The ACIRA Registry: A Regional Tool to Improve the Healthcare Pathway for Patients Undergoing Percutaneous Coronary Interventions and Coronary Angiographies in the French Aquitaine Region: Study Design and First Results

Abstract

Background: In France, there is a lack of information about practices and pathways of coronary angiographies and percutaneous coronary interventions (PCI). We present the design and the first results of the ACIRA registry, the goal of which is to answer questions about quality, security, appropriateness, efficiency of, and access to interventional cardiology (IC) healthcare pathway in the French Aquitaine region. Methods: The ACIRA registry is an on-going, multicenter, prospective, exhaustive, scalable, and nominative cohort study of patients who undergo coronary angiographies or percutaneous coronary intervention in any of the catheterization laboratories. The data related to hospitalizations and procedures are directly extracted from hospital information systems. In-hospital mortality, readmissions, and cardiovascular morbidity are collected from the French hospital medical information system database. An identity management system has been implemented to create the patient health care pathway. Results: From January 1, 2012, to June 30, 2018, 147,136 procedures performed on 106,005 patients have been included in the ACIRA registry. Conclusions: ACIRA has shown its ability to study the patient IC healthcare pathway, up to 1 year after the procedure. Nominative data enable the linkage between clinical and medico-administrative databases and possible supplementary data collection. The use of existing databases allowed us to limit patients lost to follow-up, prevent the double entry of data, improve data quality, and reduce the operating costs. The prospect of linkage with the French National Health Data System may offer promising opportunities for future medical research projects and for developing collaboration and benchmarking with other IC registries abroad.

Effects of healthcare system transformations spurred by the COVID-19 pandemic on management of stroke and STEMI: a registry-based cohort study in France

“…The two cohorts comprised adult patients, living in metropolitan France, and admitted to a care structure involved in the CNV Registry with recent stroke or STEMI, from 1 January 2019 to 31 August 2020. 17 The STEMI cohort comprised recent patients who had an STEMI<24 hours from symptom onset, managed in 6 EMSs, 30 emergency units (EUs) and 11 cathlabs in Aquitaine. The stroke cohort comprised patients who had a recent ischaemic or haemorrhagic stroke diagnosed by brain imaging with validation by a neurovascular physician (exclusion of transient ischaemic attacks), managed in 5 of the 6 EMSs and 14 (including 7 stroke units) of the 20 hospitals caring for >30 strokes per year in Aquitaine.…”

“…Therefore, there is a unique opportunity to study changes in care management in the region over time. 17 We assessed the impact of changes in use of care and health reorganisation spurred by the first wave of the COVID-19 pandemic on care management times of patients who had an STEMI and stroke hospitalised in the Aquitaine region. We also analysed the use and quality of care provided to these patients during the COVID-19 pandemic.…”

“…Therefore, there is a unique opportunity to study changes in care management in the region over time. 17 …”

Development and evaluation of the accuracy of an indicator of the appropriateness of interventional cardiology generated from a French registry

“…ACIRA is an exhaustive nominative and prospective cohort of patients cared with PCI, ICA or both. Included patients are all adults (≥ 18 years) French residents who underwent ICA or PCI in one of the 11 interventional cardiology hospitals (public university or local and private hospitals) in the Aquitaine region (southwestern France) and agreed to participate [ 16 ]. ACIRA registry identifies and describes patients who had an ICA or PCI in Aquitaine, assesses one-year outcomes and IC practices, healthcare pathway, and organization.…”

“…In France, such cardiovascular registries collect exhaustive and prospective data concerning interventional cardiology acts [ 14 , 15 ]. One of them, the ACIRA registry is running since 2012 and includes all acts of interventional cardiology performed in the Aquitaine region, southwestern France [ 16 ].…”