MONICA Manual, Part IV, Section 1

Medical Care Assessment Data
CORE DATA TRANSFER FORMAT - ACUTE CORONARY CARE
Form: 02
Version: 3          3.6.86
ITEM NAME SPECIFICATION AND CODES CHARACTERS COLUMNS
1 FORM Transfer format identification |_0|_2| 1 to 2
2 VERSN Format version |_3| 3
3 CENTRE MONICA Collaborating Centre |__|__| 4 to 5
4 RUNIT MONICA Reporting Unit |__|__| 6 to 7
5 SERIAL Serial number |__|__|__|__|__|__|__| 8 to 14
6 DBIRTH Date of birth (day, month, year) |__|__||__|__||__|__| 15 to 20
7 TIME Time between onset of symptoms and medical presence
1 = 0-5 minutes
2 = 6-59 minutes
3 = 60-119 minutes
4 = 2 hours-3 hours 59 minutes
5 = 4 hours- 23 hours 59 minutes
6 = >= 24 hours
7 = not known, but probably < 24 hours
8 = not relevant, no medical presence
9 = insufficient data
|__| 21
8 ACTIME If known accurately
hours
minutes
|__|__|__|
|__|__|
22 to 24
25 to 26
9 INITC Initial care given by
1 = bystander
2 = general practitioner
3 = mobile team, medical or paramedical
4 = hospital
5 = bystander and/or practitioner followed by mobile team
6 = routine ambulance
8 = not relevant
9 = insufficient data
|__| 27
10 CAROUT Did apparent cardiac arrest occur outside hospital?
1 = yes
2 = no
8 = not relevant, onset in hospital
9 = insufficient data
|__| 28
11 RESOUT If so, was cardiopulmonary resuscitation attempted outside hospital?
1 = yes
2 = no
8 = not relevant - no cardiac arrest outside hospital
9 = insufficient data
|__| 29
12 RESARR Was cardiopulmonary resuscitation attempted on arrival in hospital?
1 = yes
2 = no
8 = not relevant, no cardiac arrest outside hospital, or never taken to hospital
9 = insufficient data
|__| 30
13 CARIN Did apparent cardiac arrest occur in hospital?
1 = yes
2 = no
8 = not relevant, not taken to hospital
9 = insufficient data
|__| 31
14 RESIN Was cardiopulmonary resuscitation attempted after cardiac arrest in hospital?
1 = yes
2 = no
8 = not relevant, no cardiac arrest after arrival, or never in hospital
9 = insufficient data
|__| 32
15 SYSBP What was the first recorded systolic blood pressure after the start of medical care?
000 = no pressure
030-270 = as recorded
888 = not recorded
999 = insufficient data
|__|__|__| 33 to 35
16 PULSE What was the maximum recorded pulse rate during the first 24 hours of medical care?
000 = no pulse
020-300 = as recorded
888 = not recorded
999 = insufficient data
|__|__|__| 36 to 38
17 ECGSTE ST elevation (Minnesota code 9-2)
1 = yes
2 = no
8 = no ECG recorded, or all uncodable
9 = insufficient data
|__| 39
18 ECGSTD ST depression (Minnesota code 4-1,4-2)
1 = yes
2 = no
8 = no ECG recorded, or all uncodable
9 = insufficient data
|__| 40
19 ECGEVO Q wave evolution (MONICA protocol, def. 2.1 (A) i) to vii))
1 = yes
2 = no
8 = no ECG recorded, or all uncodable
9 = insufficient data
|__| 41
20 ECGANT Were the ECG changes that defined this acute event found in the anterior leads (V1-V5)?
1 = yes
2 = no
8 = no ECG recorded, or all uncodable
9 = insufficient data
|__| 42
21-23 What was the maximum enzyme level as a per cent of the high normal value?
21 CPK Creatinine phosphokinase
0001-8887,8889-9998 = as recorded
8888 = not relevant, not measured
9999 = insufficient data
|__|__|__|__| 43 to 46
22 AST As above, aspartate transaminase 0001-8887,8889-9998 = as recorded
8888 = not relevant, not measured
9999 = insufficient data
|__|__|__|__| 47 to 50
23 HBD As above, hydroxybutyric dehydrogenase 0001-8887, 8889-9998 = as recorded
8888 = not relevant, not measured
9999 = insufficient data
|__|__|__|__| 51 to 54
24 SMOKE Was the patient a regular smoker prior to this event?
1 = yes
2 = no
9 = insufficient data
|__| 55
25 CUNIT Was the patient admitted to coronary care or intensive care unit?
1 = yes
2 = no
8 = not relevant, sudden death
9 = insufficient data
|__| 56
26 CSTAY Duration in coronary care unit (days)
00-28 = as recorded
88 = not relevant
99 = insufficient data
|__|__| 57 to 58
27-78 DRUGS AND PROCEDURES
27-44 ..B before the onset of the event
45-62 ..D during the event (after onset and before discharge from hospital)
63-78 ..P post-event (on discharge from hospital)
27-44 ..B before the onset of the event
For the following medications and procedures, indicate whether the patient received them before the onset of the event
1 = yes
2 = no
8 = code for FINTB1-4 only
9 = insufficient data
27 ANTARB Antiarrhythmics other than beta blockers before onset |__| 59
28 ANTCOB Anticoagulants before onset |__| 60
29 ANTPLB Antiplatelet drugs before onset |__| 61
30 BBLOKB Beta blocker before onset |__| 62
31 CABLOB Calcium channel blocker before onset |__| 63
32 DIURB Diuretic treatment before onset |__| 64
33 HYPOTB Other hypotensive medication before onset |__| 65
34 INOB Inotropic drugs before onset |__| 66
35 NITROB Nitrates before onset |__| 67
36 STREPB Antistreptolytic therapy before onset |__| 68
37 CORANB Coronary angiography before onset |__| 69
38 CORBYB Coronary artery bypass surgery before onset |__| 70
39 ANGPLB Angioplasty before onset |__| 71
40 PACEB Pacing before onset |__| 72
41 FINTB1 Future intervention 1 before onset |_8| 73
42 FINTB2 Future intervention 2 before onset |_8| 74
43 FINTB3 Future intervention 3 before onset |_8| 75
44 FINTB4 Future intervention 4 before onset |_8| 76
45-62 ..D during the event (after onset and before discharge from hospital)
For the following medications and procedures, indicate whether the patient received them after the onset of the event, and before discharge from hospital.
1 = yes
2 = no
8 = not relevant, medically unattended death (and code for FINTD1-4)
9 = insufficient data
45 ANTARD Antiarrhythmics other than beta blockers during coronary event |__| 77
46 ANTCOD Anticoagulants during coronary event |__| 78
47 ANTPLD Antiplatelet drugs during event |__| 79
48 BBLOKD Beta blocker during event |__| 80
49 CABLOD Calcium channel blocker during event |__| 81
50 DIURD Diuretic treatment during event |__| 82
51 HYPOTD Other hypotensive medication after onset |__| 83
52 INOD Inotropic drugs during event |__| 84
53 NITROD Nitrates during event |__| 85
54 STREPD Antistreptolytic therapy during event |__| 86
55 CORAND Coronary angiography during event |__| 87
56 CORBYD Coronary artery bypass surgery during event |__| 88
57 ANGPLD Angioplasty during event |__| 89
58 PACED Pacing during event |__| 90
59 FINTD1 Future intervention 1 during event |_8| 91
60 FINTD2 Future intervention 2 during event |_8| 92
61 FINTD3 Future intervention 3 during event |_8| 93
62 FINTD4 Future intervention 4 during event |_8| 94
63-78 ..P post-event (on discharge from hospital)
For the following medications and procedures, indicate whether the patient received them on discharge from hospital.
1 = yes
2 = no
8 = not relevant because patient died (and code for FINTP1-4)
9 = insufficient data
63 ANTARP Antiarrhythmics other than beta blockers post-event (at discharge) |__| 95
64 ANTCOP Anticoagulants at discharge |__| 96
65 ANTPLP Antiplatelet drugs at discharge |__| 97
66 BBLOKP Beta blocker at discharge |__| 98
67 CABLOP Calcium channel blocker at discharge |__| 99
68 DIURP Diuretic treatment at discharge |__| 100
69 HYPOTP Other hypotensive medication at discharge |__| 101
70 INOP Inotropic drugs at discharge |__| 102
71 NITROP Nitrates at discharge |__| 103
72 STREPP Antistreptolytic therapy at discharge |__| 104
73 PACEP Pacing at discharge |__| 105
74 FINTP1 Future intervention 1 at discharge |_8| 106
75 FINTP2 Future intervention 2 at discharge |_8| 107
76 FINTP3 Future intervention 3 at discharge |_8| 108
77 FINTP4 Future intervention 4 at discharge |_8| 109
78 REHABP Rehabilitation scheme at discharge |__| 110

Note for the HTML-version: These instructions were extracted word to word from Version 3 of Form 01, which was part of the December 1986 revision of the MONICA Manual. Therefore, references to other sections of the Manual also refer the December 1986 revision, which has not been converted to HTML.


Instructions

The purpose of this record format is to provide an exact and common format for MONICA Collaborating Centres (MCCs) to transfer the Core Data on acute coronary care to the MONICA Data Centre (MDC). The data should be sent on magnetic tapes, not on paper forms. This format therefore corresponds with the layout of the information on magnetic tape and need not correspond with the format of locally used paper forms, although the information available on the latter has to be convertible to the former. Instructions for data transfer on magnetic tapes are given in Section 10: Data Transfer on Magnetic Tapes to the Data Centre. To avoid errors, special attention should be paid in extracting these data items from the local data set.

Compared to the pooling record of MONICA MEMO 30 (CVD/MNC/84.1, page 27), three items have been added here; Format version, MONICA Reporting Unit, and Date of birth.

General instructions

The ITEM NAME on the document is a computer variable name used for the item by the MDC.

The COLUMNS indicate the columns in which the code for the item is to appear in the record on the magnetic tape. Data for different events must be written on different records. It is recommended that the MONICA Collaborating Centres (MCCs) use records long enough to include all the acute coronary care data for an event. If that is not possible, the data for an event should be split into two records according to the instructions given in Section 10: Characteristics of the Tape.

Blank fields are not allowed in the magnetic tape record. Permissible characters are 0,1, 2, 3, 4, 5, 6, 7, 8, 9.

Instructions for making corrections to data that have already been sent to the MDC are given in Section 10: Data Transfer on Magnetic Tapes to the Data Centre.

Please contact the MDC for instructions if you cannot provide information as specified in this document, and contact the MONICA Quality Control Centre for Event Registration in Dundee if you are experiencing any problems with interpreting the coding of specific items.

Specific instructions for each item

Follow these instructions carefully when creating a computer file for transfer from the MONICA Collaborating Centre (MCC) to the MONICA Data Centre. Please ensure that the instructions are for the version of the Core Data Transfer Format that is being used. Specific instructions are listed by item below.

Item 1

FORM Transfer format identification

Enter 02 to indicate CORE DATA TRANSFER FORMAT, ACUTE CORONARY CARE

Item 2

VERSN Format version

Enter the version number that is being used by your MONICA Collaborating Centre. If the number is not 3, these instructions do not correspond to the format you are using. Check that you are using the valid version.

Item 3

CENTRE MONICA Collaborating Centre

Enter the official MONICA Collaborating Centre code number as it appears in Appendix 1: Official MONICA Centre and Reporting Unit Names and Code Numbers in Description of Data Collection Procedures for the WHO MONICA Project. If your centre is not listed, or is erroneously listed in this appendix, contact the MDC for instructions.

Item 4

RUNIT MONICA Reporting Unit

Enter the official MONICA Reporting Unit Code Number as it appears in Appendix 1: Official MONICA Centre and Reporting Unit Names and Code numbers in Description of Data Collection Procedures for the WHO MONICA Project. Even if your centre has only one population, enter the appropriate code number here.

Item 5

SERIAL Serial number

Enter the 7-digit serial number of the event for which the record had been completed. Each serial number issued must be unique within each MONICA Reporting Unit and within each register (stroke register or coronary event register). Different MONICA Reporting Units and different registers may use the same serial numbers. However, the serial numbers within a Reporting Unit and register must be different for each calendar year of event registration. Check that the serial number being entered is correct. Note especially that the serial number allocated for an acute coronary care transfer record must be the same serial number as that allocated for a coronary event transfer record, and the two records must refer to the same event in the same individual. It is therefore ESSENTIAL that MONICA Collaborating Centres have systems for checking that the serial numbers are correct.

Item 6

DBIRTH Date of birth (day, month, year)

Enter the exact date of birth. If the day and or the month are not known, enter 99s. If the year of birth is not known, use an estimate of the age to derive a year of birth and code that. Records with the year of birth entered as 99 (not known) are not acceptable as they cannot be allocated to an age group for analysis.

Item 7

TIME Time between onset and medical presence
1 = 0-5 minutes
2 = 6-59 minutes
3 = 60-119 minutes
4 = 2 hours to3 hrs 59 minutes
5 = 4 hours to 23 hrs 59 minutes
6 = >= 24 hours
7 = not known, but probably < 24 hours
8 = not relevant, as no medical presence
9 = insufficient data, or onset of attack indefinite

Onset is the onset of the acute symptoms of the coronary event (or, in their absence, the fatal collapse of the person). Where the patient has vague or intermittent symptoms followed by prolonged more severe symptoms, followed by a call for medical help, the time of onset will be the time of onset of the prolonged symptoms. Where several attacks of symptoms occur and each of these attacks could qualify as a possible onset, the onset should be timed from the onset of the first typical event of chest pain lasting more than 20 minutes. Where the patient has vague or intermittent or otherwise atypical symptoms before calling medical help, and then has typical symptoms after being seen, then the time of the onset should be that of the symptoms that led to a medical consultation. Where there is a vague onset and a slow increase in severity of symptoms over several days, that is a crescendo onset, then it will not be possible to time the onset accurately.

Medical presence is the time at which skilled medical care for the patient first becomes available, either in the form of a medical practitioner, or a specially trained and equipped team of paramedics, police, firemen, etc. able to treat cardiac arrest.

In the absence of medical or paramedic presence outside hospital, arrival at hospital counts as the time of medical presence. Estimate the time delay using circumstantial evidence if necessary. An estimate should be preferred to coding 9 (insufficient data).

Time delay until a doctor or resuscitation team is present should be recorded even if, when they arrive, they decide that the subject is dead and no medical intervention should be made. (Such cases would be coded as medically unattended under item 10, MANAGE, of the coronary event record). However, if the call for medical help is not for possible treatment or resuscitation, but simply to certify death, and the event is therefore not treated as a medical emergency, then the time interval should be coded as 8 - not relevant. If in doubt as to whether to code the time interval or not, code it.

Note that medical presence is not identical to item 9 INITC (initial care) as external cardiac massage given by a trained layman or ambulanceman would qualify for item 9 but not for item 7.

Item 8

ACTIME Accurate time delay between onset of symptoms and medical presence, if known.

This is expressed in hours and minutes. A coronary event must be detected within 28 days of the onset of symptoms and the time delay therefore must be less than 672 hours! If there was a crescendo or indeterminate onset, or if the data are otherwise insufficient, code 999 99. Code 888 88 if the code item TIME was 8.

Item 9

INITC Initial care given by:
1 = bystander
2 = general practitioner
3 = mobile team
4 = hospital
5 = bystander and/or practitioner followed by mobile team
6 = routine ambulance
8 = not relevant
9 = insufficient data

Code 1 for bystanders who have been trained in resuscitation techniques and who have carried out cardiopulmonary resuscitation on the victim. Bystander would include nurses etc. who happened to be present. Do not code 1 for untrained bystanders, such as relatives or friends who offer advice or treatment.

Code 2 for a doctor practising in the community who is called to the patient for that reason, whether or not the patient was previously registered as a patient with that doctor.

Code 3 for specially trained paramedics or a medical team, in either case specially trained and deployed to give cardiopulmonary resuscitation if needed. Routine ambulances do not qualify unless attendants have been specially trained for this task, including the use of defibrillators.

Code 4 for any sort of hospital.

Code 5 for bystander, and/or medical practitioner followed by medical team.

Code 6 for routine ambulance with no special facilities for cardiac resuscitation such as a defibrillator.

Code 8 for not relevant. This option should be used only where emergency or medical services were not involved at all. (For example if a body is found and death is confirmed later by medico-legal mechanisms without any "care" of the victim.) Such a case would have to be medically unattended (code 4 in item 10 MANAGE in the coronary event record).

Code 9 for insufficient data.

Item 10

CAROUT Did apparent cardiac arrest occur outside hospital?
1 = yes
2 = no
8 = not relevant (no cardiac arrest outside, or onset occurred in hospital)
9 = insufficient data

Code 1 (yes) if the patient collapsed apparently lifeless, or is found dead outside hospital, or if the first medical record on arrival at hospital shows that the patient was in cardiac arrest on arrival. Cardiac arrest does not have to be witnessed or confirmed by electrocardiographic evidence.

Code 2 (no) if the heart did not stop before reaching hospital.

Code 8 (not relevant) if the onset occurred in hospital.

Code 9 (insufficient data) if evidence is insufficient to answer otherwise.

Item 11

RESOUT If so, was cardiopulmonary resuscitation attempted outside hospital?
1 = yes
2 = no
8 = not relevant (no cardiac arrest outside, or onset occured in hospital)
9 = insufficient data

Code 1 (yes) for any known attempt that includes external cardiac massage and artificial respiration by any person or persons. It does not need to be successful. Use code 1 only if the code for item 10 was 1.

Code 2 (no) for cases in which cardiac arrest occurred outside hospital but no attempt was made at resuscitation.

Code 8 (not relevant) for cases in which no cardiac arrest occurred outside hospital or the onset of the attack occurred in hospital.

Code 9 for insufficient data.

Item 12

RESARR Was cardiopulmonary resuscitation attempted on arrival at hospital?
1 = yes
2 = no
8 = not relevant, (no cardiac arrest or never in hospital)
9 = insufficient data

Code 1 (yes) for cases in which resuscitation was initiated before transport to hospital and continued after arrival, and for those in which it was started on arrival, the patient having been brought in in a state of cardiac arrest.

Code 2 (no) if resuscitation was stopped immediately on arrival at hospital or never started despite patient being in cardiac arrest on arrival.

Code 8 (not relevant) if there was no cardiac arrest outside hospital, or if the patient was never brought to hospital, or if the onset of the attack occurred when the patient was already in hospital.

Code 9 for insufficient data.

Item 13

CARIN Did apparent cardiac arrest occur in hospital?
1 = yes
2 = no
8 = not relevant
9 = insufficient data

Code 1 (yes) if the patient collapsed apparently lifeless, or is found dead in hospital, but the collapse must have occurred after arrival in hospital. It is not possible to distinguish cardiac arrest from death, nor does the cardiac arrest have to be witnessed, and electrocardiographic confirmation is not necessary. If bystanders thought that cardiac arrest had occurred and the medical attendants subsequently doubted it, the judgement of the witnesses at the time of the episode should take precedence, unless there is clear evidence to the contrary (such as patient conscious and ECG monitor lead detached). In hospital means after being admitted to hospital or taken into the emergency room. Cardiac arrest occurring on the way to hospital, in the ambulance or in the street would not qualify even if the patient was still in cardiac arrest on arrival at hospital.

Code 2 (no) if the heart did not stop in hospital.

Code 8 (not relevant) for cases not taken to hospital, or for those already in cardiac arrest or dead on arrival at hospital.

Code 9 (insufficient data) if there is not enough data to code 1,2 or 8.

Item 14

RESIN Was cardiopulmonary resuscitation attempted after cardiac arrest in hospital?
1 = yes
2 = no
8 = not relevant, no cardiac arrest after arrival in hospital, or never in hospital
9 = insufficient data

Code 1 (yes) for external cardiac massage and/or electrical defibrillation carried out by nurses or doctors in hospital. It does not need to be successful.

Code 2 (no) if cardiac arrest or death occurred without any attempted resuscitation.

Code 8 (not relevant) if no cardiac arrest occurred in hospital or the patient was never in hospital during the event.

Code 9 (insufficient data) if there is insufficient information to code 1,2 or 8.

Item 15

SYSBP What was the first recorded systolic blood pressure after the start of medical care?
000 = no pressure
030-270 = as recorded
888 = not recorded
999 = insufficient data

This is the first RECORDED blood pressure in the available records and so blood pressure MEASURED but not recorded is not coded here.

Code 000 if the subject was in cardiac arrest, dead, or pulseless when first seen by someone who could have recorded the blood pressure.

Code systolic blood pressure recordings between 30 and 270mm Hg as recorded.

Code 888 if the records have been obtained and no blood pressure was recorded.

Code 999 if it has not been possible to obtain the records to see what was recorded.

Item 16

PULSE What was the maximum recorded pulse rate during the first 24 hours of medical care?
000 = no pulse
030-300 = as recorded
888 = not recorded
999 = insufficient data

Code 000 if the subject is first seen in cardiac arrest or dead and never recovers.

Code the maximum pulse rate per minute of 30 - 300 as recorded during the first 24 hours of medical care. If only one rate is recorded, use that. If there are no pulse readings available, heart rate can be obtained from the electrocardiograms.

Code 888 if records have been obtained and there is no record of a pulse rate on them nor an electrocardiogram.

Code 999 if it has not been possible to obtain the records.

Item 17

ECGSTE ST elevation (Minnesota code 9-2)
1 = yes
2 = no
8 = no ECGs recorded in the attack, or all ECGs uncodable for this item
9 = insufficient data

Code 1 if 9-2 is present in any one graph in any one lead group.

Code 2 if graphs are available and codable and there are no 9-2 codes.

Code 8 if no ECGs were recorded during the attack, or they were all uncodable.

Code 9 if graphs were recorded but are not available.

See Section 4, pages 22-27 of this MANUAL for Electrocardiographic criteria.

Item 18

ECGSTD ST depression (Minnesota code 4-1,4-2)
1 = yes
2 = no
8 = no ECGs recorded in the attack or all ECGs uncodable for this item
9 = insufficient data

Code 1 if Minnesota codes 4-1 or 4-2 are present in any one graph in any one lead group.

Code 2 if graphs are available and codable and there are no 4-1 or 4-2 codes.

Code 8 if no ECGs were recorded in the attack, or they were all uncodable for this item.

Code 9 if graphs were recorded but are not available.

Item 19

ECGEVO Q-wave evolution (MONICA criterion def. 2.1 (A) i) to vii)
1 = yes
2 = no
8 = no ECGs recorded in the attack or all ECGs uncodable
9 = insufficient data

Code 1 if criteria for "development of Q-waves" are satisfied according to protocol criteria (see Section 4, pages 22-27).

Code 2 if graphs are available and codable and these criteria are not satisfied.

Code 8 if no ECGs were recorded in the attack or they were all uncodable.

Code 9 if graphs were recorded but not available.

 

Item 20

ECGANT Were the ECG changes that defined this acute event found in the anterior leads (V1-V5)?
1 = yes
2 = no
8 = no ECG recorded in the attack, or all ECGs uncodable
9 = insufficient data

Code 1 if the ECG changes that led to the coding of the episode were in the anterior lead group (leads V1-V5).

This means that static evidence of old anterior infarction does not qualify. There has to be evidence of electrocardiograpic progression within the anterior lead group, and this must be as severe or more severe than any electrocardiographic progression in other lead groups.

These criteria are met by any of the following: (see Section 4, pages 22-27)

  1. if the answer to 19, ECGEVO is yes, and the criteria were met within the anterior lead group. This means that there is either a progression from no Q to an unequivocal Q within the anterior lead group, or a lesser Q progression (no Q to equivocal Q or equivocal Q to unequivocal Q), plus any necessary 4,5 or 9 code progression to satisfy MONICA criteria; both progressions occurring within the anterior lead group.
  2. if the criteria for evolution of an injury current are met within this lead group, so that both the sustained 9-2 codes and the T-wave progression occur within the anterior lead group (MONICA criterion 2.1B viii).
  3. if the criteria for probable ECG progression are met within the leads V1-V5, (MONICA criteria 2.2 i - iii) in the absence of criteria for definite electrocardiographic progression in either the anterior or other lead groups.

Code 2 if the graphs are available and codable and these criteria are not met.

Code 8 if no ECGs were recorded in the attack, or they were all uncodable.

Code 9 if graphs were recorded but are not available.

Items 21-23

What was the maximum enzyme level as a percentage of the high normal value?

Code the maximum value of each cardiac enzyme as a percentage of the upper limit of normal for that enzyme for that particular laboratory.

Code 8888 if such tests were not done.

Code 9999 if tests were done but results are not available.

Item 21

CPK Creatinine phosphokinase

0001-8887, 8889-9998 = percentage value, as recorded
8888 = creatinine phosphokinase test not done
9999 = insufficient data to know if tests done or results not available.

Different isoenzymes of this enzyme may all be used.

Item 22

AST Aspartate transaminase

0001-8887,8889-9998 = percentage value, as recorded
8888 = aspartate transaminase test not done
9999 = insufficient data to know if tests done or results not available

Item 23

HBD Hydroxybutyric dehydrogenase

0001-8887, 8889-9998 = percentage value, as recorded
8888 = hydroxybutyric dehydrogenase test not done
9999 = insufficient data to know if tests done or results not available

Different isoenzymes of this enzyme may all be used.

Item 24

SMOKE Regular smoker before onset of attack

1 = yes
2 = no
9 = insufficient data

Code 1 for any sort of tobacco smoking on a regular basis within 3 months of the onset of the attack.

Item 25

CUNIT Admission to coronary (cardiac) care or intensive care unit

1 = yes
2 = no
8 = not relevant, medically unattended death
9 = insufficient data

Coronary (cardiac) care and intensive care areas should be defined locally in terms reflecting the concept of a ward or part of a ward specially designated for the purpose of acute cardiac or cardiorespiratory care, including the provision of ECG monitors with oscilloscopes and alarms, and the constant presence of staff trained in the detection and treatment of arrhythmias.

Item 26

CSTAY Duration in coronary care unit (days)

00-27 = length of stay in calendar days
88 = not relevant (not admitted to CCU)
99 = insufficient data

The duration of stay in a special treatment area should be recorded in calendar days, obtained most easily by subtracting the date of admission from the date of transfer. Patients who die in the unit or are transferred out on the date of admission therefore have the length of stay in the unit recorded as 00 days. They are distinguished from patients who were not admitted at all (coded 2 item 25) as these are coded as 88 not relevant. Code 99 is reserved for patients who were admitted but the duration is not known, and for those in which item 25 was coded as not known. Code the total length of stay for patients admitted, transferred out and then readmitted to the CCU.

Items 27 to 78

DRUGS AND PROCEDURES

FOR ITEMS 27-78
 
1 = yes
2 = no
8 = not relevant
9 = insufficient data

The following items concern drug therapy and procedures: before the onset of the event that is being coded; during the event (that is from the time of onset until discharge from hospital, or 28 days); and post-event, that is at discharge or on mobilization of the patient after the period of acute therapy of the attack.

Each centre should prepare a list of drugs used locally which fall into each of the following drug categories. If a drug potentially falls into two different classes it should be coded into only one category so that it does not appear twice. However, a compound formulation that contains two drugs may be entered into two drug classes. The list on pages 28-30 gives the official names of drugs in different MONICA classes. Local coders should be provided with a similar list giving local names. In this list drugs have been allocated to their most specific category. For example, drugs are coded as calcium blockers, beta blockers, or inotropic drugs rather than antiarrhythmic drugs, and as diuretics rather than other hypotensive drugs.

The columns labelled FINT1, FINT2, FINT3, FINT4 are to be allocated in the future for new drugs, interventions or tests, and should for the moment be coded 8 = not relevant. Information will be circulated to MONICA Collaborating Centres when these columns are allocated, so that information can then be collected prospectively for coding.

The drug categories and procedures are given a suffix, explained here:

..B before the onset of the event.

Code 1 (yes) for medication and pacing before onset. This means that the patient was believed to be on this treatment at the time of the onset of the coronary event or within 28 days beforehand. Information on medication more than 28 days before the event which has been discontinued is not of interest. For procedures such as coronary artery angiography, angioplasty and bypass surgery, any time previous to the onset will qualify and this information should be available from the medical history.

Code 2 (no) if the patient was not on this treatment within 28 days before onset of the event, or there is no record of this procedure in the medical history. Absence of a history of medication or of the interventions in a written medical history should be taken as evidence that the answer is no.

Code 8 (not relevant) is only applicable in the before onset codes in the unallocated columns 41 - 44. All other items should be coded 1,2 or 9.

Code 9 if there is insufficient data to know whether these treatments or procedures had been used on this patient prior to the event.

..D during the event, that is, after the onset and before discharge from hospital. To prevent difficulties in follow up of subjects beyond the 28-day obligatory period, if this precedes discharge from hospital, the 28-day point can be used as the period of assessment of these treatments and procedures rather than the time of discharge from hospital, provided that the rules are kept consistent over time, and agree with those for coding drugs and procedures at mobilization and discharge (see later). Each MCC will need to decide whether to use 28 days or discharge from hospital as the division between these two groups of drugs and treatments. (Survival however must be assessed at 28 days, that is item 11 of the coronary event record).

Code 1 (yes) for any drug or procedure used between the onset of acute symptoms and the time at which convalescent or discharge therapy was started. Use emergency medical service or general practitioner records for the period outside hospital and the hospital drug records for the period of hospitalization. Code a drug even if it was used only once, and whether it was given by mouth or by injection. (MCCs will need to establish local coding rules as to whether the basis for coding during the event should be doctors prescriptions of what was ordered, or nursing records of what was given, as occasionally drugs will be written up but not administered.)

Code 2 (no) if there was no evidence that this drug or procedure was used.

Code 8 (not relevant) for the unallocated columns 59-62 and also for any patients who were found dead at the onset of the event, and who had no treatment or intervention in the event for that reason.

Code 9 (insufficient data) for patients for whom there are no records available from which therapy or interventions can be discovered, and there may have been drugs and interventions administered. If a patient was found in circumstances in which medication and procedures could not have been used, then it is reasonable to code 2 (no) rather than 9 (insufficient data).

..P post-episode (on discharge from hospital, at mobilization or at 28 days depending on local rules). Drugs and procedures prescribed for the post-acute, convalescent phase of management of the episode. If records are being examined after discharge from hospital, the medication and treatment prescribed for the patient to take away (home or to convalescence) should be coded. MCCs that normally register patients while they are still in hospital should formulate rules for following convalescent treatment.

Special rules will be needed also for a patient still in hospital at 28 days, as this is the limit of the obligatory period of follow-up.

Code 1 (yes) for drugs and treatments prescribed on discharge or mobilization.

Code 2 (no) if there is no evidence that the drug or treatment was prescribed.

Code 8 (not relevant) for unallocated columns 74-77, and for patients who died during the acute phase of treatment (that is before discharge or mobilization or 28 days).

Code 9 (insufficient data) for patients for whom no record of treatment on discharge is available and there is reason to believe that such treatment may have been prescribed.

Item 27

ANTARB Antiarrhythmics other than beta blockers before onset

Item 28

ANTCOB Anticoagulants before onset

Item 29

ANTPLB Antiplatelet drugs before onset

Item 30

BBLOKB Beta blocker before onset

Item 31

CABLOB Calcium blocker before onset

Item 32

DIURB Diuretic treatment before onset

Item 33

HYPOTB Other hypotensive medication before onset

Item 34

INOB Inotropic drugs before onset

Item 35

NITROB Nitrates before onset

Item 36

STREPB Antistreptolytic therapy before onset

Item 37

CORANB Coronary angiography before onset

Item 38

CORBYB Coronary artery bypass surgery before onset

Item 39

ANGPLB Angioplasty before onset

Item 40

PACEB Pacing before onset

Item 41

FINTB1 Future interventions 1 before onset

Item 42

FINTB2 Future interventions 2 before onset

Item 43

FINTB3 Future interventions 3 before onset

Item 44

FINTB4 Future interventions 4 before onset

Item 45

ANTARD Antiarrhythmics other than beta blockers during event

Item 46

ANTCOD Anticoagulants during event

Item 47

ANTPLD Antiplatelet drugs during event

Item 48

BBLOKD Beta blocker during event

Item 49

CABLOD Calcium channel blocker during event

Item 50

DIURD Diuretic treatment during event

Item 51

HYPOTD Other hypotensive medication during event

Item 52

INOD Inotropic drugs during event

Item 53

NITROD Nitrates during event

Item 54

STREPD Antistreptolytic therapy during event

Item 55

CORAND Coronary angiography during event

Item 56

CORBYD Coronary artery bypass surgery during event

Item 57

ANGPLD Angioplasty during event

Item 58

PACED Pacing during event

Item 59

FINTD1 Future interventions 1 during event

Item 60

FINTD2 Future interventions 2 during event

Item 61

FINTD3 Future interventions 3 during event

Item 62

FINTD4 Future interventions 4 during event

Item 63

ANTARP Antiarrhythmics other than beta blockers post-event (at discharge)

Item 64

ANTCOP Anticoagulants post-event (at discharge)

Item 65

ANTPLP Antiplatelet drugs post-event (at discharge)

Item 66

BBLOKP Beta blocker post-event (at discharge)

Item 67

CABLOP Calcium channel blocker post-event (at discharge)

Item 68

DIURP Diuretic treatment post-event (at discharge)

Item 69

HYPOTP Other hypotensive medication post-event (at discharge)

Item 70

INOP Inotropic drugs post-event (at discharge)

Item 71

NITROP Nitrates post-event (at discharge)

Item 72

STREPP Antistreptolytic therapy post-event (at discharge)

Item 73

PACEP Pacing post-event (at discharge)

Item 74

FINTP1 Future interventions 1 post-event (at discharge)

Item 75

FINTP2 Future interventions 2 post-event (at discharge)

Item 76

FINTP3 Future interventions 3 post-event (at discharge)

Item 77

FINTP4 Future interventions 4 post-event (at discharge)

Item 78

REHABP Formal rehabilitation

Item 78 must be defined locally but it implies a structured programme of graded exercises coupled with attention to coronary risk factors such as obesity, smoking, diet, etc.