ECHO INDICATORS- Getting sound indicators across languages


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Cardiovascular (CV)

INDICATOR: Coronary Ischaemic Disease admission (CID)


Coronary ischaemic disease (CID) is a common cause of hospital admission. In geographic studies on practice variation CID admissions are frequently proposed as a proxy measure of the burden of cardiovascular disease at the population level.

In ECHO, CID admissions are used in the study of revascularization procedures as both a risk adjuster and a calibrator; in the former case the CID admission rates are used to stratify or standardize revascularization rates at the population level, and in the latter case CID admissions, given their low systematic variation, are used to provide a measure of the expected systematic variation in revascularization rates.


Unplanned angina and/or acute myocardial infarction (AMI) admissions per 10,000 inhabitants aged 18 and older.

Numerator: Unplanned discharges of patients aged 18 and older with a primary diagnosis code of AMI or angina.

Denominator: Population aged 18 and older.


• The use of unplanned admissions is meant to increase the validity of CID admissions as a proxy measure of disease burden. This indicator does not account for either readmissions or admissions for diagnostic or treatment procedures.

• The validity of unplanned discharges as a proxy measure of burden of disease is at risk when access barriers to emergency rooms exist and/or when there is noticeable outpatient mortality, and both phenomena differ across areas.

• An alternative use for this indicator is to exclude “transfers out” to another hospital in order to avoid double counting. Double counting can occur when patients are transferred out to another hospital for further treatment or recovery, and CID admissions are counted in the referring hospital record and again in the referral hospital record. Due to the way in which the Danish system records transfers out, the use of this indicator would exclude a differential toll of admissions, distorting the actual burden of CID admissions. As a consequence, international comparisons including Denmark should not exclude transfers out.

For further information seeECHO Research Infrastructure.- Quality Report








'Annex mdc14.pdf'




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