A comparison of the national registry of myocardial infarction 2 with the Cooperative Cardiovascular Project

OBJECTIVES This study was performed to evaluate whether or not the simpler case identification and data abstraction processes used in National Registr y of Myocardial Infarction two (NRMI 2) are comparable with the more rigoro us processes utilized in the Cooperative Cardiovascular Project (CCP). BACKGROUND The increased demand for quality of care and outcomes data in ho spitalized patients has resulted in a proliferation of databases of varying quality. For patients admitted with myocardial infarction, there are two n ational databases that attempt to capture critical process and outcome data using different case identification and abstraction processes. METHODS We compared case ascertainment and data elements collected in Medic are-eligible patients included in the industry-sponsored NRMI 2 with Medica re enrollees included in the Health Care Financing Administration-sponsored CCP who were admitted during identical enrollment periods. Internal and ex ternal validity of NRMI 2 was defined using the CCP as the "gold standard." RESULTS Demographic and procedure use data obtained independently in each d atabase were nearly identical. There was a tendency for NRMI 2 to identify past medical histories such as prior infarct (29% vs. 31%, p < 0.001) or he art failure (21% vs. 25%, p < 0.001) less frequently than the CCP. Hospital mortality was calculated to be higher in NRMI 2 (19.7% vs. 18.1%, p < 0.00 1) due mostly to the inclusion of noninsured patients 65 years and older in NRMI 2. CONCLUSIONS We conclude that the simpler case ascertainment and data collec tion strategies employed by NRMI 2 result in process and outcome measures t hat are comparable to the more rigorous methods utilized by the CCP. Outcom es that are more difficult to measure from retrospective chart review such as stroke and recurrent myocardial infarction must be interpreted cautiousl y. (C) 1999 by the American College of Cardiology.