ID

32966

Description

CORONARY ARTERY DISEASE DATA COLLECTION Version 2.0.3 Revised: April 5th, 2017 International Consortium for Health Outcomes Measurement (ICHOM), Source: http://www.ichom.org/ Conditions: Asymptomatic Coronary Artery Disease | Stable Angina | Acute Coronary Syndrome (Includes AMI) Treatment Approaches: Lifestyle Modification | Drug Therapy | Percutaneous Coronary Intervention (PCI) | Coronary Artery Bypass Grafting (CABG) This form contains administrative follow-up items. They should be assessed at 1 and 5 years after entry event or 1 and 5 years after a new index event (e.g. new revascularization procedure or a new diagnosis of ACS). Given that longitudinal data capture is based on administrative data, this can continue to be collected and analyzed for either the original or subsequent index events. Questionnaires used in this standard set: Rose Dyspnea Scale: The Rose Dyspnea Scale is free for all health care organizations, and a license is not needed. More information may be found at http://www.ahjonline.com/article/S0002-8703(09)00266-X/abstract Patient Health Questionnaire (PHQ-2): The PHQ-2 is free for all health care organizations, and a license is not needed. Copyright Pfizer, more Information on http://www.phqscreeners.com/ Seattle Angina Questionnaire (SAQ-7): Due to the need for a license for use of the SAQ-7 the actual questions of SAQ-7 will not be part of this version of the standard set. Publication: McNamara RL, Spatz ES, Kelley TA, et al. Standardized Outcome Measurement for Patients With Coronary Artery Disease: Consensus From the International Consortium for Health Outcomes Measurement (ICHOM). J Am Heart Assoc. 2015;4(5):e001767. Published 2015 May 19. doi:10.1161/JAHA.115.001767

Link

http://www.ichom.org/

Keywords

  1. 11/22/18 11/22/18 - Sarah Riepenhausen
  2. 4/30/20 4/30/20 - Sarah Riepenhausen
Copyright Holder

ICHOM

Uploaded on

November 22, 2018

DOI

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License

Creative Commons BY-NC 3.0

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ICHOM Coronary Artery Disease

Follow-Up Administrative Form

Administrative Data
Description

Administrative Data

Alias
UMLS CUI-1
C1320722
Indicate the patient's medical record number
Description

This number will not be shared with ICHOM. In the case patient-level data is submitted to ICHOM for benchmarking or research purposes, a separate ICHOM Patient Identifier will be created and cross-linking between the ICHOM Patient Identifier and the medical record number will only be known at the treating institution INCLUSION CRITERIA: All patients TIMING: On all forms REPORTING SOURCE: Administrative or clinical RESPONSE OPTIONS: According to institution

Data type

integer

Alias
UMLS CUI [1]
C1269815
Time Relative to Baseline (e.g. Baseline, 6 months follow-up, 1 year follow-up, ...)
Description

This Item does not exist in the original standard set, instead it is asked to do the following: Please timestamp all variables. Some Standard Set variables are collected at multiple timepoints, and we will ask you to submit these variables in a concatenated VARIABLEID_TIMESTAMP form for future analyses. For example, VARIABLEID_BASE (baseline); VARIABLEID_6MO (6 month follow-up); VARIABLEID_1YR (1 year follow-up), etc.

Data type

text

Alias
UMLS CUI [1,1]
C0439564
UMLS CUI [1,2]
C1442488
Demographic Factors
Description

Demographic Factors

Alias
UMLS CUI-1
C1704791
What is your date of birth?
Description

INCLUSION CRITERIA: All patients TIMING: At time of diagnosis REPORTING SOURCE: Patient-reported, clinical, or administrative data TYPE: Date by DD/MM/YYYY

Data type

date

Measurement units
  • DD/MM/YYYY
Alias
UMLS CUI [1]
C0001779
UMLS CUI [2]
C0421451
DD/MM/YYYY
Please indicate your sex at birth
Description

INCLUSION CRITERIA: All patients TIMING: At time of diagnosis REPORTING SOURCE: Patient-reported, clinical, or administrative data TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C0079399
Cardiovascular disease progression
Description

Cardiovascular disease progression

Alias
UMLS CUI-1
C0007222
UMLS CUI-2
C0242656
Indicate if the patient was admitted due to an AMI
Description

INCLUSION CRITERIA: All patients TIMING: Tracked ongoing Reported at 1 year + 5 years after index event REPORTING SOURCE: Administrative data (diagnosis coding) TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C0155626
Indicate the date of each admission for AMI during the defined interval
Description

Date used to calculate total length of stay due to AMI INCLUSION CRITERIA: All patients If answered 'yes' to the patient being admitted for an AMI (AMI) TIMING: Tracked ongoing Reported at 1 year + 5 years after index event REPORTING SOURCE: Administrative data (diagnosis coding) TYPE: Date by DD/MM/YYYY

Data type

date

Measurement units
  • DD/MM/YYYY
Alias
UMLS CUI [1,1]
C0155626
UMLS CUI [1,2]
C1302393
DD/MM/YYYY
Indicate the date of each discharge for AMI during the defined interval
Description

Date used to calculate total length of stay due to AMI INCLUSION CRITERIA: All patients If answered 'yes' to the patient being admitted for an AMI (AMI) TIMING: Tracked ongoing Reported at 1 year + 5 years after index event REPORTING SOURCE: Administrative data (diagnosis coding) TYPE: Date by DD/MM/YYYY

Data type

date

Measurement units
  • DD/MM/YYYY
Alias
UMLS CUI [1,1]
C0155626
UMLS CUI [1,2]
C2361123
DD/MM/YYYY
Indicate if the patient was admitted due to a hemorrhagic stoke
Description

INCLUSION CRITERIA: All patients TIMING: Tracked ongoing Reported at 1 year + 5 years after index event REPORTING SOURCE: Administrative data (diagnosis coding) TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C1096400
Indicate the date of each admission for hemorrhagic stroke during the defined interval
Description

Date used to calculate total length of stay due to hemorrhagic stroke INCLUSION CRITERIA: All patients If answered 'yes' to the patient being admitted for a hemorrhagic stroke (HSTROKE) TIMING: Tracked ongoing Reported at 1 year + 5 years after index event REPORTING SOURCE: Administrative data (diagnosis coding) TYPE: Date by DD/MM/YYYY

Data type

date

Measurement units
  • DD/MM/YYYY
Alias
UMLS CUI [1,1]
C1096400
UMLS CUI [1,2]
C1302393
DD/MM/YYYY
Indicate the date of each discharge for hemorrhagic stroke during the defined interval
Description

Date used to calculate total length of stay due to hemorrhagic stroke INCLUSION CRITERIA: All patients If answered 'yes' to the patient being admitted for a hemorrhagic stroke (HSTROKE) TIMING: Tracked ongoing Reported at 1 year + 5 years after index event REPORTING SOURCE: Administrative data (diagnosis coding) TYPE: Date by DD/MM/YYYY

Data type

date

Measurement units
  • DD/MM/YYYY
Alias
UMLS CUI [1,1]
C1096400
UMLS CUI [1,2]
C2361123
DD/MM/YYYY
Indicate if the patient was admitted due to an ischemic stoke
Description

INCLUSION CRITERIA: All patients TIMING: Tracked ongoing Reported at 1 year + 5 years after index event REPORTING SOURCE: Administrative data (diagnosis coding) TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C0948008
Indicate the date of each admission for ischemic stroke during the defined interval
Description

Date used to calculate total length of stay due to ischemic stroke INCLUSION CRITERIA: All patients If answered 'yes' to the patient being admitted for an ischemic stroke (ISTROKE) TIMING: Tracked ongoing Reported at 1 year + 5 years after index event REPORTING SOURCE: Administrative data (diagnosis coding) TYPE: Date by DD/MM/YYYY

Data type

date

Measurement units
  • DD/MM/YYYY
Alias
UMLS CUI [1,1]
C0948008
UMLS CUI [1,2]
C1302393
DD/MM/YYYY
Indicate the date of each discharge for ischemic stroke during the defined interval
Description

Date used to calculate total length of stay due to ischemic stroke INCLUSION CRITERIA: All patients If answered 'yes' to the patient being admitted for an ischemic stroke (ISTROKE) TIMING: Tracked ongoing Reported at 1 year + 5 years after index event REPORTING SOURCE: Administrative data (diagnosis coding) TYPE: Date by DD/MM/YYYY

Data type

date

Measurement units
  • DD/MM/YYYY
Alias
UMLS CUI [1,1]
C0948008
UMLS CUI [1,2]
C2361123
DD/MM/YYYY
Indicate if the patient was admitted due to an unknown stoke
Description

INCLUSION CRITERIA: All patients TIMING: Tracked ongoing Reported at 1 year + 5 years after index event REPORTING SOURCE: Administrative data (diagnosis coding) TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C0038454
Indicate the date of each admission for unknown stroke during the defined interval
Description

Date used to calculate total length of stay due to unknown stroke INCLUSION CRITERIA: All patients If answered 'yes' to the patient being admitted for an unknown stroke (USTROKE) TIMING: Tracked ongoing Reported at 1 year + 5 years after index event REPORTING SOURCE: Administrative data (diagnosis coding) TYPE: Date by DD/MM/YYYY

Data type

date

Measurement units
  • DD/MM/YYYY
Alias
UMLS CUI [1,1]
C0038454
UMLS CUI [1,2]
C2316983
DD/MM/YYYY
Indicate the date of each discharge for unknown stroke during the defined interval
Description

Date used to calculate total length of stay due to unknown stroke INCLUSION CRITERIA: All patients If answered 'yes' to the patient being admitted for an unknown stroke (USTROKE) TIMING: Tracked ongoing Reported at 1 year + 5 years after index event REPORTING SOURCE: Administrative data (diagnosis coding) TYPE: Date by DD/MM/YYYY

Data type

date

Measurement units
  • DD/MM/YYYY
Alias
UMLS CUI [1,1]
C0038454
UMLS CUI [1,2]
C2361123
DD/MM/YYYY
Indicate if the patient was admitted due to heart failure
Description

Heart failure is defined as physician documentation or report of any of the following clinical symptoms of heart failure described as unusual dyspnea on light exertion, recurrent dyspnea occurring in the supine position, fluid retention; or the description of rales, jugular venous distension, pulmonary edema on physical exam, or pulmonary edema on chest x-ray presumed to be cardiac dysfunction. A low ejection fraction alone, without clinical evidence of heart failure does not qualify as heart failure INCLUSION CRITERIA: All patients TIMING: Tracked ongoing Reported at 1 year + 5 years after index event REPORTING SOURCE: Administrative data (diagnosis coding) TYPE: Single answer (Original Version 'HF' for Variable ID (already used in Baseline))

Data type

integer

Alias
UMLS CUI [1]
C0018801
Indicate the date of each admission for heart failure during the defined interval
Description

Date used to calculate total length of stay due to heart failure INCLUSION CRITERIA: All patients If answered 'yes' to the patient being admitted for heart failure (HF) TIMING: Tracked ongoing Reported at 1 year + 5 years after index event REPORTING SOURCE: Administrative data (diagnosis coding) TYPE: Date by DD/MM/YYYY

Data type

date

Measurement units
  • DD/MM/YYYY
Alias
UMLS CUI [1,1]
C0018801
UMLS CUI [1,2]
C1302393
DD/MM/YYYY
Indicate the date of each discharge for heart failure during the defined interval.
Description

Date used to calculate total length of stay due to heart failure INCLUSION CRITERIA: All patients If answered 'yes' to the patient being admitted for heart failure (HF) TIMING: Tracked ongoing Reported at 1 year + 5 years after index event REPORTING SOURCE: Administrative data (diagnosis coding) TYPE: Date by DD/MM/YYYY

Data type

date

Measurement units
  • DD/MM/YYYY
Alias
UMLS CUI [1,1]
C0018801
UMLS CUI [1,2]
C2361123
DD/MM/YYYY
Indicate if a PCI was performed
Description

INCLUSION CRITERIA: All patients TIMING: Tracked ongoing Reported at 1 year + 5 years after index event REPORTING SOURCE: Administrative data (diagnosis coding) TYPE: Multiple answer

Data type

integer

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C1532338
Indicate the date of the PCI
Description

Restricted to PCI, CABG INCLUSION CRITERIA: All patients TIMING: Tracked ongoing Reported at 1 year + 5 years after index event REPORTING SOURCE: Administrative data (diagnosis coding) TYPE: Date by DD/MM/YYYY

Data type

date

Measurement units
  • DD/MM/YYYY
Alias
UMLS CUI [1,1]
C0189573
UMLS CUI [1,2]
C2584899
DD/MM/YYYY
Indicate the date of the PCI
Description

Restricted to PCI, CABG INCLUSION CRITERIA: All patients TIMING: Tracked ongoing Reported at 1 year + 5 years after index event REPORTING SOURCE: Administrative data (diagnosis coding) TYPE: Date by DD/MM/YYYY

Data type

date

Measurement units
  • DD/MM/YYYY
Alias
UMLS CUI [1,1]
C0189573
UMLS CUI [1,2]
C2584899
DD/MM/YYYY
Indicate if a CABG was performed
Description

INCLUSION CRITERIA: All patients TIMING: Tracked ongoing Reported at 1 year + 5 years after index event REPORTING SOURCE: Administrative data (diagnosis coding) TYPE: Multiple answer

Data type

integer

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0010055
Indicate the date of the CABG
Description

Restricted to PCI, CABG INCLUSION CRITERIA: All patients TIMING: Tracked ongoing Reported at 1 year + 5 years after index event REPORTING SOURCE: Administrative data (diagnosis coding) TYPE: Date by DD/MM/YYYY

Data type

date

Measurement units
  • DD/MM/YYYY
Alias
UMLS CUI [1,1]
C0010055
UMLS CUI [1,2]
C2584899
DD/MM/YYYY
Indicate the date of the CABG
Description

Restricted to PCI, CABG INCLUSION CRITERIA: All patients TIMING: Tracked ongoing Reported at 1 year + 5 years after index event REPORTING SOURCE: Administrative data (diagnosis coding) TYPE: Date by DD/MM/YYYY

Data type

date

Measurement units
  • DD/MM/YYYY
Alias
UMLS CUI [1,1]
C0010055
UMLS CUI [1,2]
C2584899
DD/MM/YYYY
Indicate if the patient has a new requirement for dialysis
Description

INCLUSION CRITERIA: All patients TIMING: Tracked ongoing Reported at 1 year + 5 years after index event REPORTING SOURCE: Administrative data (diagnosis coding) TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C0011946
UMLS CUI [1,2]
C1514873
Indicate the date the patient first began dialysis treatment
Description

INCLUSION CRITERIA: All patients If answered 'yes' that the began dialysis treatment TIMING: Tracked ongoing Reported at 1 year + 5 years after index event REPORTING SOURCE: Administrative data (diagnosis coding) TYPE: Date by DD/MM/YYYY

Data type

date

Measurement units
  • DD/MM/YYYY
Alias
UMLS CUI [1,1]
C0011946
UMLS CUI [1,2]
C2584899
DD/MM/YYYY
Survival
Description

Survival

Alias
UMLS CUI-1
C1148433
Indicate if the patient has died, regardless of cause
Description

INCLUSION CRITERIA: All patients TIMING: Tracked ongoing Reported at 1 year + 5 years after index event REPORTING SOURCE: Administrative data (diagnosis coding) TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C0011065
Indicate the date the patient was declared dead
Description

INCLUSION CRITERIA: All patients, If answered 'yes' on Mortality: Patient died regardless of cause (DEATHADMIN) TIMING: Tracked ongoing Reported at 1 year + 5 years after index event REPORTING SOURCE: Administrative data (diagnosis coding) TYPE: Date by DD/MM/YYYY

Data type

date

Measurement units
  • DD/MM/YYYY
Alias
UMLS CUI [1]
C1148348
DD/MM/YYYY
Indicate where the patient died
Description

INCLUSION CRITERIA: All patients, If answered 'yes' on Mortality: Patient died regardless of cause (DEATHADMIN) TIMING: Tracked ongoing Reported at 1 year + 5 years after index event REPORTING SOURCE: Administrative data (diagnosis coding) TYPE: Single answer

Data type

integer

Measurement units
  • DD/MM/YYYY
Alias
UMLS CUI [1]
C2924451

Similar models

Follow-Up Administrative Form

Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative Data
C1320722 (UMLS CUI-1)
Patient ID
Item
Indicate the patient's medical record number
integer
C1269815 (UMLS CUI [1])
Time Relative to Baseline
Item
Time Relative to Baseline (e.g. Baseline, 6 months follow-up, 1 year follow-up, ...)
text
C0439564 (UMLS CUI [1,1])
C1442488 (UMLS CUI [1,2])
Item Group
Demographic Factors
C1704791 (UMLS CUI-1)
Age
Item
What is your date of birth?
date
C0001779 (UMLS CUI [1])
C0421451 (UMLS CUI [2])
Item
Please indicate your sex at birth
integer
C0079399 (UMLS CUI [1])
Code List
Please indicate your sex at birth
CL Item
Male (1)
C0086582 (UMLS CUI-1)
(Comment:en)
CL Item
Female (2)
C0086287 (UMLS CUI-1)
(Comment:en)
Item Group
Cardiovascular disease progression
C0007222 (UMLS CUI-1)
C0242656 (UMLS CUI-2)
Item
Indicate if the patient was admitted due to an AMI
integer
C0155626 (UMLS CUI [1])
Code List
Indicate if the patient was admitted due to an AMI
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Admission for acute myocardial infarction (AMI)
Item
Indicate the date of each admission for AMI during the defined interval
date
C0155626 (UMLS CUI [1,1])
C1302393 (UMLS CUI [1,2])
Discharge for acute myocardial infarction (AMI)
Item
Indicate the date of each discharge for AMI during the defined interval
date
C0155626 (UMLS CUI [1,1])
C2361123 (UMLS CUI [1,2])
Item
Indicate if the patient was admitted due to a hemorrhagic stoke
integer
C1096400 (UMLS CUI [1])
Code List
Indicate if the patient was admitted due to a hemorrhagic stoke
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Admission for hemorrhagic stroke
Item
Indicate the date of each admission for hemorrhagic stroke during the defined interval
date
C1096400 (UMLS CUI [1,1])
C1302393 (UMLS CUI [1,2])
Discharge for hemorrhagic stroke
Item
Indicate the date of each discharge for hemorrhagic stroke during the defined interval
date
C1096400 (UMLS CUI [1,1])
C2361123 (UMLS CUI [1,2])
Item
Indicate if the patient was admitted due to an ischemic stoke
integer
C0948008 (UMLS CUI [1])
Code List
Indicate if the patient was admitted due to an ischemic stoke
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Admission for ischemic stroke
Item
Indicate the date of each admission for ischemic stroke during the defined interval
date
C0948008 (UMLS CUI [1,1])
C1302393 (UMLS CUI [1,2])
Discharge for ischemic stroke
Item
Indicate the date of each discharge for ischemic stroke during the defined interval
date
C0948008 (UMLS CUI [1,1])
C2361123 (UMLS CUI [1,2])
Item
Indicate if the patient was admitted due to an unknown stoke
integer
C0038454 (UMLS CUI [1])
Code List
Indicate if the patient was admitted due to an unknown stoke
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Admission for unknown stroke
Item
Indicate the date of each admission for unknown stroke during the defined interval
date
C0038454 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Discharge for unknown stroke
Item
Indicate the date of each discharge for unknown stroke during the defined interval
date
C0038454 (UMLS CUI [1,1])
C2361123 (UMLS CUI [1,2])
Item
Indicate if the patient was admitted due to heart failure
integer
C0018801 (UMLS CUI [1])
Code List
Indicate if the patient was admitted due to heart failure
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Admission for heart failure
Item
Indicate the date of each admission for heart failure during the defined interval
date
C0018801 (UMLS CUI [1,1])
C1302393 (UMLS CUI [1,2])
Discharge for heart failure
Item
Indicate the date of each discharge for heart failure during the defined interval.
date
C0018801 (UMLS CUI [1,1])
C2361123 (UMLS CUI [1,2])
Item
Indicate if a PCI was performed
integer
C0262926 (UMLS CUI [1,1])
C1532338 (UMLS CUI [1,2])
Code List
Indicate if a PCI was performed
CL Item
No additional procedure (0)
C1298908 (UMLS CUI-1)
C1524062 (UMLS CUI-2)
C0087111 (UMLS CUI-3)
(Comment:en)
CL Item
PCI (1)
C1532338 (UMLS CUI-1)
(Comment:en)
Date of intervention #1
Item
Indicate the date of the PCI
date
C0189573 (UMLS CUI [1,1])
C2584899 (UMLS CUI [1,2])
Date of intervention #2
Item
Indicate the date of the PCI
date
C0189573 (UMLS CUI [1,1])
C2584899 (UMLS CUI [1,2])
Item
Indicate if a CABG was performed
integer
C0262926 (UMLS CUI [1,1])
C0010055 (UMLS CUI [1,2])
Code List
Indicate if a CABG was performed
CL Item
No additional procedure (0)
C1298908 (UMLS CUI-1)
C1524062 (UMLS CUI-2)
C0087111 (UMLS CUI-3)
(Comment:en)
CL Item
CABG (1)
C0010055 (UMLS CUI-1)
(Comment:en)
Date of intervention #1
Item
Indicate the date of the CABG
date
C0010055 (UMLS CUI [1,1])
C2584899 (UMLS CUI [1,2])
Date of intervention #2
Item
Indicate the date of the CABG
date
C0010055 (UMLS CUI [1,1])
C2584899 (UMLS CUI [1,2])
Item
Indicate if the patient has a new requirement for dialysis
integer
C0011946 (UMLS CUI [1,1])
C1514873 (UMLS CUI [1,2])
Code List
Indicate if the patient has a new requirement for dialysis
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Date of documented first dialysis
Item
Indicate the date the patient first began dialysis treatment
date
C0011946 (UMLS CUI [1,1])
C2584899 (UMLS CUI [1,2])
Item Group
Survival
C1148433 (UMLS CUI-1)
Item
Indicate if the patient has died, regardless of cause
integer
C0011065 (UMLS CUI [1])
Code List
Indicate if the patient has died, regardless of cause
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Death: Date of death
Item
Indicate the date the patient was declared dead
date
C1148348 (UMLS CUI [1])
Item
Indicate where the patient died
integer
C2924451 (UMLS CUI [1])
Code List
Indicate where the patient died
CL Item
Home (1)
C0442519 (UMLS CUI-1)
(Comment:en)
CL Item
Acute care hospital or rehab (2)
C3661916 (UMLS CUI-1)
C0034991 (UMLS CUI-2)
(Comment:en)
CL Item
Nursing home or hospice (3)
C0028688 (UMLS CUI-1)
C0085555 (UMLS CUI-2)
(Comment:en)
CL Item
Other (888)
C0205394 (UMLS CUI-1)
(Comment:en)

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