Routinely collected hospital admission and death registry data showed strong agreement with clinical trial-adjudicated direct follow-up for serious vascular events (κ = 0.78; 95% CI, 0.76-0.80).
RCT (n=15,480)
2 × 2 factorial
Routinely collected hospital admission and death registry data in the UK can be used as a reliable sole method of follow-up for major cardiovascular events in primary prevention trials, potentially reducing trial costs without needing clinical adjudication.
Effect estimate: κ 0.78 (95% CI 0.76-0.80)
Importance: Routinely collected data could substantially decrease the cost of conducting trials. Objective: To assess the accuracy and completeness of UK routine data for ascertaining serious vascular events (SVEs) compared with adjudicated follow-up data. Design, Setting, and Participants: This was a secondary analysis of a randomized clinical trial. From June 24, 2005, to July 28, 2011, the ASCEND (A Study of Cardiovascular Events in Diabetes) primary prevention trial used mail-based methods to randomize people with diabetes without evidence of atherosclerotic vascular disease using a 2 × 2 factorial design to aspirin and/or ω-fatty acids vs matching placebo in the UK. Direct participant mail-based follow-up was the main source of outcome data, with more than 90% of the primary outcome events undergoing adjudication. Follow-up was completed on July 31, 2017. In parallel, more than 99% of participants were linked to routinely collected hospital admission and death registry data (ie, routine data), enabling post hoc randomized comparisons of different sources of outcome data (conducted from September 1, 2018, to October 1, 2021). Interventions: Random allocation to 100 mg of aspirin once daily vs matching placebo and separately to 1 g of ω-3 fatty acids once daily vs placebo. Main Outcomes and Measures: The primary outcome consisted of SVEs (a composite of nonfatal myocardial infarction, ischemic stroke, transient ischemic attack TIA, or vascular death, excluding hemorrhagic stroke). Results: A total of 15 480 participants were randomized (mean SD age, 63 9 years; 9684 62.6% men) and followed up for a mean (SD) of 7.4 (1.8) years. For SVEs, agreement between adjudicated direct follow-up and routine data sources was strong (1401 vs 1127 events; κ = 0.78 95% CI, 0.76-0.80; sensitivity, 72.0% 95% CI, 69.7%-74.4%; specificity, 99.2% 95% CI, 99.0%-99.3%), and sensitivity improved for SVEs excluding transient ischemic attack (1129 vs 1026 events; sensitivity, 80.6% 95% CI, 78.3%-82.9%). Rate ratios for the aspirin-randomized comparison for adjudicated direct follow-up vs follow-up solely through routine data alone were 0.88 (95% CI, 0.79-0.97) vs 0.91 (95% CI, 0.81-1.02) for the primary outcome and 0.92 (95% CI, 0.82-1.03) vs 0.91 (95% CI, 0.80-1.02) for SVEs excluding TIA. Results were similar for the ω-3 fatty acid comparison, and adjudication did not seem to markedly change rate ratios. Conclusions and Relevance: Post hoc analyses of the ASCEND trial suggest that routinely collected hospital admission and death registry data in the UK could be used as the sole method of follow-up for myocardial infarction, ischemic stroke resulting in hospitalization, vascular death, and arterial revascularization in primary prevention cardiovascular trials, without the need for verification by clinical adjudication.
Harper et al. (Tue,) conducted a rct in Diabetes without evidence of atherosclerotic vascular disease (n=15,480). Aspirin and/or ω-3 fatty acids vs. Matching placebo was evaluated on Serious vascular events (SVEs) ascertained by adjudicated direct follow-up vs routine data (κ 0.78, 95% CI 0.76-0.80). Routinely collected hospital admission and death registry data showed strong agreement with clinical trial-adjudicated direct follow-up for serious vascular events (κ = 0.78; 95% CI, 0.76-0.80).