Temporal trends in ischemic and hemorrhagic strokes in Northern Italy: results from the cardiovascular monitoring unit in Northern Italy population-based register, 1998-2004

Cardiovascular diseases monitoring: lessons from population-based registries to address future opportunities and challenges in Europe

Background

Population-based registries implement the comprehensive collection of all disease events that occur in a well-characterized population within a certain time period and represent the preferred tools for disease monitoring at a population level. Main characteristics of a Population-based registry are to provide answers to defined research questions, also related to clinical and health policy purposes, assuring completeness of event identification, and implementing a process of case adjudication (validation) according to standardised diagnostic criteria.

Methods

The application of a standard methodology results in the availability of reliable and comparable data and facilitates the transferability of health information for research and evidence-based health policies. Although registries are extremely useful, they require considerable resources to be implemented and maintained, high cost and efforts, to produce stable and reliable indicators.

Results

Thanks to available health information and information technology, current administrative databases on hospital admissions and discharges, medication use, in-patient care utilization, surgical operations, drug dispensations, ticket exemption and invasive procedures are increasingly available. They represent basic sources of information for implementing Population-based registries.Main strengths and limitations of Population-based registries are described taking into consideration the example of cardiovascular diseases, as well as future challenges and opportunities for implementing Population-based registries at European level.

Conclusions

The integration of population-based registries and current administrative health databases may help to complete the picture of the disease rebuilding the evolution of the disease as a continuum from the onset to the possible consequent complications.

Combined use of short-term and long-term cardiovascular risk scores in primary prevention: an assessment of clinical utility

AIMS

To evaluate the clinical utility of cardiovascular disease (CVD) risk stratification based on a combined use of short-term and long-term risk scores in the primary prevention setting.

METHODS

CVD-free participants 40-65 years old initially to seven population-based cohorts enrolled in northern and central Italy were stratified as 'low' (ESC-SCORE ≤ 1%), 'intermediate' (SCORE 1-4%) and 'moderate/high' short-term CVD risk (SCORE ≥ 4% or diabetes). The long-term CVD risk was estimated using the CAMUNI-MATISS model, validated for the Italian population. Participants were followed up for a median time of 16 years to ascertain the first major CVD event, fatal or nonfatal. To compare the 'combined' (SCORE + CAMUNI-MATISS) with the 'current' (SCORE alone) stratification, we estimated the difference in Net Benefit between the two strategies.

RESULTS

Study sample included 3935 men (468 CVD events) and 4393 women (210 events). Under the 'current' stratification, 76% of men and 21% of women were at 'intermediate' risk and eligible to treatment. Only 40% of them had elevated predicted long-term risk and could have received indication to treatment under the 'combined' strategy. The latter would have saved 3 and 3.5 unnecessary treatments per every CVD case in men and women, respectively, and the Net Benefit significantly increased [men: 4.1, 95% confidence interval (CI): 2.7-5.6; women: 4.4, 95% CI: 1.7-6.9].Similarly, among the 74% of women not receiving indication for prevention because at 'low' short-term risk, the 'combined' stratification significantly increased the Net Benefit (1.4, 95% CI: 0.6-2.1) and reduced from 40 to 10% the proportion of events occurring among women not eligible to any preventive action.

CONCLUSION

In the Italian population, a combination of validated short-term and long-term CVD risk scores has the potential to select for prevention women whose risk is currently not fully addressed and to reduce unnecessary costly treatment.