Year : 2013 | Volume
: 16 | Issue : 3 | Page : 161--162
The value of database and data interpretation
Praveen Kumar Neema
Professor and Head Anaesthesiology, All India Institute of Medical Sciences Raipur, (CG), India
Praveen Kumar Neema
Professor and Head Anaesthesiology, All India Institute of Medical Sciences Raipur- 492 099 (CG)
|How to cite this article:|
Neema PK. The value of database and data interpretation.Ann Card Anaesth 2013;16:161-162
|How to cite this URL:|
Neema PK. The value of database and data interpretation. Ann Card Anaesth [serial online] 2013 [cited 2020 Jan 28 ];16:161-162
Available from: http://www.annals.in/text.asp?2013/16/3/161/114235
Meticulous data analysis generates meaningful knowledge and the way to move forward safely. In 1948, the Framingham Heart Study started in the town of Framingham, Massachusetts with an objective to identify the common factors or characteristics that contribute to cardiovascular disease (CVD). The researchers recruited 5,209 men and women between the ages of 30 and 62 years. The Framingham Study led to the identification of the major CVD risk factors - high blood pressure, high blood cholesterol, smoking, obesity, diabetes, and physical inactivity. The study was directed by the National Heart Institute (now known as the National Heart, Lung, and Blood Institute or NHLBI). The study produced approximately 1,200 articles in leading medical journals. The findings of the Framingham Heart Study resulted in the application of various preventive measures including lifestyle changes and the development of effective therapeutic measures. Indeed, the current practice of medicine the world over owes a lot to the investigators of the Framingham Heart Study.
This issue of the Annals of Cardiac Anaesthesia includes two important analytical studies, 'The application of European system for cardiac operative risk evaluation II and Society of Thoracic Surgeons risk-score for risk stratification in Indian patients undergoing cardiac surgery'  and 'Epidural catheterization in cardiac surgery: The 2012 risk assessment'.  The first study by Borde et al., include only about 500 patients, but convincingly demonstrates the poor applicability of EuroSCORE II and Society of Thoracic Surgeons (STS) risk score for estimating the risk of mortality especially in high-risk patients undergoing cardiac surgery. The authors argue further that the STS risk score is inadequate for the risk stratification of Indian patients, as the present Indian cardiac surgical patient population includes many patients of rheumatic heart disease needing double valve replacement with or without tricuspid annuloplasty and the STS score does not have the risk scoring for the same.
In the United States of America, the National Institutes of Health (NIH) is the medical research agency of the nation supporting scientific studies that turn discovery into health. The NIH is made up of 27 institutes and centers, each with a specific research agenda, often focusing on particular diseases or body systems. The leadership at NIH plays an active role in shaping the research planning activities, and outlook of the agency. The NIH selects health centers for overseeing and conduct of research activities. The STS score was developed at the Duke Clinical Research Institute, and the database currently has records of more than three million patients.  The STS database is a voluntary registry that collects data from most cardiac centers in the United States. In India, the Indian Council of Medical Research (ICMR) is the research agency of the nation. The research priorities of the Council coincide with the national health priorities such as control and management of communicable diseases, fertility control, maternal and child health, control of nutritional disorders, development of alternative strategies for health care delivery, containment within safety limits of environmental and occupational health problems, research on major noncommunicable diseases like cancer, cardiovascular diseases, blindness, diabetes, and other metabolic and hematological disorders, mental health research, and drug research (including traditional remedies). Although the research programs of the ICMR include all aspects of medical research, the majority of the research programs are directed toward preventable and communicable diseases. The clinical research in various medical fields is run by the state-sponsored medical colleges and tertiary care institutions with their own research wings acting as academic research arms and supervisory bodies. This may be an important reason that India does not have a central registry for various diseases. It is important to examine and determine whether this system of clinical research has really produced meaningful knowledge. Using the search line 'top 10 cited articles in cardiac anesthesia', 'top 10 cited articles in cardiac surgery', 'top 10 cited articles in thoracic surgery', and 'top 10 cited articles in vascular surgery' in Google Scholar from 2000 to 2013 did not yield any contributing article from India. Here, it is noteworthy that perhaps the highest number of off-pump coronary artery bypass grafting (OPCABG) surgeries is being performed in India. Needless to say, we should have been the pioneers in discovering everything about OPCABG surgery. Apparently, the present system of clinical research has not delivered what it is supposed to do. This underperformance of the present system may be due to the fact that the research is limited to the center and the collected data are limited in number. Needless to emphasize, there is an urgent need to initiate a central registry for the recording of data of cardiac surgical patients for research and analysis, and the development of an Indian scoring system for patients undergoing cardiac surgery. The major task is, how to go about it? Who should take the initiative? How to ensure submission of patient data from various institutions with the central registry? The Medical Council of India can take the initiative, create a central registry, and manage it on similar lines as the NIH and make it an obligatory requirement for the state-run institutions/medical colleges to submit their patient data to the central registry. Meanwhile, The Indian Association of Cardiothoracic Vascular Anaesthesiologists (IACTA) can ask for an undertaking from hospitals/research centers recognized by the society for granting fellowship in transesophageal echocardiography and cardiac anesthesia to submit their patient data to the research wing of the IACTA; the data so collected would form a large database for the generation of new knowledge. The IACTA and its research wing can be a model for other societies to emulate.
The second study by Hammerling et al., analyzes the risk of epidural hematoma following epidural catheterization in patients undergoing cardiac surgery. The authors argue that the risk of epidural hematoma is equivalent to that of the annual risk of prostate cancer in men, annual risk of breast cancer in women, and the risk of death in motor vehicle accidents. The invited commentary by Professor Barken is revealing and shows error in data comparison with respect to time over which the risks were compared.  The epidural hematoma in the reported cardiac surgical patients occurred in the first 24 hours after surgery which was compared to the annual risk of prostate cancer in men, annual risk of breast cancer in women, and the risk of death in motor vehicle accidents; the transformation to equivalent comparison will result in a 350 times higher risk of epidural hematoma. The same concern applies to Hemmerling's comparison of the rates of epidural hematoma with annual heart disease mortality. The inappropriate data analysis and comparison can inadvertently result in the generation of misleading information influencing the clinical practice based on unscientifically interpreted data.
|1||Borde D, Gandhe U, Hargave N, Pandey K, Khullar V. The application of European system for cardiac operative risk evaluation II and Society of Thoracic Surgeons risk-score for risk stratification in Indian patients undergoing cardiac surgery. Ann Card Anesth 2013;16:163-6.|
|2||Hemmerling TM, Cyr S, Terrasini N. Epidural catheterization in cardiac surgery: The 2012 risk assessment. Ann Card Anesth 2013;16:169-77.|
|3||Varma PK. A small step in the right direction. Ann Card Anesth 2013;16:167-8.|
|4||Barkan H. Invited commentary on - Epidural catheterization in cardiac surgery: The 2012 risk assessment. Ann Card Anesth 2013;16:177-9.|