Quality assurance of national internet-based patient register data: Experiences during the operation of the Hungarian Myocardial Infarction Registry, 2010­2020 / Internetalapú, országos betegségregiszter adatainak minoségbiztosítása: Tapasztalatok a Nemzeti Szívinfarktus Regiszter muködtetése során, 2010­2020

Összefoglaló. Bevezetés: A Nemzeti Szívinfarktus Regiszterben 111 788 beteg 122 351 infarktusos eseményéhez kapcsolódó 145 292 kezelés adatai szerepelnek. Módszer: A rögzített adatokat az üzemeltetok folyamatosan kontrollálják, bemutatják azokat a minoségbiztosítási módszereket, amelyekkel az adatbázis teljességét és megfeleloségét biztosítják. Az online informatikai rendszerben az adatbevitel során 119 automatikus ellenorzési algoritmust muködtetnek. Az automatikus ellenorzési algoritmussal nem kezelheto adatok ellenorzését 5 részállású, egészségügyi képzettségu kontroller és 2 foállású munkatárs végzi. A regiszter muködése során folyamatosan fejlesztették az ellenorzés módszereit, ennek során 2018-tól a kontrollerek által ellenorzött adatlapok utóellenorzésére is sor kerül. Az utóellenorzés során a már ellenorzött adatlapok 2,4%-ában további javításra volt szükség. Eredmények: Az utóellenorzés eredménye, hogy a kontrolleri munkát hatékonyabbá sikerült tenni, mivel egyre kevesebb az utóellenorzés során hibásnak talált adatlapok száma. Megvizsgálták, hogy az adatlap kérdéseire milyen arányban kaptak értékelheto választ. Az értékelheto válaszok aránya a legtöbb esetben meghaladta a 90%-ot, azonban a panaszok kezdetének ideje az adatlapok 39%-ában volt megadva, míg a dohányzási szokásokkal kapcsolatos válasz az esetek 59%-ában volt megfelelo. Megbeszélés: A szerzok rámutatnak arra, hogy a Nemzeti Egészségbiztosítási Alapkezelo és a Nemzeti Szívinfarktus Regiszter adatbázisának folyamatos egyeztetése hozzájárul a regisztráció teljességének biztosításához, lehetové teszi a betegek állapotának hosszú távú követését. Miután a program kötelezo jelleguvé vált 2014. 01. 01-jén, az elso évben a szívinfarktus-diagnózissal finanszírozott betegek kétharmada (67%) szerepelt a regiszter adatbázisában; ez az arány a 2017-2019-es években meghaladta a 90%-ot (91,7-93,6-91,3%). Következtetés: Vizsgálatukból a szerzok azt a következtetést vonják le, hogy a betegségregiszter muködése során szükséges az adatok teljességének és megfeleloségének folyamatos ellenorzése. A regiszter adatbázisának 90% feletti teljessége az ellátórendszer minoségi paramétereinek folyamatos követését teszi lehetové. Orv Hetil. 2021; 162(2): 61-68. INTRODUCTION: The Hungarian Myocardial Infarction Registry contains data on 145 592 treatments related to the 111 788 patients and the 122 351 myocardial infarctions. METHOD: The recorded information is continuously monitored, and the quality assurance methods used to ensure the completeness and adequacy of the database are presented. In the online IT system, 119 automatic verification algorithms are operated during data entry. Data that cannot be handled by the automated verification algorithm is checked by five part-time health-qualified controllers and two full-time employees. During the operation of the register, the control methods were continuously developed, during which the data sheets checked by the controllers will be post-checked from 2018 onwards. During the post-checked process, 2.4% of the datasheets required further correction. RESULTS: The number of data sheets found to be incorrect during the post-audit was decreasing. The authors examined the proportion of evaluable answers to the questionnaire. The rate of evaluable responses was over 90% in most cases; however, the time of the onset of symptoms was given in 39% of the datasheets, while the answer to smoking habits was adequate in 59% of cases. DISCUSSION: The authors point out that the continuous consultation of the database of the National Health Fund Management Centre and the Hungarian Myocardial Infarction Registry contributes to ensuring the completeness of registration, enabling long-term monitoring of the condition of patients. In the first year of the mandatory period of the program, two-thirds (67%) of patients treated with a diagnosis of myocardial infarction were included in the registry database, and this proportion exceeded 90% in the years 2017-2019 (91.7-93.6-91.3%). CONCLUSION: The study of the authors concludes that the completeness and adequacy of the data need to be constantly monitored during the operation of the patient registry. The integrity of the register database above 90% enables the continuous monitoring of the quality parameters of the system. Orv Hetil. 2021; 162(2): 61-68.

[Treatment of patients with myocardial infarction in Hungary on the basis of available health data]. / Szívinfarktus miatt kezelt betegek ellátásának vizsgálata Magyarországon a rendelkezésre álló egészségügyi adatok alapján.

The authors review data sources related to death arising from myocardial infarction, as well as the major elements of the Hungarian data collection of the Central Statistical Office, the National Health Insurance Fund and the National Registry of Myocardial Infarction. They also discuss conclusions which can be drawn from the data. It was found that the financial database - in accordance with its purpose - is suitable for monitoring the costs arising during the treatment of patient, but the quality and efficiency of treatment cannot be judged on the basis of this database. The Central Statistical Office compiles mortality data on the basis of international conventions, the basis of which is the autopsy report. However, the validity of statistical data depends on the correct completion of this report. Therefore. it is not possible to judge treatment of patients with myocardial infarction simply on the basis of mortality statistics. Considering national databases, only patient registries are suitable for monitoring the quality and efficiency of treatment currently. It is recommended that data of the National Registry of Myocardial Infarction should be used when the quality of treatment of patients with myocardial infarction is evaluated.

Value of rilmenidine therapy and its combination with perindopril on blood pressure and left ventricular hypertrophy in patients with essential hypertension (VERITAS).

OBJECTIVES: The primary objective was to assess the effects of rilmenidine monotherapy and in combination with perindopril on blood pressure (BP) in patients assessed with grade 1 or 2 essential hypertension. The study also examined the effects of 2-year rilmenidine monotherapy on left ventricular hypertrophy (LVH) and on diastolic function of the left ventricle, along with the effects of rilmenidine on left ventricular mass index in hypertensive patients with no LVH, and the relationship between BP reduction and any change in LVH. RESEARCH DESIGN AND METHODS: Mild-to-moderate hypertensive patients (n = 500) were enrolled in a multicentre 2-year open study and treated with rilmenidine (1-2 mg per day) monotherapy or rilmenidine plus perindopril (2, 4 or 8 mg per day) if control of hypertension was not achieved with rilmenidine monotherapy within 12 weeks. Blood pressure was recorded at regular intervals by the investigators and LVH measured by centralised single-blind echocardiographic reading. RESULTS: Rilmenidine monotherapy (average dose 1.42 mg) produced a significant decrease in BP from the baseline of 163 +/- 10/100 +/- 5 mmHg to 134 +/- 10/86 +/- 7 mmHg at 1 year and to 136 +/- 10/84 +/- 7 mmHg at 2 years (p < 0.001 for both). In 188 patients with LVH, the left ventricular mass index was significantly reduced from 161.4 +/- 30.5 to 131.3 +/- 26.5 at 1 year and to 134.1 +/- 26.0 g/m(2) at 2 years (p < 0.001 for both). Addition of perindopril to those patients whose BP was not normalised by rilmenidine monotherapy after 12 weeks further decreased BP significantly from 150 +/- 13/93 +/- 8 mmHg to 142 +/- 14/89 +/- 7 mmHg at the end of the 2nd year. CONCLUSIONS: Long-term rilmenidine monotherapy was shown to be efficient in controlling BP and in reducing LVH. The addition of perindopril to rilmenidine monotherapy proved to be effective and well tolerated in those patients who did not respond to rilmenidine alone.

[Comparison of invasive diagnostic techniques and revascularization therapy of acute coronary syndrome in Hungarian and international databases]. / Az akut coronariasyndromában alkalmazott invazív diagnosztika és terápia gyakorisága a magyar és a nemzetközi gyakorlatban (nemzetközi vizsgálatok adatai alapján).

UNLABELLED: INTRODUCTION, AIMS, METHODS: The databases of large multicentric trials dealing with acute coronary syndrome (OASIS Registry, CORE, PURSUIT, FRAX.I.S.) were analysed. RESULTS: Significant differences were disclosed comparing the baseline and history characteristics of patients randomized from Eastern or Western Europe. In most investigations the patients from Eastern Europe had a higher prevalence of hypertension, diabetes, angina and myocardial infarction. Invasive diagnostics and revascularization therapy were less frequently used in Eastern than in Western Europe in all the trials. The prevalence of myocardial infarction and the case fatality rate were not uniformly different during the early days, but after 30 days the case fatality rate in Eastern Europe was significantly higher than in Western Europe. CONCLUSION: It is suggested that the differences in demographic and baseline characteristics were only partially responsible for the difference in mortality. The low intervention rate and delayed revascularization may contribute to the high rate of myocardial infarction and mortality in Eastern Europe.

[Tissue Doppler echocardiography: a new technique to assess diastolic function]. / Szöveti Doppler-echocardiographia--új módszer a diastolés funkció jellemzésére.

UNLABELLED: Diastolic dysfunction and elevated filling pressure have important role in heart failure. Traditional Doppler echocardiography (DE) however is of limited value in the measurement of these variables. The objective of this study was the evaluation of a new technique, the pulsed tissue Doppler echocardiography of the lateral mitral anulus (PTDI) in diastolic function. 96 consecutive patients were included into the study who were in sinus rhythm, mitral valve disease was excluded and ejection fraction was either > or = 50% (50 patients) or < or = 40% (46 patients). DE technique was used to measure mitral E, A velocity, deceleration time (DT). Myocardial early diastolic (Ea), late diastolic (Aa) velocities were measured at the lateral mitral anulus by PTDI, and E/A, Ea/Aa, E/Ea ratios were calculated. Based on accepted DE criteria of diastolic dysfunction there were 19 normal subjects, 18 patients had abnormal relaxation, 8 had pseudonormalization pattern and 12 had restrictive dysfunction, the rest of patients did not fulfill these criteria. RESULTS: PDTI indicated an association of diastolic dysfunction to systolic dysfunction, which could not be shown by DE. Myocardial Ea velocity was age-dependent only in patients with good systolic function, and it was less than 15 cm/s in all types of diastolic dysfunction. E/Ea ratio over 8 indicated elevated filling pressure, but it was related to E/A ratio only in cases of good systolic function. Importantly one third of cases could be classified into diastolic dysfunction patterns only using tissue Doppler. CONCLUSIONS: Myocardial diastolic velocities can be easily measured by pulsed tissue Doppler technique at the lateral mitral anulus. Decreased early diastolic tissue velocity indicates diastolic dysfunction independently of its type, and it is generally associated to systolic dysfunction, independently of age. Pseudonormalization is defined as the combination of normal mitral inflow and decreased tissue diastolic velocity.