MESA Events April 2017 Aaron Folsom MD Events

Events Process (1) Identification • Follow-up call: reports of diagnoses, hospitalizations, procedures (2) Investigation

Status of Investigations • 16, 855 investigations have been started, 16, 470 (98%) closed.

Event Release for Analysis • Events through calendar year 2014 were released Fall 2016.

Definition of Combination Endpoints MI CHD Hard CHD All CVD Hard CVD All *

Classified Events (person-based) Total n Released n Rate* per 104 PY Hard CHD (MI,

Classified Events (person-based) Total n Released n MI 294 283 Angina 334 327 (Coronary

Operational Issues • Follow-up rates are 82% (or less)--approximately 10% are “do not contact”,

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MESA Events April 2017 Aaron Folsom, MD

Events Process (1) Identification • Follow-up call: reports of diagnoses, hospitalizations, procedures (2) Investigation • Data gathering: hospital records, death certificates • Eligibility determination and scanning of records • Central abstraction (3) Classification • Events Review Committee

Status of Investigations • 16, 855 investigations have been started, 16, 470 (98%) closed. Overdue by Center (n) Overdue WFU Col JHU Minn NWU UCLA Total 52 18 42 0 16 55 183 • Of 4, 300 possible events for review, 4, 090 (95%) are classified.

Event Release for Analysis • Events through calendar year 2014 were released Fall 2016. Average follow-up = 11. 7 y. • Next release Spring 2017 (calendar year 2015)

Definition of Combination Endpoints MI CHD Hard CHD All CVD Hard CVD All * Angina X X X* Resusc Cardiac Arrest Stroke CHD Death X X Stroke Death X X X X Other Athero Death Other CVD Death X X If angina was classified as probably rather than definite, it is included in CHD All and CVD All only if coronary revascularization was performed at the same time or afterwards.

Classified Events (person-based) Total n Released n Rate* per 104 PY Hard CHD (MI, RCA, CHD death) 424 405 42 -62 All CHD (Hard CHD plus angina) 619 596 68 -90 Hard CVD (Hard CHD plus stroke) 655 637 61 -102 All CVD (without HF) 885 94 -138 910 * High at WF, lowest at NW (All CHD=JHU), other centers comparable

Classified Events (person-based) Total n Released n MI 294 283 Angina 334 327 (Coronary revasc) 391 382 CHF 317 308 Stroke 267 PVD (outside of MESA) 116 113 Total deaths 1308 1129

Operational Issues • Follow-up rates are 82% (or less)--approximately 10% are “do not contact”, but another 8% are not doing follow -up interviews, so their events are also missed. • Investigations lagging somewhat in 3 centers • Access to hospital records has been an issue, as has accurate retrieval for central abstracting • No recent QC assessment of events review • CMS data show missed events