1. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation Electronic discharge summary (Epi-Cardio, Epicrisis Computada) as a tool for a prospective multicentric registry of CCU patients. A GEDIC-ARIAM collaboration EPI-CARDIO registry

2. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation EPI-CARDIO What is EPI-CARDIO? Is an independent research project, conformed by a collaborative network of cardiovascular acute care units that share a multicentric registry of cardiovascular acute pathology OBJECTIVES TOOL NETWORK BACKGROUND INTRODUCTION FEASIBILITY RESULTS

3. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation In Argentina there is a lack of communitary prospective surveys of patients admitted to CCU The electronic case report form for in-hospital patients is restricted to a few academic institutions. The challenge was to develop a low cost tool to be a part of the routine practice and simultaneously to keep good quality information about in-hospital evolution and medical strategies of acute cardiovascular disease. OBJECTIVES TOOL NETWORK INTRODUCTION BACKGROUND FEASIBILITY RESULTS

4. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation Short term objectives 1)To provide an electronic discharge letter software without costs to institutions with CCU to: a) registre in a database all patients admitted in cardiovascular care units b) generate a complete discharge report-letter 2) To build a multicentric registry of acute cardiovascular patologhy 3) To keep an active interaction with all the institutions of the network TOOL NETWORK BACKGROUND INTRODUCTION OBJECTIVES FEASIBILITY RESULTS

5. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation Medium term objectives 1)To explore indicators of quality of care in critical care units 2)To measure and to improve the rate of use of drugs recomended by the guidelines for acute cardiovascular pathology TOOL NETWORK BACKGROUND INTRODUCTION OBJECTIVES FEASIBILITY RESULTS

6. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation Long term objectives 1)To assess educational interventions with the objective of improving the quality of medical care and to evaluate the clinical impact of these interventions 2)To share and to compare information with registries of another regions TOOL NETWORK BACKGROUND INTRODUCTION OBJECTIVES FEASIBILITY RESULTS

7. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation The software was developed over a database with Access ® format (.MDB) Functions and utilities: 1)Permanent data base of admitted patients 2)Printed institutional discharge report 3)Copies for patient chart, patient and treating physician 4)Send by e-mail to coordinating centre the data, for the generation of institutional and registry reports. 5)Special forms for more frequent pathologies, with the objective of evaluate practics and uses, and measure the rate of fulfillment of the guidelines OBJECTIVES NETWORK BACKGROUND INTRODUCTION TOOL FEASIBILITY RESULTS

8. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation OBJECTIVES NETWORK BACKGROUND INTRODUCTION TOOL/FORMAT FEASIBILITY RESULTS Main screen of the software

9. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation OBJECTIVES NETWORK BACKGROUND INTRODUCTION TOOL FEASIBILITY RESULTS Discharge report generated automatically

10. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation Network operation PatientClinical recordPhysician Backup Avoid missing data Send EPICARDIO Centers Coordinating center Processing Send of Individual and global reports DATA BASE Main Database OBJECTIVES BACKGROUND INTRODUCTION FEASIBILITY RESULTS TOOL NETWORK Charge data of patients and generate discharge report

11. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation OBJECTIVES TOOL BACKGROUND INTRODUTCION RESULTS FEASIBILITY NETWORK FEASIBILITY of the project (after 1 y.) Based on Quick incorporation of centres Shortening administrative work time (estimated time <10 minutes) Utility of individual and global reports Active participation of investigators in research projects 12.000 (twelve thousands) patients included in 12 months

12. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation Brief review of results Brief review of results Showing the power of the tool

13. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation Present of the registry Total Institutions: (using the tool)  70 centers Active Institutions: (sharing the core registry)  42 centers

14. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation Patients included (linear progression) months

15. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation Distribution of EPI-CARDIO Centers in Argentina

16. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation Diagnosis at discharge n: 11634

17. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation Acute coronary syndromes whith ST elevation 601 patients with full available data included Incidence: 5,2% of total admissions Mortality 7,82%

18. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation Reperfusion strategies (45% out of time window) Rep. strategy

19. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation Acute coronary syndroms without ST elevation Were included (complete data) 1091 patients Mortality 2,29%

20. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation Invasive strategy n:1091

21. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation Heart failure Were included 1299 pacients with heart failure. Mortality 5,79%

22. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation Heart failure Mechanical ventilatory assistance 7 %Mechanical ventilatory assistance 7 % Swan-Ganz 5 %Swan-Ganz 5 % Non invasiveNon invasive ventilation 3,1%ventilation 3,1% Diuretics (cont.Diuretics (cont. IV infusion) 26,3%IV infusion) 26,3% IV inotropics 21,6%IV inotropics 21,6% Procedures

23. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation Cardiovascular surgery n: 558 %

24. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation Conclusions EPI-CARDIO allows: To establish in a continuous way the incidence of pathology admitted in coronary units. To evaluate in-hospital evolution and associated procedures. To know diagnostic and therapeutic uses in the “real world”. EPI-CARDIO allows: To establish in a continuous way the incidence of pathology admitted in coronary units. To evaluate in-hospital evolution and associated procedures. To know diagnostic and therapeutic uses in the “real world”.

25. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation Limitations Selection bias: predominant incorporation of institutions from urban centres, with less incorporation of periferic institutions. Some degree of under-registry of dead patients, due to double function of the software as registry and “discharge report”.

26. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation Epi-cardio/ARIAM collaboration We share with ARIAM group his web database Epi-cardio investigators can: generate immediate reports of his own data through LATINO-ARIAM website compare it with other institutions, regions and countries, initially Argentina and Spain.

27. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation Latino-ARIAM web page Database Tools for reports generation

28. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation Example of immediate statistic reports of Latino-ARIAM website

29. www.epi-cardio.com.ar EPI-CARDIO Multicentric Network of Clinical Evaluation Conclusions 1)Epi-cardio was quickly included in the clinical practice in a growing number of institutions. 2) To share information in a network allows to get permanent epidemological data of acute cardiovascular pathology. Future Future The progressive difusion of Epi-Cardio could be an economic solution for the continuous evaluation of the cardiologic practice in Argentina. Latino-ARIAM collaboration alows as to extend the registry to other countries and communities.