ID

37746

Description

ICHOM Atrial Fibrillation data collection Version 1.0.0 Published: 3rd April 2019 International Consortium for Health Outcomes Measurement (ICHOM), Source: http://www.ichom.org/ The following conditions and treatment approaches (or interventions) are covered by our Standard Set. Conditions: Atrial Fibrillation Population: An adult (≥ 18 years) diagnosed with atrial fibrillation (including symptomatic patients) Treatment approaches: Management of cardiovascular risk factors and institution of preventive therapy | Pharmacological management| Non-Pharmacological management Excluded populations: Children and Young persons below 18 years Excluded conditions: Patients diagnosed with cardiotoxic acute atrial fibrillation This document contains the 6-month - Clinical/Provider Form. It has to be filled in at the 6 month timepoints between the annually form. Collecting Patient-Reported Outcome Measure: PROMIS Global Health. As there is an official distribution site, the questions of this questionnaire will not be included in this version of the standard set. For more information see: https://bit.ly/29aOZu9 Montreal Cognitive Assessment Test. For more information see: https://www.mocatest.org/ The Standard set of ICHOM was supported by the BigData@Heart organization.

Link

http://www.ichom.org/

Keywords

Versions (3)
  1. 8/21/19 8/21/19 -
  2. 8/21/19 8/21/19 -
  3. 4/30/20 4/30/20 - Sarah Riepenhausen
Copyright Holder

ICHOM

Uploaded on

August 21, 2019

DOI

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License

Creative Commons BY-NC 3.0
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ICHOM Atrial Fibrillation

English

6-month - Clinical/Provider Form

1 forms  
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
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_AT (After treatment); VARIABLEID_AS (After surgery); VARIABLEID_UPDATE (Update at least annually), etc.

Data type

text

Alias
UMLS CUI [1,1]
C0439564
UMLS CUI [1,2]
C1442488
Long-term consequences of disease
Description

Long-term consequences of disease

Alias
UMLS CUI-1
C0443252
UMLS CUI-2
C0686907
UMLS CUI-3
C0012634
Did patient anticoagulation therapy status change?
Description

Inclusion Criteria: If ‘1 = Yes’ to ANTICOAG Timing: 6 months Data Source: Clinical Type: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C1522577
UMLS CUI [1,2]
C0003281
UMLS CUI [1,3]
C0443172
Provide date when the anticoagulation therapy began
Description

Inclusion Criteria: If ‘1 = Yes’ to ANTICOAGCHANGE Timing: 6-months Data Source: Clinical Type: Single answer Response Options: DD/MM/YYY

Data type

date

Measurement units
  • DD/MM/YYY
Alias
UMLS CUI [1,1]
C1522577
UMLS CUI [1,2]
C0003281
UMLS CUI [1,3]
C0808070
DD/MM/YYY
If the patient stopped anticoagulation therapy, please provide reason
Description

Inclusion Criteria: If ‘2 = Yes, the patient stopped taking the therapy’ to ANTICOAGCHANGE Timing: 6 months Data Source: Clinical Type: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C1522577
UMLS CUI [1,2]
C1298908
UMLS CUI [1,3]
C0003281
Other reason for no anticoagulation therapy, specification
Description

Note: This item does not exist in the original standard set. It can be filled in if you tick "Other" in the item "NOANTICOAGFU" Inclusion Criteria: If Other reason for no anticoagulation therapy Timing: 6 months Data Source: Clinical Type: Single answer

Data type

text

Alias
UMLS CUI [1,1]
C3840932
UMLS CUI [1,2]
C1298908
UMLS CUI [1,3]
C0003281
UMLS CUI [1,4]
C2348235
Complications of treatment
Description

Complications of treatment

Alias
UMLS CUI-1
C0087111
UMLS CUI-2
C0009566
Which class of medication was discontinued by the patient 1 = Antithrombotic
Description

Inclusion Criteria: If ‘1 = Yes’ to MEDSEDISCONT Timing: Baseline, 6 monthly Data Source: Clinical Type: Multiple answer

Data type

boolean

Alias
UMLS CUI [1,1]
C0558681
UMLS CUI [1,2]
C1704311
Which class of medication was discontinued by the patient 2 = Anticoagulation
Description

Inclusion Criteria: If ‘1 = Yes’ to MEDSEDISCONT Timing: Baseline, 6 monthly Data Source: Clinical Type: Multiple answer

Data type

boolean

Alias
UMLS CUI [1,1]
C0558681
UMLS CUI [1,2]
C0003281
Which class of medication was discontinued by the patient 3 = Antiplatelet
Description

Inclusion Criteria: If ‘1 = Yes’ to MEDSEDISCONT Timing: Baseline, 6 monthly Data Source: Clinical Type: Multiple answer

Data type

boolean

Alias
UMLS CUI [1,1]
C0558681
UMLS CUI [1,2]
C1096021
Which class of medication was discontinued by the patient 4 = Rhythm control
Description

Inclusion Criteria: If ‘1 = Yes’ to MEDSEDISCONT Timing: Baseline, 6 monthly Data Source: Clinical Type: Multiple answer

Data type

boolean

Alias
UMLS CUI [1,1]
C0558681
UMLS CUI [1,2]
C0871269
UMLS CUI [1,3]
C2587213
Which class of medication was discontinued by the patient 5 = Rate control
Description

Inclusion Criteria: If ‘1 = Yes’ to MEDSEDISCONT Timing: Baseline, 6 monthly Data Source: Clinical Type: Multiple answer

Data type

boolean

Alias
UMLS CUI [1,1]
C0558681
UMLS CUI [1,2]
C0018810
UMLS CUI [1,3]
C2587213
Which class of medication was discontinued by the patient 6 = Other (specify)
Description

Inclusion Criteria: If ‘1 = Yes’ to MEDSEDISCONT Timing: Baseline, 6 monthly Data Source: Clinical Type: Multiple answer

Data type

boolean

Alias
UMLS CUI [1,1]
C0558681
UMLS CUI [1,2]
C0205394
Which class of medication was discontinued by the patient 999 = Unknown
Description

Inclusion Criteria: If ‘1 = Yes’ to MEDSEDISCONT Timing: Baseline, 6 monthly Data Source: Clinical Type: Multiple answer

Data type

boolean

Alias
UMLS CUI [1,1]
C0558681
UMLS CUI [1,2]
C0439673
Other class of medication discontinuation, specification
Description

Note: This item does not exist in the original standard set. It can be filled in if you tick "MEDCLASS_6". Inclusion Criteria: If you tick "MEDCLASS_6" Timing: Baseline, 6 monthly Data Source: Clinical Type: Free text

Data type

text

Alias
UMLS CUI [1,1]
C0558681
UMLS CUI [1,2]
C0205394
UMLS CUI [1,3]
C2348235
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Similar models

6-month - Clinical/Provider Form

1 forms
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
text
C0439564 (UMLS CUI [1,1])
C1442488 (UMLS CUI [1,2])
Item Group
Long-term consequences of disease
C0443252 (UMLS CUI-1)
C0686907 (UMLS CUI-2)
C0012634 (UMLS CUI-3)
Item
Did patient anticoagulation therapy status change?
integer
C1522577 (UMLS CUI [1,1])
C0003281 (UMLS CUI [1,2])
C0443172 (UMLS CUI [1,3])
Change in anticoagulation therapy status (follow-up)
Code List
Did patient anticoagulation therapy status change?
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes, the patient started taking the therapy (1)
C1705108 (UMLS CUI-1)
C0087111 (UMLS CUI-2)
C0439659 (UMLS CUI-3)
(Comment:en)
CL Item
Yes, the patient stopped taking the therapy (2)
C1705108 (UMLS CUI-1)
C0087111 (UMLS CUI-2)
C2746065 (UMLS CUI-3)
(Comment:en)
Anticoagulation therapy follow up
Item
Provide date when the anticoagulation therapy began
date
C1522577 (UMLS CUI [1,1])
C0003281 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,3])
Item
If the patient stopped anticoagulation therapy, please provide reason
integer
C1522577 (UMLS CUI [1,1])
C1298908 (UMLS CUI [1,2])
C0003281 (UMLS CUI [1,3])
Patient not prescribed anticoagulation therapy at follow up
Code List
If the patient stopped anticoagulation therapy, please provide reason
CL Item
Not recommended by current guidelines. Anticoagulants are not appropriate for beneficial reasons e.g. young patient with no underlying heart conditions (1)
C3846195 (UMLS CUI-1)
C1548788 (UMLS CUI-2)
C0003280 (UMLS CUI-3)
C0086387 (UMLS CUI-4)
(Comment:en)
CL Item
Not recommended by current guidelines. Anticoagulants inappropriate for harmful reason or due to harm reasons e.g. patients with serious bleeding events (2)
C3846195 (UMLS CUI-1)
C1548788 (UMLS CUI-2)
C0003280 (UMLS CUI-3)
C0035647 (UMLS CUI-4)
(Comment:en)
CL Item
Patient decline (3)
C0040809 (UMLS CUI-1)
(Comment:en)
CL Item
Medication and / or monitoring / follow-up unavailable (4)
C0013227 (UMLS CUI-1)
C1522577 (UMLS CUI-2)
C0686905 (UMLS CUI-3)
C0030695 (UMLS CUI-4)
C1522577 (UMLS CUI-5)
C0686905 (UMLS CUI-6)
(Comment:en)
CL Item
Cognitive disfunction (5)
C0338656 (UMLS CUI-1)
(Comment:en)
CL Item
Short life expectancy (6)
C0023671 (UMLS CUI-1)
C1806781 (UMLS CUI-2)
(Comment:en)
CL Item
High costs (including health insurance issue) (7)
C0085552 (UMLS CUI-1)
C0021682 (UMLS CUI-2)
(Comment:en)
CL Item
Other (specify) (8)
C3840932 (UMLS CUI-1)
(Comment:en)
Other reason for no anticoagulation therapy, specification
Item
Other reason for no anticoagulation therapy, specification
text
C3840932 (UMLS CUI [1,1])
C1298908 (UMLS CUI [1,2])
C0003281 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,4])
Item Group
Complications of treatment
C0087111 (UMLS CUI-1)
C0009566 (UMLS CUI-2)
Class of medication discontinued by patient: Antithrombotic
Item
Which class of medication was discontinued by the patient 1 = Antithrombotic
boolean
C0558681 (UMLS CUI [1,1])
C1704311 (UMLS CUI [1,2])
Class of medication discontinued by patient: Anticoagulation
Item
Which class of medication was discontinued by the patient 2 = Anticoagulation
boolean
C0558681 (UMLS CUI [1,1])
C0003281 (UMLS CUI [1,2])
Class of medication discontinued by patient: Antiplatelet
Item
Which class of medication was discontinued by the patient 3 = Antiplatelet
boolean
C0558681 (UMLS CUI [1,1])
C1096021 (UMLS CUI [1,2])
Class of medication discontinued by patient: Rhythm control
Item
Which class of medication was discontinued by the patient 4 = Rhythm control
boolean
C0558681 (UMLS CUI [1,1])
C0871269 (UMLS CUI [1,2])
C2587213 (UMLS CUI [1,3])
Class of medication discontinued by patient: Rate control
Item
Which class of medication was discontinued by the patient 5 = Rate control
boolean
C0558681 (UMLS CUI [1,1])
C0018810 (UMLS CUI [1,2])
C2587213 (UMLS CUI [1,3])
Class of medication discontinued by patient: Other
Item
Which class of medication was discontinued by the patient 6 = Other (specify)
boolean
C0558681 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
Class of medication discontinued by patient: Unknown
Item
Which class of medication was discontinued by the patient 999 = Unknown
boolean
C0558681 (UMLS CUI [1,1])
C0439673 (UMLS CUI [1,2])
Other class of medication discontinuation, specification
Item
Other class of medication discontinuation, specification
text
C0558681 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
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