The Clinical Sciences and Statistics Core (CSSC) provides organizational, managerial and biostatistical support to research projects involving registries and databases within NHCS. It aims to facilitate clinical research to utilise the vast amounts of data available from the NHC clinical database network. NHCS internal databases link imaging data with clinical information in multiple modalities: echocardiography, nuclear cardiology, coronary angiography and intervention, vascular imaging, stress testing and electrophysiology related testing. The core provides NHCS researchers with the database knowledge, governance processes and biostatistical support to fulfil their research goals.
CSSC also directly manages the Singapore Cardiac Data bank (SCDB), a national registry collecting epidemiological and clinical information on cardiovascular diseases and procedures such as percutaneous coronary interventions (PCI), coronary bypass surgery, electrophysiology and pacing as well as heart failure admissions. All restructured hospitals in Singapore contribute to SCDB.
CSSC can also assist NHCS researchers to coordinate with external organizations for database/registry research projects, such as the National Registry of Disease Outcomes (NRDO) and Singapore Consortium of Cohort Studies (SCCS).
SCDB was established in 2000 as a national data bank of cardiovascular diseases and procedures. It is a rich source of national data with 80% of hospital care delivered in public institutions. Current modules include Cath/PCI, Adult cardiac surgery, ICD, pacemaker, electrophysiology studies, ablation and heart failure admissions. The data is utilized for a number of quality reporting purposes and research projects. A recent project is the development of a bespoke risk model for predicting 30 day mortality following PCI using NHCS data collected by SCDB. This project is being expanded to involve national data and to explore prediction of other adverse outcomes such as MI or stroke.
Figure 1. SingCLOUD participating organisations.
SingCLOUD is a research project initiated by NHCS and its participating institutions which includes MOH, all restructured hospitals and polyclinics. It aims to perform data extraction, integration and analysis across multiple clinical, administrative, financial and pharmacy databases in the participating institutions. The key data components will include clinical cardiovascular specific data, procedural data, financial and administrative data (e.g. cost of medications and supplies, length of stay, diagnosis codes etc.), short-to-long term clinical outcomes (including hospital re-admissions, cardiovascular events, death), and quality-of-care indices (e.g. compliance to guideline-recommended therapy and medications). SingCLOUD leverages on the Health Data Grid (HDG), which is a virtual repository that enables access to anonymised and merged data from disparate databases at multiple institutions. The structures of HDG will preserve patients’ privacy and confidentiality, ensure IT security and allow access only by authorised persons. The building of HDG is complete and SingCLOUD is currently at the stage of data analysis.
The Longitudinal project is a retrospective observational study that involves merging data from a number of different databases in NHCS, SGH and SHP. The dataset includes patient’s data admitted with suspected or proven CAD, CHF or AF at NHCS, SGH or SHP Polyclinics, from 2001 onwards, and tracking their outcomes over a 10 year period.
A number of research projects have utilised subsets of the Longitudinal dataset to provide insights in to patient long-term outcomes. Abstracts have been submitted and accepted for both poster and oral presentations in various conferences such as American College of Cardiology Scientific Sessions, World Congress of Cardiology, Transcatheter Cardiovascular Therapeutics Asia Pacific (TCTAP) and Singapore Cardiac Society Annual Scientific Meeting. The most recent analysis involving Longitudinal data aims to determine the cumulative longitudinal cost of caring for these patients. This includes total cost over a 3, 5 and 10 year period, cost of A&E visits, cost of hospitalizations for cardiovascular causes, and cost of repeat procedures, medications and investigations (e.g. blood tests and other non-invasive tests) over this period. Predictive analytics developing models for prediction of risk of death, MI, or stroke; risk of repeat procedure and readmissions; and models for estimating future cost of care of a particular patient post-discharge are also in progress.
Ongoing collaborations exist with the National Registry of Disease Outcomes (NRDO), Singapore Consortium of Cohort Studies (SCCS), and the Singapore Eye Research Institute (SERI).
Abstracts accepted for poster and oral presentations at various conferences national and international conferences: American congress of Cardiology, World Congress of Cardiology, Transcatheter Cardiovascular Therapeutics Asia Pacific (TCTAP) and Singapore Cardiac Society Annual Scientific Meeting.
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