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Gill SK, Karwath A, Uh HW, Cardoso VR, Gu Z, Barsky A, Slater L, Acharjee A, Duan J, Dall'Olio L, el Bouhaddani S, Chernbumroong S, Stanbury M, Haynes S, Asselbergs FW, Grobbee DE, Eijkemans MJC, Gkoutos GV, Kotecha D. Artificial intelligence to enhance clinical value across the spectrum of cardiovascular healthcare. Eur Heart J 2023; 44:713-725. [PMID: 36629285 PMCID: PMC9976986 DOI: 10.1093/eurheartj/ehac758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/22/2022] [Accepted: 12/05/2022] [Indexed: 01/12/2023] Open
Abstract
Artificial intelligence (AI) is increasingly being utilized in healthcare. This article provides clinicians and researchers with a step-wise foundation for high-value AI that can be applied to a variety of different data modalities. The aim is to improve the transparency and application of AI methods, with the potential to benefit patients in routine cardiovascular care. Following a clear research hypothesis, an AI-based workflow begins with data selection and pre-processing prior to analysis, with the type of data (structured, semi-structured, or unstructured) determining what type of pre-processing steps and machine-learning algorithms are required. Algorithmic and data validation should be performed to ensure the robustness of the chosen methodology, followed by an objective evaluation of performance. Seven case studies are provided to highlight the wide variety of data modalities and clinical questions that can benefit from modern AI techniques, with a focus on applying them to cardiovascular disease management. Despite the growing use of AI, further education for healthcare workers, researchers, and the public are needed to aid understanding of how AI works and to close the existing gap in knowledge. In addition, issues regarding data access, sharing, and security must be addressed to ensure full engagement by patients and the public. The application of AI within healthcare provides an opportunity for clinicians to deliver a more personalized approach to medical care by accounting for confounders, interactions, and the rising prevalence of multi-morbidity.
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Affiliation(s)
- Simrat K Gill
- Institute of Cardiovascular Sciences, University of Birmingham, Vincent Drive, B15 2TT Birmingham, UK
- Health Data Research UK Midlands, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Andreas Karwath
- Health Data Research UK Midlands, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Vincent Drive, B15 2TT Birmingham, UK
| | - Hae-Won Uh
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Victor Roth Cardoso
- Institute of Cardiovascular Sciences, University of Birmingham, Vincent Drive, B15 2TT Birmingham, UK
- Health Data Research UK Midlands, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Vincent Drive, B15 2TT Birmingham, UK
| | - Zhujie Gu
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Andrey Barsky
- Health Data Research UK Midlands, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Vincent Drive, B15 2TT Birmingham, UK
| | - Luke Slater
- Health Data Research UK Midlands, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Vincent Drive, B15 2TT Birmingham, UK
| | - Animesh Acharjee
- Health Data Research UK Midlands, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Vincent Drive, B15 2TT Birmingham, UK
| | - Jinming Duan
- School of Computer Science, University of Birmingham, Birmingham, UK
- Alan Turing Institute, London, UK
| | - Lorenzo Dall'Olio
- Department of Physics and Astronomy, University of Bologna, Bologna, Italy
| | - Said el Bouhaddani
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Saisakul Chernbumroong
- Health Data Research UK Midlands, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Vincent Drive, B15 2TT Birmingham, UK
| | | | | | - Folkert W Asselbergs
- Amsterdam University Medical Center, Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Marinus J C Eijkemans
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Georgios V Gkoutos
- Health Data Research UK Midlands, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Vincent Drive, B15 2TT Birmingham, UK
| | - Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, Vincent Drive, B15 2TT Birmingham, UK
- Health Data Research UK Midlands, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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2
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Kotecha D, DeVore AD, Asselbergs FW. Fit for the future: empowering clinical trials with digital technology. Eur Heart J 2023; 44:64-67. [PMID: 36369983 DOI: 10.1093/eurheartj/ehac650] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/25/2022] [Accepted: 10/28/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Dipak Kotecha
- University of Birmingham Institute of Cardiovascular Sciences, Medical School, Vincent Drive, Birmingham B15 2TT, UK
- Health Data Research UK Midlands, Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2GW, UK
- Department of Cardiology, Division of Heart & Lungs, University Medical Center Utrecht, Heidelberglaan 8, 3584 CX Utrecht, The Netherlands
| | - Adam D DeVore
- Division of Cardiology and Duke Clinical Research Institute, Duke University School of Medicine, 300 W. Morgan Street, Durham, NC 27701, USA
| | - Folkert W Asselbergs
- Department of Cardiology, Division of Heart & Lungs, University Medical Center Utrecht, Heidelberglaan 8, 3584 CX Utrecht, The Netherlands
- Institute of Cardiovascular Science and Institute of Health Informatics, Faculty of Population Health Sciences, University College London, 222 Euston Road, London NW1 2DA, UK
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Kotecha D, Asselbergs FW, Achenbach S, Anker SD, Atar D, Baigent C, Banerjee A, Beger B, Brobert G, Casadei B, Ceccarelli C, Cowie MR, Crea F, Cronin M, Denaxas S, Derix A, Fitzsimons D, Fredriksson M, Gale CP, Gkoutos GV, Goettsch W, Hemingway H, Ingvar M, Jonas A, Kazmierski R, Løgstrup S, Thomas Lumbers R, Lüscher TF, McGreavy P, Piña IL, Roessig L, Steinbeisser C, Sundgren M, Tyl B, van Thiel G, van Bochove K, Vardas PE, Villanueva T, Vrana M, Weber W, Weidinger F, Windecker S, Wood A, Grobbee DE. CODE-EHR best practice framework for the use of structured electronic healthcare records in clinical research. Eur Heart J 2022; 43:3578-3588. [PMID: 36208161 PMCID: PMC9452067 DOI: 10.1093/eurheartj/ehac426] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/29/2022] Open
Abstract
Big data is central to new developments in global clinical science aiming to improve the lives of patients. Technological advances have led to the routine use of structured electronic healthcare records with the potential to address key gaps in clinical evidence. The covid-19 pandemic has demonstrated the potential of big data and related analytics, but also important pitfalls. Verification, validation, and data privacy, as well as the social mandate to undertake research are key challenges. The European Society of Cardiology and the BigData@Heart consortium have brought together a range of international stakeholders, including patient representatives, clinicians, scientists, regulators, journal editors and industry. We propose the CODE-EHR Minimum Standards Framework as a means to improve the design of studies, enhance transparency and develop a roadmap towards more robust and effective utilisation of healthcare data for research purposes.
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Affiliation(s)
- Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, Medical School, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust and Health Data Research UK Midlands, Birmingham, UK
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Stephan Achenbach
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Stefan D Anker
- Department of Cardiology and Berlin Institute of Health Centre for Regenerative Therapies, German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Germany
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital, Ulleval, Oslo, Norway
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Colin Baigent
- MRC Population Health Research Unit, Nuffield Department of Population Health, Oxford, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Amitava Banerjee
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- University College London Hospitals NHS Trust, London, UK
| | | | | | - Barbara Casadei
- Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford NIHR Oxford Biomedical Research Centre, Oxford, UK
| | | | - Martin R Cowie
- Royal Brompton Hospital, Division of Guy’s St Thomas’ NHS Foundation Trust, London, UK
- School of Cardiovascular Medicine Sciences, King’s College London, London, UK
| | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- European Heart Journal, Oxford University Press, University of Oxford, Oxford, UK
| | - Maureen Cronin
- Vifor Pharma, Glattbrugg, Switzerland and Ava AG, Zurich, Switzerland
| | - Spiros Denaxas
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- Alan Turing Institute, London, UK
- British Heart Foundation Data Science Centre, London, UK
| | | | - Donna Fitzsimons
- School of Nursing and Midwifery, Queen’s University Belfast, Northern Ireland
| | - Martin Fredriksson
- Late Clinical Development, Cardiovascular, Renal and Metabolism (CVRM), Biopharmaceuticals RD, AstraZeneca, Gothenburg, Sweden
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine and Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Georgios V Gkoutos
- University Hospitals Birmingham NHS Foundation Trust and Health Data Research UK Midlands, Birmingham, UK
- College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Wim Goettsch
- National Health Care Institute (ZIN), Diemen, Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Harry Hemingway
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Martin Ingvar
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
- Department of Neuroradiology, Karolinska University Hospital Stockholm, Stockholm, Sweden
| | - Adrian Jonas
- Data and Analytics Group, National Institute for Health and Care Excellence, London, UK
| | - Robert Kazmierski
- Office of Cardiovascular Devices, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - R Thomas Lumbers
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- Barts Health NHS Trust and University College London Hospitals NHS Trust
| | - Thomas F Lüscher
- Centre for Molecular Cardiology, University of Zurich, Zurich, Switzerland
- Research, Education & Development, Royal Brompton and Harefield Hospitals, London, UK
- Faculty of Medicine, Imperial College London, London, UK
| | - Paul McGreavy
- European Society of Cardiology Patient Forum, European Society of Cardiology, Brussels, Belgium
| | - Ileana L Piña
- Central Michigan University College of Medicine, Midlands, MI, USA
- Centre for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - Carl Steinbeisser
- Bayer AG, Leverkusen, Germany
- Steinbeisser Project Management, Munich, Germany
| | - Mats Sundgren
- Data Science AI, Biopharmaceuticals RD, AstraZeneca, Gothenburg, Sweden
| | - Benoît Tyl
- Centre for Therapeutic Innovation, Cardiovascular and Metabolic Disease, Institut de Recherches Internationales Servier, Suresnes, France
| | - Ghislaine van Thiel
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Panos E Vardas
- Hygeia, Mitera, Hospitals Hellenic Health Group, Athens, Greece
- European Heart Agency, European Society of Cardiology, Brussels, Belgium
| | | | | | | | | | - Stephan Windecker
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Angela Wood
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Diederick E Grobbee
- Department of Epidemiology, University Medical Centre Utrecht, Division Julius Centrum, Utrecht, Netherlands
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4
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Țica O, Țica O, Bunting KV, deBono J, Gkoutos GV, Popescu MI, Kotecha D. Post-mortem examination of high mortality in patients with heart failure and atrial fibrillation. BMC Med 2022; 20:331. [PMID: 36195871 PMCID: PMC9533594 DOI: 10.1186/s12916-022-02533-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of combined heart failure (HF) and atrial fibrillation (AF) is rising, and these patients suffer from high rates of mortality. This study aims to provide robust data on factors associated with death, uniquely supported by post-mortem examination. METHODS A retrospective cohort study of hospitalized adults with a clinical diagnosis of HF and AF at a tertiary centre in Romania between 2014 and 2017. A standardized post-mortem examination was performed where death occurred within 24 h of admission, when the cause of death was not clear or by physician request. National records were used to collect mortality data, subsequently categorized and analysed as HF-related death, vascular death and non-cardiovascular death using Cox proportional hazards regression. RESULTS A total of 1009 consecutive patients with a mean age of 73 ± 11 years, 47% women, NYHA class 3.0 ± 0.9, left ventricular ejection fraction (LVEF) 40.1 ± 11.0% and 100% anticoagulated were followed up for 1.5 ± 0.9 years. A total of 291 (29%) died, with post-mortems performed on 186 (64%). Baseline factors associated with mortality were dependent on the cause of death. HF-related death in 136 (47%) was associated with higher NYHA class (hazard ratio [HR] 2.45 per one class increase, 95% CI 1.73-3.46; p < 0.001) and lower LVEF (0.95 per 1% increase, 0.93-0.97; p < 0.001). Vascular death occurred in 75 (26%) and was associated with hypertension (HR 2.83, 1.36-5.90; p = 0.005) and higher LVEF (1.08 per 1% increase, 1.05-1.11; p < 0.001). Non-cardiovascular death in 80 (28%) was associated with clinical obesity (HR 2.20, 1.21-4.00; p = 0.010) and higher LVEF (1.10 per 1% increase, 1.06-1.13; p < 0.001). Across all causes, there was no relationship between mortality and AF type (p = 0.77), HF type (p = 0.85) or LVEF (p = 0.58). CONCLUSIONS Supported by post-mortem data, the cause of death in HF and AF patients is heterogeneous, and the relationships with typical markers of mortality are critically dependent on the mode of death. The poor prognosis in this group demands further attention to improve management beyond anticoagulation.
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Affiliation(s)
- Otilia Țica
- Institute of Cardiovascular Sciences, Medical School, University of Birmingham, Vincent Drive, Birmingham, B15 2TT, UK.
- Cardiology Department, Emergency County Clinical Hospital of Oradea, Gheorghe Doja street, No 65, 410165, Oradea, Romania.
| | - Ovidiu Țica
- Pathology Department, Emergency County Clinical Hospital of Oradea, Gheorghe Doja street, no 65, 410165, Oradea, Romania
| | - Karina V Bunting
- Institute of Cardiovascular Sciences, Medical School, University of Birmingham, Vincent Drive, Birmingham, B15 2TT, UK
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2GW, UK
| | - Joseph deBono
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2GW, UK
| | - Georgios V Gkoutos
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2GW, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Health Data Research (HDR)-UK Midlands, Institute of Translational Medicine, B15 2GW, Birmingham, UK
| | - Mircea I Popescu
- Cardiology Department, Emergency County Clinical Hospital of Oradea, Gheorghe Doja street, No 65, 410165, Oradea, Romania
| | - Dipak Kotecha
- Institute of Cardiovascular Sciences, Medical School, University of Birmingham, Vincent Drive, Birmingham, B15 2TT, UK.
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2GW, UK.
- Health Data Research (HDR)-UK Midlands, Institute of Translational Medicine, B15 2GW, Birmingham, UK.
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5
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Kotecha D, Asselbergs FW, Achenbach S, Anker SD, Atar D, Baigent C, Banerjee A, Beger B, Brobert G, Casadei B, Ceccarelli C, Cowie MR, Crea F, Cronin M, Denaxas S, Derix A, Fitzsimons D, Fredriksson M, Gale CP, Gkoutos GV, Goettsch W, Hemingway H, Ingvar M, Jonas A, Kazmierski R, Løgstrup S, Lumbers RT, Lüscher TF, McGreavy P, Piña IL, Roessig L, Steinbeisser C, Sundgren M, Tyl B, Thiel GV, Bochove KV, Vardas PE, Villanueva T, Vrana M, Weber W, Weidinger F, Windecker S, Wood A, Grobbee DE. CODE-EHR best-practice framework for the use of structured electronic health-care records in clinical research. Lancet Digit Health 2022; 4:e757-e764. [PMID: 36050271 DOI: 10.1016/s2589-7500(22)00151-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/20/2022] [Indexed: 11/16/2022]
Abstract
Big data is important to new developments in global clinical science that aim to improve the lives of patients. Technological advances have led to the regular use of structured electronic health-care records with the potential to address key deficits in clinical evidence that could improve patient care. The COVID-19 pandemic has shown this potential in big data and related analytics but has also revealed important limitations. Data verification, data validation, data privacy, and a mandate from the public to conduct research are important challenges to effective use of routine health-care data. The European Society of Cardiology and the BigData@Heart consortium have brought together a range of international stakeholders, including representation from patients, clinicians, scientists, regulators, journal editors, and industry members. In this Review, we propose the CODE-EHR minimum standards framework to be used by researchers and clinicians to improve the design of studies and enhance transparency of study methods. The CODE-EHR framework aims to develop robust and effective utilisation of health-care data for research purposes.
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Affiliation(s)
- Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK; Health Data Research UK Midlands, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Department of Cardiology, Division of Heart and Lungs, University of Utrecht, Utrecht, Netherlands.
| | - Folkert W Asselbergs
- Health Data Research UK London, London, UK; Institute of Cardiovascular Science and Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, UK
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan D Anker
- Department of Cardiology and Berlin Institute of Health Centre for Regenerative Therapies, German Centre for Cardiovascular Research, Charité Universitätsmedizin, Berlin, Germany
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Colin Baigent
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, Oxford, UK; Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Amitava Banerjee
- Health Data Research UK London, London, UK; University College London Hospitals NHS Trust, London, UK
| | | | | | - Barbara Casadei
- Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford National Institute for Health and Care Research Oxford Biomedical Research Centre, Oxford, UK
| | | | - Martin R Cowie
- Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; School of Cardiovascular Medicine Sciences, King's College London, London, UK
| | - Filippo Crea
- European Heart Journal, Oxford University Press, University of Oxford, Oxford, UK; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Maureen Cronin
- Vifor Pharma, Glattbrugg, Switzerland; Ava, Zurich, Switzerland
| | - Spiros Denaxas
- Health Data Research UK London, London, UK; Alan Turing Institute, London, UK; British Heart Foundation Data Science Centre, London, UK
| | | | - Donna Fitzsimons
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland
| | - Martin Fredriksson
- Late Clinical Development, Cardiovascular, Renal and Metabolism, Biopharmaceuticals, AstraZeneca, Gothenburg, Sweden
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine and Leeds Institute for Data Analytics, University of Leeds, Leeds, UK; Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Georgios V Gkoutos
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Health Data Research UK Midlands, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Wim Goettsch
- University Medical Centre Utrecht, and Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, University of Utrecht, Utrecht, Netherlands; National Health Care Institute, Diemen, Netherlands
| | | | - Martin Ingvar
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden; Department of Neuroradiology, Karolinska University Hospital Stockholm, Stockholm, Sweden
| | - Adrian Jonas
- Data and Analytics Group, National Institute for Health and Care Excellence, London, UK
| | - Robert Kazmierski
- Office of Cardiovascular Devices, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - R Thomas Lumbers
- Health Data Research UK London, London, UK; Institute of Health Informatics, Barts Health NHS Trust and University College London Hospitals NHS Trust, London, UK
| | - Thomas F Lüscher
- Centre for Molecular Cardiology, University of Zurich, Zurich, Switzerland; Research, Education and Development, Royal Brompton and Harefield Hospitals, London, UK; Faculty of Medicine, Imperial College London, London, UK
| | - Paul McGreavy
- European Society of Cardiology Patient Forum, European Society of Cardiology, Brussels, Belgium
| | - Ileana L Piña
- Centre for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA; College of Medicine, Central Michigan University, Midlands MI, USA
| | | | - Carl Steinbeisser
- Bayer, Leverkusen, Germany; Steinbeisser Project Management, Munich, Germany
| | - Mats Sundgren
- Data Science and Artificial Intelligence, Biopharmaceuticals, AstraZeneca, Gothenburg, Sweden
| | - Benoît Tyl
- Centre for Therapeutic Innovation, Cardiovascular and Metabolic Disease, Institut de Recherches Internationales Servier, Suresnes, France
| | - Ghislaine van Thiel
- Julius Center for Health Sciences and Primary Care, University of Utrecht, Utrecht, Netherlands
| | | | - Panos E Vardas
- Hygeia, Mitera, Hospitals Hellenic Health Group, Athens, Greece; European Heart Agency, European Society of Cardiology, Brussels, Belgium
| | | | | | - Wim Weber
- The British Medical Journal, London, UK
| | | | - Stephan Windecker
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Angela Wood
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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6
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Wang X, Mobley AR, Tica O, Okoth K, Ghosh RE, Myles P, Williams T, Haynes S, Nirantharakumar K, Shukla D, Kotecha D, Mehta S, Breeze S, Lancaster K, Fordyce S, Allen N, Calvert M, Denniston A, Gkoutos G, Jayawardana S, Ball S, Baigent C, Brocklehurst P, Lester W, McManus R, Seri S, Valentine J, Camm AJ, Haynes S, Moore DJ, Rogers A, Stanbury M, Flather M, Walker S, Wang D. Systematic approach to outcome assessment from coded electronic healthcare records in the DaRe2THINK NHS-embedded randomized trial . EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 3:426-436. [PMID: 36712153 PMCID: PMC9708037 DOI: 10.1093/ehjdh/ztac046] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/15/2022] [Indexed: 02/01/2023]
Abstract
Aims Improving the efficiency of clinical trials is key to their continued importance in directing evidence-based patient care. Digital innovations, in particular the use of electronic healthcare records (EHRs), allow for large-scale screening and follow up of participants. However, it is critical these developments are accompanied by robust and transparent methods that can support high-quality and high clinical value research. Methods and results The DaRe2THINK trial includes a series of novel processes, including nationwide pseudonymized pre screening of the primary-care EHR across England, digital enrolment, remote e-consent, and 'no-visit' follow up by linking all primary- and secondary-care health data with patient-reported outcomes. DaRe2THINK is a pragmatic, healthcare-embedded randomized trial testing whether earlier use of direct oral anticoagulants in patients with prior or current atrial fibrillation can prevent thromboembolic events and cognitive decline (www.birmingham.ac.uk/dare2think). This study outlines the systematic approach and methodology employed to define patient information and outcome events. This includes transparency on all medical code lists and phenotypes used in the trial across a variety of national data sources, including Clinical Practice Research Datalink Aurum (primary care), Hospital Episode Statistics (secondary care), and the Office for National Statistics (mortality). Conclusion Co-designed by a patient and public involvement team, DaRe2THINK presents an opportunity to transform the approach to randomized trials in the setting of routine healthcare, providing high-quality evidence generation in populations representative of the community at risk.
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Affiliation(s)
- Xiaoxia Wang
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK,Health Data Research UK Midlands, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alastair R Mobley
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK,Health Data Research UK Midlands, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Otilia Tica
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Kelvin Okoth
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Rebecca E Ghosh
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK
| | - Puja Myles
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK
| | - Tim Williams
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK
| | | | | | - David Shukla
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK,Primary Care Clinical Research, NIHR Clinical Research Network West Midlands, Birmingham, UK
| | - Dipak Kotecha
- Corresponding author. Heritage Building, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2GW, UK. Tel: +44 121 3718122,
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Kotecha D, Asselbergs FW, Achenbach S, Anker SD, Atar D, Baigent C, Banerjee A, Beger B, Brobert G, Casadei B, Ceccarelli C, Cowie MR, Crea F, Cronin M, Denaxas S, Derix A, Fitzsimons D, Fredriksson M, Gale CP, Gkoutos GV, Goettsch W, Hemingway H, Ingvar M, Jonas A, Kazmierski R, Løgstrup S, Lumbers RT, Lüscher TF, McGreavy P, Piña IL, Roessig L, Steinbeisser C, Sundgren M, Tyl B, van Thiel G, van Bochove K, Vardas PE, Villanueva T, Vrana M, Weber W, Weidinger F, Windecker S, Wood A, Grobbee DE. CODE-EHR best practice framework for the use of structured electronic healthcare records in clinical research. BMJ 2022; 378:e069048. [PMID: 36562446 PMCID: PMC9403753 DOI: 10.1136/bmj-2021-069048] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 12/27/2022]
Affiliation(s)
- Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, Medical School, Birmingham, UK
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Stephan Achenbach
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Stefan D Anker
- Department of Cardiology and Berlin Institute of Health Centre for Regenerative Therapies, German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Germany
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital, Ulleval, Oslo, Norway
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Colin Baigent
- MRC Population Health Research Unit, Nuffield Department of Population Health, Oxford, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Amitava Banerjee
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- University College London Hospitals NHS Trust, London, UK
| | | | | | - Barbara Casadei
- Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford NIHR Oxford Biomedical Research Centre, Oxford, UK
| | | | - Martin R Cowie
- Royal Brompton Hospital, Division of Guy's St Thomas' NHS Foundation Trust, London, UK
- School of Cardiovascular Medicine Sciences, King's College London, London, UK
| | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- European Heart Journal, Oxford University Press, University of Oxford, Oxford, UK
| | - Maureen Cronin
- Vifor Pharma, Glattbrugg, Switzerland and Ava AG, Zurich, Switzerland
| | - Spiros Denaxas
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- Alan Turing Institute, London, UK
- British Heart Foundation Data Science Centre, London, UK
| | | | - Donna Fitzsimons
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland
| | - Martin Fredriksson
- Late Clinical Development, Cardiovascular, Renal and Metabolism (CVRM), Biopharmaceuticals RD, AstraZeneca, Gothenburg, Sweden
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine and Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Georgios V Gkoutos
- University Hospitals Birmingham NHS Foundation Trust and Health Data Research UK Midlands, Birmingham, UK
- College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Wim Goettsch
- National Health Care Institute (ZIN), Diemen, Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Harry Hemingway
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Martin Ingvar
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
- Department of Neuroradiology, Karolinska University Hospital Stockholm, Stockholm, Sweden
| | - Adrian Jonas
- Data and Analytics Group, National Institute for Health and Care Excellence, London, UK
| | - Robert Kazmierski
- Office of Cardiovascular Devices, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - R Thomas Lumbers
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- Barts Health NHS Trust and University College London Hospitals NHS Trust
| | - Thomas F Lüscher
- Centre for Molecular Cardiology, University of Zurich, Zurich, Switzerland
- Faculty of Medicine, Imperial College London, London, UK
| | - Paul McGreavy
- European Society of Cardiology Patient Forum, European Society of Cardiology, Brussels, Belgium
| | - Ileana L Piña
- Central Michigan University College of Medicine, Midlands, MI, USA
- Centre for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - Carl Steinbeisser
- Bayer AG, Leverkusen, Germany
- Steinbeisser Project Management, Munich, Germany
| | - Mats Sundgren
- Data Science AI, Biopharmaceuticals RD, AstraZeneca, Gothenburg, Sweden
| | - Benoît Tyl
- Centre for Therapeutic Innovation, Cardiovascular and Metabolic Disease, Institut de Recherches Internationales Servier, Suresnes, France
| | - Ghislaine van Thiel
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Panos E Vardas
- Hygeia, Mitera, Hospitals Hellenic Health Group, Athens, Greece
- European Heart Agency, European Society of Cardiology, Brussels, Belgium
| | | | | | | | | | - Stephan Windecker
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Angela Wood
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Diederick E Grobbee
- Department of Epidemiology, University Medical Centre Utrecht, Division Julius Centrum, Utrecht, Netherlands
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