Coronary and cerebrovascular population-based registers in Europe: are morbidity indicators comparable? : Results from the EUROCISS Project

Abstract

Background: The EUROCISS Project (European Cardiovascular Indicators Surveillance Set), as part of the Health Monitoring Programme financed by the European Commission, has been implemented to develop health indicators and recommendations for the monitoring of cardiovascular diseases (CVDs). Morbidity data are rarely available in the different countries and when available, they are very rarely comparable. The aims of this paper are to list the existing population-based registers of acute myocardial infarction (AMI) and stroke in Europe, describe their methodology, and discuss their comparability. Methods: using a questionnaire a comprehensive and updated picture on available sources of information, data, indicators, and methods were collected for population-based registers. The information requested generally included: the studied disease; the scope of the study (geographical area, temporal duration, age range, population); adopted methodologies (case definition, ICD coding for mortality and hospital discharge records, linkage and validation methods); morbidity indicators (attack rate, incidence, prevalence, case fatality rate). Results: Belgium, Denmark, Finland, France, Germany, Italy, Norway, Spain, and Sweden have ongoing population-based registers for AMI. Denmark, Finland, France, Germany, Italy, Norway, and Sweden have ongoing population-based registers for stroke. Selection procedures of events, differences in age range, different validation procedures and methods make the results from these registers difficult to compare. Conclusions: Population-based registers provide the best indicators for AMI and stroke, such as attack rate and case fatality. Registers cover large samples of the population, usually regions or large municipalities. The comparability of data across countries depends on standardization, case definition, completeness, proper linkage, common diagnostic criteria and validation procedures. Given the high burden of AMI and stroke, efforts are needed in implementing registers in all European countries.