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/ Notice: This work was conducted using resources from ICHOM, the International Consortium for Health Outcomes Measurement (www.ICHOM.org). The content is solely the responsibility of the authors and does not necessarily represent the official views of ICHOM. 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 peri-interventional clinical items. The items cover a timespan from prior to the intervention (e.g. PCI or CABG) until 30 days after it. They should be assessed at the entry event and at any new index event (e.g. new revascularization procedure or new diagnosis of ACS). 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 For this version of the standard set, semantic annotation with UMLS CUIs has been added.

Link:

http://www.ichom.org/

Keywords:
Versions (2) ▾
  1. 11/22/18
  2. 4/30/20
Copyright Holder:
ICHOM
Uploaded on:

April 30, 2020

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License:
Creative Commons BY-NC 4.0
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ICHOM Coronary Artery Disease

Peri-Inverventional Clinical Form

Administrative Data
Demographic Factors
DD/MM/YYYY
Please indicate your sex at birth
Baseline health status
Indicate units of height
Indicate units of weight
Indicate whether troponin T or I
beats/min
mmHg
Indicate whether the patient has a documented discharge diagnosis of NSTEMI or STEMI
Indicate whether the patient has had an episode of cardiogenic shock at first medical contact
Indicate if the patient has had an episode of cardiac arrest evaluated by pre- hospital emergency services or emergency department personnel
Indicate the clinical status of the patient prior to entering the operating room
Indicate the clinical status of the patient prior to entering the operating room
Indicate whether the patient has Left Main Coronary Disease
Indicate the patient’s pre-procedural creatinine level unit
Prior Treatments
Indicate if the patient has had a previous CABG
DD/MM/YYYY
Indicate if the patient had a previous percutaneous coronary intervention (PCI) of any type (balloon angioplasty, stent or other)
DD/MM/YYYY
TREATMENT VARIABLES
Indicate the PCI procedure type
Indicate the cardiac surgery procedure type
Indicate the episode type
Acute complications of treatment
Indicate if the patient has died, regardless of cause
DD/MM/YYYY
Indicate where the patient died
Indicate whether the patient had a stroke
Indicate type of stroke if documented on imaging, or via lumbar puncture, neurosurgery, or autopsy
Indicate whether the patient has a diagnosis of acute renal failure
DD/MM/YYYY
DD/MM/YYYY
DD/MM/YYYY
Major surgery complications
Indicate whether the patient had prolonged pulmonary ventilator >24 hours after CABG
Indicate whether the patient had a deep sternal infection involving muscle, bone, and/or mediastinum REQUIRING OPERATIVE INTERVENTION
Indicate if the patient required a return to the operating room for bleeding with or without tamponade, graft occlusion, valve dysfunction, or other cardiac reason
Major interventional cardiology complications
Indicate if a significant dissection was observed at the time of PCI
Indicate if angiographic or clinical evidence of perforation was observed at the time of the PCI procedure
Indicate the occurrence of any emergency cardiothoracic surgical procedure (whether or not this actually involves the placing of bypass grafts)
Indicate if the patient experienced any non-cardiac vascular complications (excluding external bleeding or hematomas) at the percutaneous entry site that required treatment or intervention
Indicate if the patient experienced a suspected or confirmed bleeding event