Acute Coronary SyndromeNCT01111071
Variation Between Hospitals in Short-term Mortality After Acute Coronary Syndromes: A CALIBER Study
An observational study of Acute Coronary Syndrome, run by University College, London at 1 site in United Kingdom.
Trial summary
We seek to investigate whether hospitals in England and Wales vary in their rate of mortality following admission for heart attack or unstable angina, the extent of such variation, whether discharge diagnosis affects the extent of variation, and whether such variation has changed over time. Read more about this study
- Who is it for?
- Ages 30 years and older
- Conditions the study is for
- Acute Coronary Syndrome
- How many people
- 316,648 participants
- Where
- 1 siteUnited Kingdom
- Study dates
- Apr 2010to Dec 2014
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 30 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Study population: Patients admitted with acute coronary syndrome to acute hospitals in England and Wales participating in the Myocardial Ischaemia National Audit Project (MINAP)
Who may be able to join
- admitted between January 2003 to June 2009 (or latest date data available)
Who cannot join
- admitted to hospital with fewer than 25 admissions in given year
Trial locations and contacts
1 site in 1 country.
United Kingdom1 site
Epidemiology and Public Health, University College London
London, WC1E 6BT
About this study
We seek to investigate whether hospitals in England and Wales vary in their rate of mortality following admission for heart attack or unstable angina, the extent of such variation, whether discharge diagnosis affects the extent of variation, and whether such variation has changed over time. Furthermore, we will investigate what individual- or hospital-level factors explain variation in mortality between hospitals.
Read the detailed description
Several studies have looked at between-hospital variation in mortality following myocardial infarction but have lacked patient-level data. Those with individual-level data have been limited by:
- use of in-hospital mortality as an outcome measure, which can be affected by length of stay,
- restriction to patients aged 65 and over, or otherwise selected patients, and
- patient-level explanatory factors lacking clinical detail, particularly medications given in hospital.
MINAP patient-level data allow the investigation of hospital variation in mortality (in-hospital and 30-day) in a group of unselected patients, taking into account clinical details such as medication use in hospital, as well as features of the hospitals providing care. The proposed study will establish the extent of variation between hospitals in England and Wales, whether this varies by ACS diagnosis, whether the variation has reduced over time and finally which patient-level or hospital-level factors explain any variation found.
A statistical analytic protocol for this study, dated 15.4.2010, is available on request.
This study is part of the CALIBER (Cardiovascular disease research using linked bespoke studies and electronic records) programme funded over 5 years from the NIHR and Wellcome Trust. The central theme of the CALIBER research is linkage of the Myocardial Ischaemia National Audit Project (MINAP) with primary care (GPRD) and other resources. The overarching aim of CALIBER is to better understand the aetiology and prognosis of specific coronary phenotypes across a range of causal domains, particularly where electronic records provide a contribution beyond traditional studies. CALIBER has received both Ethics approval (ref 09/H0810/16) and ECC approval (ref ECC 2-06(b)/2009 CALIBER dataset).
- Conditions
- Acute Coronary Syndrome
- Keywords
- hospital variation, 30 day mortality, in hospital mortality, acute coronary syndrome, myocardial infarction, unstable angina, hospital performance, trends
- Medical subject headings
- Acute Coronary Syndrome, Myocardial Infarction, Angina, Unstable
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
| Study group | Role | What they receive |
|---|---|---|
| STEMI | patients with discharge diagnosis of ST elevation myocardial infarction | |
| nSTEMI | patients with discharge diagnosis of non ST elevation myocardial infarction | |
| unstable angina | patients with discharge diagnosis of unstable angina |
What is being measured
The primary outcome is the main question the study is designed to answer.
all-cause 30-day mortality
all-cause 30-day mortality following hospitalisation for acute coronary syndrome
Measured: 30 day
Secondary outcomes (1)
all-cause in-hospital mortality
all-cause in-hospital mortality following hospitalisation for acute coronary syndrome
Measured: length of hospital stay
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted27 Apr 2010 (estimated)
- Study startApr 2010
- Primary completionSep 2014
- Study completionDec 2014
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (15)Papers the sponsor has linked to this study.
- Other trials for Acute Coronary SyndromeStudies of the same condition, open and under way.
- More trials run by University College, LondonThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Time perspective
- Prospective
- Enrolment
- 316,648 participants (actual)
Sponsor and investigators
- Lead sponsor
- University College, London
- Sponsor type
- University, hospital or other
- Collaborators
- Barts & The London NHS Trust, Queen Mary University of London, University of Bristol, Yale University
- Responsible party
- Principal investigator, Julie George, University College, London
- Investigators
- Julie L George, MSc, Principal investigator, University College, London
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT01111071
- Sponsor's protocol ID
- CALIBER-09-03
- Other IDs
- RP-PG-0407-10314
- Status last verified
- May 2016
- First submitted
- 16 Apr 2010
- Last updated
- 12 May 2016
- Results posted
- No
- Data monitoring committee
- Yes
- Individual data sharing
- No: permissions to use anonymised data from data owners do not allow further sharing.
Publications
Bradley EH, Herrin J, Elbel B, McNamara RL, Magid DJ, Nallamothu BK, Wang Y, Normand SL, Spertus JA, Krumholz HM. Hospital quality for acute myocardial infarction: correlation among process measures and relationship with short-term mortality. JAMA. 2006 Jul 5;296(1):72-8. doi: 10.1001/jama.296.1.72.
PubMed 16820549Heidenreich PA, Lewis WR, LaBresh KA, Schwamm LH, Fonarow GC. Hospital performance recognition with the Get With The Guidelines Program and mortality for acute myocardial infarction and heart failure. Am Heart J. 2009 Oct;158(4):546-53. doi: 10.1016/j.ahj.2009.07.031.
PubMed 19781413Peterson ED, Roe MT, Mulgund J, DeLong ER, Lytle BL, Brindis RG, Smith SC Jr, Pollack CV Jr, Newby LK, Harrington RA, Gibler WB, Ohman EM. Association between hospital process performance and outcomes among patients with acute coronary syndromes. JAMA. 2006 Apr 26;295(16):1912-20. doi: 10.1001/jama.295.16.1912.
PubMed 16639050Alter DA, Austin PC, Tu JV; Canadian Cardiovascular Outcomes Research Team. Community factors, hospital characteristics and inter-regional outcome variations following acute myocardial infarction in Canada. Can J Cardiol. 2005 Mar;21(3):247-55.
PubMed 15776114Krumholz HM, Chen J, Wang Y, Radford MJ, Chen YT, Marciniak TA. Comparing AMI mortality among hospitals in patients 65 years of age and older: evaluating methods of risk adjustment. Circulation. 1999 Jun 15;99(23):2986-92. doi: 10.1161/01.cir.99.23.2986.
PubMed 10368115Krumholz HM, Wang Y, Mattera JA, Wang Y, Han LF, Ingber MJ, Roman S, Normand SL. An administrative claims model suitable for profiling hospital performance based on 30-day mortality rates among patients with an acute myocardial infarction. Circulation. 2006 Apr 4;113(13):1683-92. doi: 10.1161/CIRCULATIONAHA.105.611186. Epub 2006 Mar 20.
PubMed 16549637Krumholz HM, Wang Y, Chen J, Drye EE, Spertus JA, Ross JS, Curtis JP, Nallamothu BK, Lichtman JH, Havranek EP, Masoudi FA, Radford MJ, Han LF, Rapp MT, Straube BM, Normand SL. Reduction in acute myocardial infarction mortality in the United States: risk-standardized mortality rates from 1995-2006. JAMA. 2009 Aug 19;302(7):767-73. doi: 10.1001/jama.2009.1178.
PubMed 19690309Granger CB, Steg PG, Peterson E, Lopez-Sendon J, Van de Werf F, Kline-Rogers E, Allegrone J, Dabbous OH, Klein W, Fox KA, Eagle KA; GRACE Investigators. Medication performance measures and mortality following acute coronary syndromes. Am J Med. 2005 Aug;118(8):858-65. doi: 10.1016/j.amjmed.2005.01.070.
PubMed 16084178Rasmussen S, Zwisler AD, Abildstrom SZ, Madsen JK, Madsen M. Hospital variation in mortality after first acute myocardial infarction in Denmark from 1995 to 2002: lower short-term and 1-year mortality in high-volume and specialized hospitals. Med Care. 2005 Oct;43(10):970-8. doi: 10.1097/01.mlr.0000178195.07110.d3.
PubMed 16166866Rasmussen S, Abildstrom SZ, Rasmussen JN, Gislason GH, Schramm TK, Folke F, Kober L, Torp-Pedersen C, Madsen M. Hospital variation in use of secondary preventive medicine after discharge for first acute myocardial infarction during 1995-2004. Med Care. 2008 Jan;46(1):70-7. doi: 10.1097/MLR.0b013e3181484952.
PubMed 18162858Rosato S, Seccareccia F, D'Errigo P, Fusco D, Maraschini A, Badoni G, Perucci CA. Thirty-day mortality after AMI: effect modification by gender in outcome studies. Eur J Public Health. 2010 Aug;20(4):397-402. doi: 10.1093/eurpub/ckp194. Epub 2009 Nov 27.
PubMed 19946045Popescu I, Werner RM, Vaughan-Sarrazin MS, Cram P. Characteristics and outcomes of America's lowest-performing hospitals: an analysis of acute myocardial infarction hospital care in the United States. Circ Cardiovasc Qual Outcomes. 2009 May;2(3):221-7. doi: 10.1161/CIRCOUTCOMES.108.813790. Epub 2009 May 5.
PubMed 20031841Kosseim M, Mayo NE, Scott S, Hanley JA, Brophy J, Gagnon B, Pilote L. Ranking hospitals according to acute myocardial infarction mortality: should transfers be included? Med Care. 2006 Jul;44(7):664-70. doi: 10.1097/01.mlr.0000215848.87202.c7.
PubMed 16799361Murphy NF, MacIntyre K, Stewart S, Capewell S, McMurray JJ. Reduced between-hospital variation in short term survival after acute myocardial infarction: the result of improved cardiac care? Heart. 2005 Jun;91(6):726-30. doi: 10.1136/hrt.2004.042929.
PubMed 15894761Leyland AH, Boddy FA. League tables and acute myocardial infarction. Lancet. 1998 Feb 21;351(9102):555-8. doi: 10.1016/S0140-6736(97)09362-8.
PubMed 9492774
Study at a glance
From the registry record, last updated by the sponsor on 12 May 2016. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Variation Between Hospitals in Short-term Mortality After Acute Coronary Syndromes: A CALIBER Study
- ClinicalTrials.gov ID
- NCT01111071
- Acronym / sponsor ID
- CALIBER-09-03
- Conditions
- Acute Coronary Syndrome
- Keywords
- hospital variation, 30 day mortality, in hospital mortality, acute coronary syndrome, myocardial infarction, unstable angina, hospital performance, trends
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 316,648 participants (actual)
- Lead sponsor
- University College, LondonUniversity, hospital or other
- Collaborators
- Barts & The London NHS Trust, Queen Mary University of London, University of Bristol, Yale University
- Study start
- Apr 2010
- Primary completion
- Sep 2014 (actual)
- Study completion
- Dec 2014 (actual)
- First posted
- 27 Apr 2010 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
We seek to investigate whether hospitals in England and Wales vary in their rate of mortality following admission for heart attack or unstable angina, the extent of such variation, whether discharge diagnosis affects the extent of variation, and whether such variation has changed over time. Furthermore, we will investigate what individual- or hospital-level factors explain variation in mortality between hospitals.
Detailed description
Several studies have looked at between-hospital variation in mortality following myocardial infarction but have lacked patient-level data. Those with individual-level data have been limited by:
- use of in-hospital mortality as an outcome measure, which can be affected by length of stay,
- restriction to patients aged 65 and over, or otherwise selected patients, and
- patient-level explanatory factors lacking clinical detail, particularly medications given in hospital.
MINAP patient-level data allow the investigation of hospital variation in mortality (in-hospital and 30-day) in a group of unselected patients, taking into account clinical details such as medication use in hospital, as well as features of the hospitals providing care. The proposed study will establish the extent of variation between hospitals in England and Wales, whether this varies by ACS diagnosis, whether the variation has reduced over time and finally which patient-level or hospital-level factors explain any variation found.
A statistical analytic protocol for this study, dated 15.4.2010, is available on request.
This study is part of the CALIBER (Cardiovascular disease research using linked bespoke studies and electronic records) programme funded over 5 years from the NIHR and Wellcome Trust. The central theme of the CALIBER research is linkage of the Myocardial Ischaemia National Audit Project (MINAP) with primary care (GPRD) and other resources. The overarching aim of CALIBER is to better understand the aetiology and prognosis of specific coronary phenotypes across a range of causal domains, particularly where electronic records provide a contribution beyond traditional studies. CALIBER has received both Ethics approval (ref 09/H0810/16) and ECC approval (ref ECC 2-06(b)/2009 CALIBER dataset).
Study design
- Time perspective
- Prospective
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| STEMI | – | –patients with discharge diagnosis of ST elevation myocardial infarction |
| nSTEMI | – | –patients with discharge diagnosis of non ST elevation myocardial infarction |
| unstable angina | – | –patients with discharge diagnosis of unstable angina |
Who may qualify
- Ages
- 30 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- Patients admitted with acute coronary syndrome to acute hospitals in England and Wales participating in the Myocardial Ischaemia National Audit Project (MINAP)
Key inclusion criteria (1 listed)
- admitted between January 2003 to June 2009 (or latest date data available)
Key exclusion criteria (1 listed)
- admitted to hospital with fewer than 25 admissions in given year
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
all-cause 30-day mortality
Time frame: 30 day
all-cause 30-day mortality following hospitalisation for acute coronary syndrome
1 secondary outcome
all-cause in-hospital mortality
Time frame: length of hospital stay
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 12 May 2016.
- Background: PubMed 16820549Bradley EH, Herrin J, Elbel B, McNamara RL, Magid DJ, Nallamothu BK, Wang Y, Normand SL, Spertus JA, Krumholz HM. Hospital quality for acute myocardial infarction: correlation among process measures and relationship with short-term mortality. JAMA. 2006 Jul 5;296(1):72-8. doi: 10.1001/jama.296.1.72.
- Background: PubMed 19781413Heidenreich PA, Lewis WR, LaBresh KA, Schwamm LH, Fonarow GC. Hospital performance recognition with the Get With The Guidelines Program and mortality for acute myocardial infarction and heart failure. Am Heart J. 2009 Oct;158(4):546-53. doi: 10.1016/j.ahj.2009.07.031.
- Background: PubMed 16639050Peterson ED, Roe MT, Mulgund J, DeLong ER, Lytle BL, Brindis RG, Smith SC Jr, Pollack CV Jr, Newby LK, Harrington RA, Gibler WB, Ohman EM. Association between hospital process performance and outcomes among patients with acute coronary syndromes. JAMA. 2006 Apr 26;295(16):1912-20. doi: 10.1001/jama.295.16.1912.
- Background: PubMed 15776114Alter DA, Austin PC, Tu JV; Canadian Cardiovascular Outcomes Research Team. Community factors, hospital characteristics and inter-regional outcome variations following acute myocardial infarction in Canada. Can J Cardiol. 2005 Mar;21(3):247-55.
- Background: PubMed 10368115Krumholz HM, Chen J, Wang Y, Radford MJ, Chen YT, Marciniak TA. Comparing AMI mortality among hospitals in patients 65 years of age and older: evaluating methods of risk adjustment. Circulation. 1999 Jun 15;99(23):2986-92. doi: 10.1161/01.cir.99.23.2986.
- Background: PubMed 16549637Krumholz HM, Wang Y, Mattera JA, Wang Y, Han LF, Ingber MJ, Roman S, Normand SL. An administrative claims model suitable for profiling hospital performance based on 30-day mortality rates among patients with an acute myocardial infarction. Circulation. 2006 Apr 4;113(13):1683-92. doi: 10.1161/CIRCULATIONAHA.105.611186. Epub 2006 Mar 20.
- Background: PubMed 19690309Krumholz HM, Wang Y, Chen J, Drye EE, Spertus JA, Ross JS, Curtis JP, Nallamothu BK, Lichtman JH, Havranek EP, Masoudi FA, Radford MJ, Han LF, Rapp MT, Straube BM, Normand SL. Reduction in acute myocardial infarction mortality in the United States: risk-standardized mortality rates from 1995-2006. JAMA. 2009 Aug 19;302(7):767-73. doi: 10.1001/jama.2009.1178.
- Background: PubMed 16084178Granger CB, Steg PG, Peterson E, Lopez-Sendon J, Van de Werf F, Kline-Rogers E, Allegrone J, Dabbous OH, Klein W, Fox KA, Eagle KA; GRACE Investigators. Medication performance measures and mortality following acute coronary syndromes. Am J Med. 2005 Aug;118(8):858-65. doi: 10.1016/j.amjmed.2005.01.070.
- Background: PubMed 16166866Rasmussen S, Zwisler AD, Abildstrom SZ, Madsen JK, Madsen M. Hospital variation in mortality after first acute myocardial infarction in Denmark from 1995 to 2002: lower short-term and 1-year mortality in high-volume and specialized hospitals. Med Care. 2005 Oct;43(10):970-8. doi: 10.1097/01.mlr.0000178195.07110.d3.
- Background: PubMed 18162858Rasmussen S, Abildstrom SZ, Rasmussen JN, Gislason GH, Schramm TK, Folke F, Kober L, Torp-Pedersen C, Madsen M. Hospital variation in use of secondary preventive medicine after discharge for first acute myocardial infarction during 1995-2004. Med Care. 2008 Jan;46(1):70-7. doi: 10.1097/MLR.0b013e3181484952.
- Background: PubMed 19946045Rosato S, Seccareccia F, D'Errigo P, Fusco D, Maraschini A, Badoni G, Perucci CA. Thirty-day mortality after AMI: effect modification by gender in outcome studies. Eur J Public Health. 2010 Aug;20(4):397-402. doi: 10.1093/eurpub/ckp194. Epub 2009 Nov 27.
- Background: PubMed 20031841Popescu I, Werner RM, Vaughan-Sarrazin MS, Cram P. Characteristics and outcomes of America's lowest-performing hospitals: an analysis of acute myocardial infarction hospital care in the United States. Circ Cardiovasc Qual Outcomes. 2009 May;2(3):221-7. doi: 10.1161/CIRCOUTCOMES.108.813790. Epub 2009 May 5.
- CArdiovascular disease research Linking Bespoke studies and Electronic RecordsLink provided by the sponsor.
- Individual participant dataSharing planned: No. permissions to use anonymised data from data owners do not allow further sharing.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Julie L George, MSc principal investigator
University College, London
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Acute Coronary Syndrome, run by University College, London at 1 site in United Kingdom.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 12 May 2016. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
all-cause 30-day mortality (time frame: 30 day). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT01111071, which also lists 15 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 May 2016.