Disease trajectories following myocardial infarction: insights from process mining of 145 million hospitalisation episodes

Figures

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  Fig. 1. Derivation of myocardial infarction (MI) and risk-set matched control cohorts from Hospital Episode Statistics (HES) hospitalisation episodes for adults over the age of 18 in England, 2008–2017.

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  Fig. 2. The network of disease transitions for temporally sequenced diseases following myocardial infarction (MI), for adults with MI in England, 2008–2017. Directed edges between chapter headings represent progression of individuals from one primary diagnosis to the next, grouped by ICD-10 chapters. Disease trajectories from all individuals within the MI cohort (n = 375,669) are used to construct this network. The number of individuals (and percentage of cohort) who progress from one disease chapter to the next is shown when at least 1% of individuals contribute to that progression. Edge colour (ref: colour-bar) and thickness are proportional to the number of individuals that progress from one chapter to another. Index Hospitalisation Event is defined as the first primary diagnoses (MI) at the time of matching. An interactive version of this figure—showing counts for all connections; the network for the secondary analyses; and granular sub-chapter transitions—is available at https://multimorbidity-research-leeds.github.io/.

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  Fig. 3. Disease trajectories† of primary hospitalisation cause for adults with myocardial infarction (MI) in England, compared with an age, sex, and year matched control cohort, 2008–2017. A: Chronological disease trajectories including primary diagnoses codes according to ICD-10 chapter headings, ordered by relative risk. B: Number of MI cases and matched controls following each trajectory. C: The relative risk and 95% confidence intervals of disease trajectories between MI and matched control cases, and hazard ratios—all-cause mortality calculated using time-to-event models adjusted for age, sex, year, and deprivation, accounting for cases nested within hospital trusts using random effects. D: ICD-10 chapter headings. An interactive version of this figure—showing a breakdown of disease counts within chapters—is available at https://multimorbidity-research-leeds.github.io/. The RMST for each trajectory is available in Figure S7. ∗Index Hospitalisation Event refers to the initial MI diagnoses for the MI cohort and the first primary diagnoses at the time of matching for the matched control cohort. †Only disease trajectories which were followed by at least 0.1% of the MI cohort are shown.

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  Fig. 4. Disease trajectories† of primary and secondary hospitalisation cause for adults with myocardial infarction (MI) in England, compared with an age, sex, and year matched control cohort, 2008–2017. A: Chronological disease trajectories including primary and secondary diagnoses codes according to ICD-10 chapter headings, ordered by relative risk. B: Number of MI cases and matched controls following each trajectory. C: The relative risk and 95% confidence intervals of disease trajectories between MI and matched control cases, and hazard ratios—all-cause mortality calculated using time-to-event models adjusted for age, sex, year, and deprivation, accounting for cases nested within hospital trusts using random effects. Hazard ratios are missing (n/a) where the number of deaths fell below the events-per-variable threshold, or too few cases existed for the model to converge. D: ICD-10 chapter headings. An interactive version of this figure—showing a breakdown of disease counts within chapters—is available at https://multimorbidity-research-leeds.github.io/. The RMST for each trajectory is available in Figure S11. ∗Index Hospitalisation Event refers to the initial MI diagnoses for the MI…