lance for events occurring through December 31, 2010. A renewal is pending that will extend surveillance through December 31, 2014.

All residents of the four geographically defined communities are included in ARIC community surveillance regardless of race or ethnicity. The white minority in Jackson and the black minority in Forsyth County are oversampled. The number of persons reported to be neither black nor white has been small in these communities and currently produce unstable event rates. Both men and women of all race or ethnic groups are eligible for selection in ARIC community surveillance.

Frequency of Collection and Sources of Data: ARIC community surveillance identifies, samples, and investigates hospitalizations on a continuous basis and produces annual event rates in the four communities. Sources include hospitalized events for acute myocardial infarction are identified from electronic lists of discharges obtained for catchment area hospitals on an ongoing basis. Hospitalizations selected (sampled) for investigation are identified and medical records for those events are obtained by trained ARIC medical record abstractors. Medical records are abstracted using a standardized, web-based data entry system.

Fatal events for investigation are identified through electronic lists of deaths obtained from local or state health departments. Deaths are sampled based on underlying cause of death codes. Sampled death certificates are obtained and abstracted by trained ARIC staff. Death with an underlying cause of death code that is related to CHD and occurring out-of-hospital are targeted for further investigation through telephone interview with next of kin or witness. The decedent’s physician is also identified from the death certificate and sent a questionnaire requesting information relevant to classification of the death. If a coroner or medical examiner, information is also obtained if appropriate. For ARIC cohort participants, hospitalizations for investigation are identified through an annual follow-up telephone interview conducted by ARIC staff. In addition to the events noted above, stroke related hospitalizations are also indentified among cohort members. Any hospitalization reported by a cohort member through annual follow-up telephone interviews or found through routine community surveillance is identified and obtained for abstraction. Deaths among cohort members are identified either through annual follow-up contact, monitoring of electronic death files from local and state health departments, or by on-going monitoring of obituaries in the study communities by ARIC staff.

Mode of Data Collection: Data on hospitalizations and deaths are collected manually through detailed abstraction of medical record or death records. Data from next of kin for out-of-hospital deaths are collected through a telephone interview. Mailed surveys are also used to solicit information from physicians identified on death certificates for selected cases.

Specific Questions Related to CVD, COPD, Asthma, and/or Diabetes: In ARIC community surveillance, information collected on sampled hospitalized myocardial infarction and heart failure events include specific items on medical history and comorbid conditions such as chronic pulmonary disease and diabetes. Furthermore, all discharge codes for sampled cases are also recorded. However, hospitalizations for chronic pulmonary disease, asthma, and/or diabetes are not specifically investigated in ARIC community surveillance.

Among ARIC cohort participants, all hospitalizations for any reason are indentified and ICD-9-CM discharge diagnoses and procedure codes recorded. Those related to myocardial infarction, heart failure, and stroke are investigated further as noted above. During the annual follow-up interview of cohort participants, questions are asked that relate to pulmonary signs and symptoms as well as self-reported physician diagnosis of diabetes.

Information Obtained: Measures available through ARIC community surveillance are summarized as follows:

  • Incidence: Annual incidence rates of hospitalized acute myocardial infarction (1987–2014)
  • Annual incidence rates of hospitalized acute decompensated heart failure (2005–2014)
  • Annual mortality rates due to coronary heart disease (1987–2014)
  • Annual mortality due to sudden cardiac death (1987–2014)
  • Case fatality: Annual case fatality rates (through one year) after hospitalized acute MI (1987–2014)
  • Clinical care information: Procedures during hospital stay for hospitalized acute MI (* includes data on time since event onset): Cardiac catheterization, coronary angiography, coronary angioplasty,* coronary atherectomy,* Swan-Ganz catheterization, echocardiography, coronary bypass surgery,* intracoronary thrombolytic therapy,* intravenous thrombolytic therapy,* aortic balloon pump, MRI scan of heart, exercise

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