The Cardiovascular Disease and Outcomes Research Program has several ongoing research studies, including research on atrial fibrillation, heart failure, atherosclerosis and myocardial infarction.
Data for these studies come from the Heart Disease in Communities cohort via the Rochester Epidemiology Project. The extensive medical record linkage system of the Rochester Epidemiology Project allows for the capture of all diagnoses, procedures, demographics, vitals, laboratory data, outpatient prescriptions, patient-provided information, inpatient and outpatient visits, and deaths. For patients from Olmsted County, the median medical record duration is 47 years.
Some key exposures include:
- Cardiovascular risk factors. The depth of electronic health record information enables us to accurately characterize cardiovascular risk factors. Some of the many risk factors we systematically ascertain for cohort participants include body mass index; smoking status; and diagnoses of hypertension, hyperlipidemia and diabetes. We use standardized definitions whenever possible and incorporate vitals, laboratory data and prescription information to characterize these exposures, allowing for recalibration of the definitions as necessary when new guidelines are released that update the criteria for diagnosis.
- Frailty and multimorbidity. We created an electronic index of frailty using diagnoses and self-reported data on activities of daily living that predicted death equally as well as a physical assessment of frailty in patients with heart failure. Our team has developed a major line of work focusing on multimorbidity and multiple chronic conditions in patients with heart disease.
- Patient-centric factors. We have obtained survey data on patient-centric factors that include social support, self-management and health literacy in patients with heart failure in Southeast Minnesota since 2013.
- Imaging. Through the Rochester Epidemiology Project, we have access to extensive imaging data, including noninvasive and invasive cardiac testing.
- Biospecimens. A large proportion of patients from our Heart Disease in Communities cohort have given consent to prospective evaluations and to broad (including national) use of their stored biological specimens for research. The biorepository contains about 30,000 biospecimens from 4,665 unique patients, with prospective recruitment ongoing.
Some key outcomes from the cohort include:
- Disease. All recurrent events are captured with the same ascertainment methods.
- Procedures. Using computable phenotypes, we capture all revascularization procedures, including percutaneous coronary intervention and coronary artery bypass grafting.
- Health care utilization. All outpatient visits, emergency department visits and hospitalizations are enumerated for all patients, with a rate of visits per person-year of 8.7. Because cohort patients have an average of nine health care visits a year, which are all captured through the Rochester Epidemiology Project, our ascertainment of outcomes is uniquely comprehensive.
- Vital status. The Rochester Epidemiology Project obtains death information from death certificates from the state of Minnesota, medical records and periodic searches of the National Death Index. Information on the occurrence and cause of death is virtually complete.