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Neth Heart J. 2018 Jan;26(1):13-20. doi: 10.1007/s12471-017-1055-3.

Nationwide claims data validated for quality assessments in acute myocardial infarction in the Netherlands.

Author information

Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Vektis B.V., Zeist, The Netherlands.
KPMG-Plexus, Amstelveen, The Netherlands.
Department of Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands.
Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands.
Department of Cardiology, Deventer Ziekenhuis, Deventer, The Netherlands.
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.



Since health insurance is compulsory in the Netherlands, the centrally registered medical claims data might pose a unique opportunity to evaluate quality of (cardiac) care on a national level without additional collection of data. However, validation of these claims data has not yet been assessed.


Retrospective cohort study.


National claims data ('national registry') were compared with data collected by patient records reviews in four representative hospitals ('validation registry'). In both registries, we extracted the national diagnosis codes for ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction of 2012 and 2013. Additionally, data on medication use at one year after acute myocardial infarction (AMI) was extracted from the Dutch pharmacy information systems and also validated by local patient records reviews. The data were compared at three stages: 1) validation of diagnosis and treatment coding; 2) validation of the hospital where follow-up has taken place; 3) validation of follow-up medical treatment after 365 days.


In total, 3,980 patients ('national registry') and 4,014 patients ('validation registry') were compared at baseline. After one-year follow-up, 2,776 and 2,701 patients, respectively, were evaluated. Baseline characteristics, diagnosis and individual medication were comparable between the two registries. Of all 52,672 AMI patients in the Netherlands in 2012 and 2013, 81% used aspirin, 76% used P2Y12 inhibitors, 85% used statins, 82% used beta-blockers and 74% angiotensin converting enzyme inhibitors/angiotensin II antagonists. Optimal medical treatment was achieved in 49% of the patients with AMI.


Nationwide routinely collected claims data in patients with an acute myocardial infarction are highly accurate. This offers an opportunity for use in quality assessments of cardiac care.


Acute myocardial infarction; Administrative data; Claims data; Quality indicator; Quality of health care; Secondary prevention care

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