Nhu cầu về dữ liệu lớn trong thực hành lâm sàng góc nhìn từ bác sỹ tim mạch

“The future of precision medicine will enable health care providers to tailor treatment and prevention strategies to people’s unique characteristics, including their genome sequence, mic

Big Data:

Perspective from Cardiology

A/Prof (Adj) Yeo Khung Keong, MBBS, FAMS, FACC, FSCAI

National Heart Centre Singapore

Disclosures

• Abbott Vascular: Speaker, Proctor (MitraClip)

• Boston Scientific: Consultant, honorarium

• Philips: Honorarium

• Medtronic: Research support

• St Jude Medical: Speaker, honorarium

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What is Big Data?

• HUGE data volume

What’s the Big Deal?

• New medical discoveries

• Improved ability to predict cost, outcomes

• Policy and planning

– Manpower

– Resources

– Budgeting

• Management of epidemic and outbreaks

• Pragmatic Research trials

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Human Model Expert Model Big Data Model

Healthcare is at the beginning of a necessary transformation

D ATA A N D T E C H N O L O G Y H AV E T R A N S F O R M E D F I N A N C E

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“The future of precision medicine will enable health care

providers to tailor treatment and prevention strategies to

people’s unique characteristics, including their genome

sequence, microbiome composition, health history, lifestyle, and diet To get there, we need to incorporate many

different types of data, from metabolomics (the chemicals in the body at a certain point in time), the microbiome (the

collection of microorganisms in or on the body), and data about the patient collected by health care providers and the patients themselves Success will require that health data

is portable, that it can be easily shared between providers, researchers, and most importantly, patients and research participants.”

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Key words

“The future of precision medicine will enable health care

sequence, microbiome composition, health history,

many different types of data, from metabolomics (the

chemicals in the body at a certain point in time), the

microbiome (the collection of microorganisms in or on the

will require that health data is portable, that it can be easily

importantly, patients and research participants.”

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UK Biobank: 500,000 patients

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Benefits: New Medical Discovery

May 2016 NEJM

Genomic data!

Registry Based RCT

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Registry Based RCT

• Enrollment from national SCAAR registry

• Endpoints from national registries

• 7244 patients!!

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Quality Improvement

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RIKS-HIA Quality Index

RIKS-HIAs Quality index summarizes

the quality of care at a hospital by using

9 different quality indicators

Quality indicators 0,5 point 1 point

Aspirin in AMI patients 90% 95%

P2Y12-rec blocker in NSTEMI

patients

85% 90%

Beta-blocker in AMI patients 85% 90%

Statin in AMI patients 90% 95%

ACE-inhibitors/ARB in target

group of AMI patients

85% 90%

2005

RIKS-HIAs Quality Index

Chung et al Lancet 2014; 383:1305-12

30 day mortality after acute MI in Sweden vs UK

Comparison of short-term outcome after acute myocardial infarction

Chung et al Lancet 2014;

383:1305-12

4-country comparison – Stable Post-MI patients

All-cause death MI/stroke/all-cause death

Follow-up (years) Observed risk (%)

Sweden 26.9 (26.5–27.2) USA 36.2 (35.7–36.6) England 24.1 (22.7–25.5) France 17.9 (16.0–19.8)

Sweden 19.8 (19.4–20.2) USA 18.2 (17.6–18.9) England 21.3 (18.2–24.2) France 16.7 (14.3–19.2)

Hemingway et al ESC Congress 2014, Registry Hot Line Session

What has been done?

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Asia

> 4 billion population

– Who owns the data

– What about algorithms

Governance

• Who ‘owns’ the data?

• How should or can it be used?

• Who should be on the paper?

• What if data does not look good?

• Who should be in-charge?

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• Singapore MIR (1988–1997)1,2

– Set up in 1987, SMIR is a nationwide unselected registry

of patients with acute MI

– National Registry of Diseases (Acute Myocardial Infarction Notification) Regulations 2012 come into operation on 1st September 2012

Singapore Myocardial Infarction Registry

MIR, Myocardial Infarction Registry

1Tan ATH et al Ann Acad Med Singapore 2002;31:479–86 (1988–1997); 2 Singapore Myocardial Infarction Registry (Report 1, 2012, www.nrdo.gov.sg./, data collation 2007–2010

For further study details please see slide notes

SingCLOUD

Jurong General Sengkang General

52,654 Patients

Unique count of drug name in presentation table

166,491 Medications (Drug Name)

44812

4677 6330

8,108,134 Patients

2,689,306 Medications (Drug Name)

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Data Sources

376

Tables / views built and tested

Female Male Unknown

Number of patients by age group Number of patients by gender

Examples

• Medicare, CMS data

• SwedeHeart

Proposal

• National Data from each country

• Asia Pacific Society of Cardiology

– STEMI admin data, registry data

– No patient level data

– Biobank

Invitation

• Join us!

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