2013 ACCF/AHA Key Data Elements and Definitions for Measuring the Clinical Management and Outcomes of Patients With Acute Coronary Syndromes and Coronary Artery Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Acute Coronary Syndromes and Coronary Artery Disease Clinical Data Standards)

Perspective:

The following are 10 points to remember about this report:

1. The new clinical data standards aim to standardize terminology and help improve transfer of health data for research initiatives, clinical registries, structured reporting, and use within electronic health records (EHRs) to enhance effective communication among health care professionals.

2. The document also synchronized its terminology and definitions with those of the Food and Drug Administration (FDA), which will greatly help in reducing problems for future trial design and interpretation of trial results.

3. The seven categories addressed in the document are: demographic and admission information, history and risk factors, clinical presentation, diagnostic procedures, invasive therapeutic interventions, medications, and outcomes.

4. Clinical presentation includes the date and time of symptom onset, heart rate, systolic blood pressure on first medical contact, height, and weight.

5. Invasive therapeutic intervention includes type of pacemaker implanted, the date of noninvasive stress testing, the culprit artery responsible for the acute coronary syndrome, and the percent of stenosis in the left main coronary artery.

6. Medication category includes the dose of anticoagulant administered, the administration of a beta-blocker in the first 24 hours, and the prescription of aspirin at hospital discharge.

7. Outcomes include death during hospitalization, occurrence of reinfarction, surgical intervention required for bleeding, and the requirement of transfusion.

8. These data elements and definitions can also be used in the development of performance measures by identifying underutilization of therapies.

9. Incorporation of this common language into EHRs will not only mean less variability in how patients are assessed, diagnosed, and treated, but also makes the records themselves an invaluable database for clinical research.

10. Although initially targeted for people conducting registries and trials, standardization of terminology would also improve patient care and outcomes.

Keywords: Electronic Health Records, Coronary Artery Disease, Acute Coronary Syndrome, United States Food and Drug Administration, Hospitalization


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