation to defining a patient's diagnosis, risk status and outcomes is a prerequisite to achieving the above aims.
The ACS data set specification is based on the American College of Cardiology (ACC) Data Set for Acute Coronary Syndrome as published in the Journal of the American College of Cardiology in December 2001 (38:2114-30) as well as more recent scientific evidence around the diagnosis of myocardial infarction. The data elements are alphabetically listed and grouped in a similar manner to the American College of Cardiology's data set format. These features of the Australian ACS data set should ensure that the data is internationally comparable.
The data elements described here have been identified as high priority for inclusion in the NHDD for the collection of data relating to ACS management, along with supporting elements already existing within the NHDD (as listed). It is recommended that other data elements be collected as best practice - however, these are not listed here, as they are considered to be of a secondary priority. Such data elements include date of Coronary Artery Bypass Grafting (CABG), Percutaneous Coronary Intervention (PCI) and diagnostic cardiac catheterisation/angiography and recording the number of units of blood transfused.
However, the working group will approach the Australian Institute of Health and METeOR website.
Many of the data elements in this data set specification may also be used in the collection of other cardiovascular clinical information.
Where appropriate, it may be useful if the data definitions in this data set specification were used to address data definition needs in non-clinical environments such as public health surveys etc. This could allow for qualitative comparisons between data collected in, and aggregated from, clinical settings (i.e. using application of the ACS data set specification), with that collected through other means (e.g. public health surveys, reports).
A set of core ACS data elements and standardised definitions can inform the development and conduct of future registries at both the national and local level.
The working group formed under the National Heart Foundation of Australia (NHFA) and the Cardiac Society of Australia and New Zealand (CSANZ) initiative was diverse and included representation from the following organizations: the NHFA, the CSANZ, the Australasian College of Emergency Medicine, the Australian Institute of Health and Welfare, the Australasian Society of Cardiac & Thoracic Surgeons, Royal Australian College of Physicians (RACP), RACP - Towards a Safer Culture, National Centre for Classification in Health (Brisbane), the NSW Aboriginal Health & Medical Research Council, the George Institute for International Health, the School of Population Health at the University of Western Australia and the National Cardiovascular Monitoring System Advisory Committee.
To ensure the broad acceptance of the data set, the working group also sought consultation from the heads of cardiology departments, other specialist professional bodies and regional key opinion leaders in the field of acute coronary syndromes.
Collection and usage attributes
This data set specification is primarily concerned with the clinical use of ACS-Data. Acute care environments such as hospital emergency departments, coronary care units or similar acute care areas are the settings in which implementation of the core ACS data set specification should be considered. A wider range of health and health related establishments that create, use or maintain, records on health care clients, could also use it.