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Definition

The Acute coronary syndrome (ACS) data set specification is not mandated for collection but is recommended as best practice if ACS data are to be collected. This data set specification enables individual hospitals or health service areas to develop collection methods and policies appropriate for their service.

The scope for the ACS data set specification is to collect data on the period between when a person with ACS symptoms was first referred to a hospital or directly presented at a hospital, and when a person leaves the hospital, either from the emergency department or is discharged from the hospital. Some of the data relevant to the management of patients attending hospital with ACS symptoms is specified for collection at follow-up visits with a specialist or as a non-admitted patient.

Acute coronary syndromes reflect the spectrum of coronary artery disease resulting in acute myocardial ischaemia, and span unstable angina, non-ST segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI). Clinically these diagnoses encompass a wide variation in risk, require complex and time urgent risk stratification and represent a large social and economic burden.

The definitions used in this data set specification are designed to underpin the data collected by health professionals in their day-to-day acute care practice. They relate to the realities of an acute clinical consultation for patients presenting with chest pain/ discomfort and the need to correctly identify, evaluate and manage patients at increased risk of a coronary event.

The data elements specified in this metadata set provide a framework for:

  • promoting the delivery of evidenced-based acute coronary syndrome management care to patients;
  • facilitating the ongoing improvement in the quality and safety of acute coronary syndrome management in acute care settings in Australia and New Zealand;
  • improving the epidemiological and public health understanding of this syndrome; and
  • supporting acute care services as they develop information systems to complement the above.

This is particularly important, as the scientific evidence supporting the development of the data elements within the ACS data set specification indicate that accurate identification of the evolving myocardial infarction patient or the high/intermediate risk patient leading to the implementation of the appropriate management pathway impacts on the patient's outcome. Having a nationally recognised set of definitions in relation to defining a patient's diagnosis, risk status and outcomes is a prerequisite to achieving the above aims.

The ACS data set specification is based on the American College of Cardiology (ACC) Data Set for Acute Coronary Syndrome as published in the Journal of the American College of Cardiology in December 2001 (38:2114-30) as well as more recent scientific evidence around the diagnosis of myocardial infarction presented in the National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand Guidelines for the management of acute coronary syndromes (MJA 2006;184;S1-S32). The data elements are alphabetically listed and grouped in a similar manner to the American College of Cardiology's data set format. These features of the Australian ACS data set should ensure that the data is internationally comparable.

Many of the data elements in this data set specification may also be used in the collection of other cardiovascular clinical information.

Where appropriate, it may be useful if the data definitions in this data set specification were also used to address data definition needs in non-clinical environments such as public health surveys etc. This could allow for qualitative comparisons between data collected in, and aggregated from, clinical settings (i.e. using application of the ACS data set specification), with that collected through other means (e.g. public health surveys, reports).

A set of ACS data elements and standardised definitions can inform the development and conduct of future registries at both the national and local level.

The working group formed under the National Heart Foundation of Australia (Heart Foundation) and the Cardiac Society of Australia and New Zealand (CSANZ) initiative was diverse and included representation from the following organisations: the Heart Foundation, the CSANZ, the Australasian College of Emergency Medicine, the Australian Institute of Health and Welfare, the Australasian Society of Cardiac & Thoracic Surgeons, Royal Australian College of Physicians (RACP), RACP - Towards a Safer Culture, National Centre for Classification in Health (Brisbane), the NSW Aboriginal Health & Medical Research Council, the George Institute for International Health, the School of Population Health at the University of Western Australia and the National Cardiovascular Monitoring System Advisory Committee.

To ensure the broad acceptance of the data set specification, the working group also sought consultation from the heads of cardiology departments, other specialist professional bodies and regional key opinion leaders in the field of acute coronary syndromes.

Metadata items in this Data Set Specification

Below is a list of all the components within this Dataset Specification.
Each entry includes the item name, whether the item is optional, mandatory or conditional and the maximum times the item can occur in a dataset.
If the items must occur in a particular order in the dataset, the sequence number is included before the item name.


Data Elements

Reference Data Element Data Type Length Inclusion #
Emergency department stay—transport mode (arrival), code N
Specific Information:
This data element should only be collected for patients who presented to the emergency department for treatment related to acute coronary syndromes.
Conditional Inclusion:
This data element should only be collected for patients who presented to the emergency department for treatment related to acute coronary syndromes.
Number 1 optional 1
Episode of admitted patient care—admission date, DDMMYYYY Date/Time 8 optional 1
Episode of admitted patient care—admission time, hhmm Date/Time 4 optional 1
Episode of admitted patient care—separation date, DDMMYYYY Date/Time 8 optional 1
Episode of admitted patient care—separation mode, code N - - optional 1
Episode of care—principal diagnosis, code (ICD-10-AM 7th edn) ANN{.N[N]} - - optional 1
Episode of care—principal source of funding, hospital code NN String 2 optional 1
Establishment—organisation identifier (Australian), NNX[X]NNNNN - - optional 1
Health service event—presentation date, DDMMYYYY
Specific Information:
This data element should only be collected for patients who presented to the emergency department for treatment related to acute coronary syndromes.
Date/Time 8 optional 1
Health service event—presentation time, hhmm
Specific Information:
This data element should only be collected for patients who presented to the emergency department for treatment related to acute coronary syndromes.
- - optional 1
Health service event—referral to rehabilitation service date, DDMMYYYY
Specific Information:
Required to derive those referred to a rehabilitation service from those eligible to attend and who actually attend. This metadata item can be used to determine the time lag between referral and commencement of rehabilitation.
Date/Time 8 optional 1
Laboratory standard—upper limit of normal range for creatine kinase isoenzyme, total units per litre N[NNN] Number 4 optional 1
Laboratory standard—upper limit of normal range for creatine kinase myocardial band isoenzyme, total micrograms per litre N[NNN] Number 4 conditional 1
Laboratory standard—upper limit of normal range for creatine kinase myocardial band isoenzyme, total units per litre N[NNN] Number 4 conditional 1
Laboratory standard—upper limit of normal range for troponin assay, total micrograms per litre N[NNN] Number 4 conditional 1
Laboratory standard—upper limit of normal range of glycosylated haemoglobin, percentage N[N].N Number 3 conditional 1
Non-admitted patient emergency department service episode—triage category, code N
Conditional Inclusion:
This data element should only be collected for patients who presented to the emergency department for treatment related to acute coronary syndromes.
Number 1 conditional 1
Non-admitted patient emergency department service episode—type of visit to emergency department, code N
Specific Information:
This data element should only be collected for patients who presented to the emergency department for treatment related to acute coronary syndromes.
- - optional 1
Person with acute coronary syndrome—bleeding location, instrumented code N(N) Number 2 optional 1
Person with acute coronary syndrome—bleeding location, non-instrumented code N(N) Number 2 optional 1
Person with acute coronary syndrome—lifestyle counselling type, code N Number 1 optional 1
Person with acute coronary syndrome—underlying cause of acute coronary syndrome, code N Number 9 optional 1
Person—acute coronary syndrome procedure type, code NN String 2 optional 1
Person—acute coronary syndrome related medical history, code NN Number 2 optional 1
Person—acute coronary syndrome risk stratum, code N Number 1 optional 1
Person—acute coronary syndrome symptoms onset date, DDMMYYYY Date/Time 8 optional 1
Person—acute coronary syndrome symptoms onset time, hhmm Date/Time 4 optional 1
Person—angina episodes count (24 hours preceding hospital presentation), total number NN[N] Number 3 conditional 1
Person—angina status, Canadian Cardiovascular Society code N
Specific Information:
This is the status of angina that a person experiences following discharge from hospital.
Number 1 optional 1
Person—bleeding episode status, Thrombolysis in Myocardial Infarction (TIMI) code N Number 1 optional 1
Person—C-reactive protein level (measured), total milligrams per litre N[NN].N
Specific Information:
The C-reactive protein (CRP) level should be measured as early as possible following presentation to the hospital.
Number 4 optional 1
Person—C-reactive protein level measured date, DDMMYYYY
Specific Information:

The date of C-reactive protein (CRP) measurement recorded should be after or the same as the date of onset of ACS symptoms.

Date/Time 8 optional 1
Person—C-reactive protein level measured time, hhmm Date/Time 4 optional 1
Person—chest pain pattern, code N
Specific Information:

The Canadian Cardiovascular Society classes of angina can be used to support categorisation of chest pain patterns. Canadian Cardiovascular Society (CCS) classes of angina (Campeau L. Grading of angina pectoris. Circulation 1976; 54:522.)

  1. Ordinary physical activity (for example, walking or climbing stairs) does not cause angina; angina occurs with strenuous or rapid or prolonged exertion at work or recreation.
  2. Slight limitation of ordinary activity (for example, angina occurs walking or stair climbing after meals, in cold, in wind, under emotional stress, or only during the few hours after awakening; walking more than 2 blocks on the level or climbing more than 1 flight of ordinary stairs at a normal pace; and in normal conditions).
  3. Marked limitation of ordinary activity (for example, angina occurs with walking 1 or 2 blocks on the level or climbing 1 flight of stairs in normal conditions and at a normal pace).
  4. Inability to perform any physical activity without discomfort; angina syndrome may be present at rest.
Number 1 optional 1
Person—cholesterol level (measured), total millimoles per litre N[N].N Number 3 optional 1
Person—clinical evidence status (acute coronary syndrome related medical history), yes/no code N Number 1 optional 1
Person—clinical procedure timing, code N Number 1 optional 1
Person—country of birth, code (SACC 2011) NNNN Number 4 optional 1
Person—creatine kinase isoenzyme level (measured), total units per litre N[NNN]
Specific Information:
The measured CK isoenzyme levels and the timing of these measurements are important to the diagnosis of myocardial infarction.
Number 4 conditional 1
Person—creatine kinase myocardial band isoenzyme measured date, DDMMYYYY
Specific Information:

The measured CK isoenzyme levels and the timing of these measurements are important to the diagnosis of myocardial infarction.

Date/Time 8 conditional 1
Person—creatine kinase myocardial band isoenzyme measured time, hhmm
Specific Information:

The measured CK isoenzyme levels and the timing of these measurements are important to the diagnosis of myocardial infarction.

Date/Time 4 conditional 1
Person—creatine kinase-myocardial band isoenzyme level (measured), total micrograms per litre N[NNN] Number 4 conditional 1
Person—creatine kinase-myocardial band isoenzyme level (measured), total units per litre N[NNN]
Specific Information:
For Acute coronary syndrome (ACS) reporting, can be used to determine diagnostic strata.
Number 4 conditional 1
Person—creatinine serum level measured date, DDMMYYYY
Specific Information:

In settings where the monitoring of a person's health is ongoing and where a measure can change over time (such as general practice), the Service contact—service contact date, DDMMYYYY should be recorded.

Record absolute result of the most recent serum creatinine measurement in the last 12 months to the nearest µmol/L (micromoles per litre).

Date/Time 8 conditional 1
Person—creatinine serum level, total micromoles per litre NN[NN] String 4 conditional 1
Person—date of birth, DDMMYYYY Date/Time 8 optional 1
Person—date of death, DDMMYYYY
Specific Information:
If a date of death is recorded, the cause of death must also be recorded. These data are recorded regardless of the cause of death.
Date/Time 8 optional 1
Person—diabetes mellitus status, code NN String 2 conditional 1
Person—diabetes therapy type, code NN String 2 conditional 1
Person—diagnostic cardiac catheterisation date, DDMMYYYY Date/Time 8 conditional 1
Person—diagnostic cardiac catheterisation time, hhmm Date/Time 4 conditional 1
Person—dyslipidaemia treatment with anti-lipid medication indicator (current), code N Number 1 conditional 1
Person—glycosylated haemoglobin level (measured), percentage N[N].N Number 3 optional 1
Person—height (measured), total centimetres NN[N].N Number 4 conditional 1
Person—high-density lipoprotein cholesterol level (measured), total millimoles per litre [N].NN Number 3 optional 1
Person—hypertension treatment with antihypertensive medication indicator (current), code N Number 1 optional 1
Person—implantable cardiac defibrillator procedure date, DDMMYYYY Date/Time 8 optional 1
Person—implantable cardiac defibrillator procedure time, hhmm Date/Time 4 optional 1
Person—Indigenous status, code N Number 1 optional 1
Person—intra-aortic balloon pump procedure date, DDMMYYYY Date/Time 8 conditional 1
Person—intra-aortic balloon pump procedure time, hhmm Date/Time 4 conditional 1
Person—Killip classification, code N
Specific Information:

For Acute Coronary Syndrome (ACS) reporting, this data element describes the objective evidence of haemodynamic compromise by clinical examination at the time of presentation. Rales or crepitations represent evidence of pulmonary interstitial oedema on lung auscultation and an S3 is an audible extra heart sound by cardiac auscultation.

Number 1 optional 1
Person—low-density lipoprotein cholesterol level (calculated), total millimoles per litre N[N].N Number 3 conditional 1
Person—most recent stroke date, DDMMYYYY
Specific Information:
Record the date of the most recent stroke that preceded presentation to the hospital.
Date/Time 8 conditional 1
Person—non-invasive ventilation administration date, DDMMYYYY Date/Time 8 conditional 1
Person—non-invasive ventilation administration time, hhmm Date/Time 4 optional 1
Person—pacemaker insertion date, DDMMYYYY Date/Time 8 optional 1
Person—pacemaker insertion time, hhmm Date/Time 4 conditional 1
Person—person identifier, XXXXXX[X(14)] - - optional 1
Person—premature cardiovascular disease family history status, code N Number 1 optional 1
Person—reason for readmission following acute coronary syndrome episode, code N[N] Number 2 optional 1
Person—sex, code N Number 1 optional 1
Person—tobacco smoking status, code N
Specific Information:
Smoker type is used to define sub-populations of adults (age 18+ years) based on their smoking behaviour. Smoking has long been known as a health risk factor. Population studies indicate a relationship between smoking and increased mortality/morbidity. This metadata item can be used to estimate smoking prevalence.

Other uses are:

  • To evaluate health promotion and disease prevention programs (assessment of interventions)
  • To monitor health risk factors and progress towards National Health Goals and Targets
Number 1 optional 1
Person—triglyceride level (measured), total millimoles per litre N[N].N Number 3 optional 1
Person—troponin assay type, code N
Specific Information:

For Acute coronary syndrome (ACS) reporting, record the type of troponin assay (I or T) used to assess troponin levels during this presentation.

Number 1 optional 1
Person—troponin level (measured), total micrograms per litre NN.NN
Specific Information:

For Acute coronary syndrome (ACS ) reporting, can be used to determine diagnostic strata.

Number 4 optional 1
Person—troponin level measured date, DDMMYYYY Date/Time 8 optional 1
Person—troponin level measured time, hhmm Date/Time 4 optional 1
Person—underlying cause of death, code (ICD-10 2nd edn) ANN-ANN
Conditional Inclusion:
If a date of death is recorded, the cause of death must also be recorded. These data are recorded regardless of the cause of death.
String 6 optional 1
Person—units of blood transfused, total N[NNN]
Conditional Inclusion:
Record the total number of blood units (either whole blood or packed red blood cells) that the person has received following a haemorrhagic event.
Number 4 conditional 1
Person—vascular condition status (history), code NN String 2 conditional 1
Person—weight (measured), total kilograms N[NN].N Number 4 conditional 1

Comments

Guide for use:

There are six data clusters in the Acute coronary syndrome (clinical) DSS. To ensure a complete description of the clinical management of acute coronary syndromes (ACS), it is recommended that all data clusters be collected along with the individual data elements during the current ACS event by the individual hospital or health service area.

The six data clusters in this DSS include:

  1. Acute coronary syndrome clinical event cluster
  2. Functional stress test cluster
  3. Electrocardiogram cluster
  4. Ventricular ejection fraction cluster
  5. Acute coronary syndrome pharmacotherapy cluster
  6. Coronary artery cluster

References

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