The National Echocardiography Database Australia (NEDA): Rationale and methodology

doi:10.1016/j.ahj.2018.07.001

American Heart Journal

Volume 204, October 2018, Pages 186-189

https://doi.org/10.1016/j.ahj.2018.07.001 Get rights and content

The National Echocardiography Database Australia (NEDA) is a new echocardiography database collecting digital measurements on both a retrospective and prospective basis. To date, echocardiographic data from 435,133 individuals (aged 61.6 ± 17.9 years) with linkage to 59,725 all-cause deaths during a median of 40 months follow-up have been collected. These data will inform a number of initial analyses focusing on pulmonary hypertension, aortic stenosis and the role of artificial intelligence to facilitate accurate diagnoses of cardiac abnormalities.

Section snippets

Rationale and aim of the National Echocardiography Database Australia (NEDA)

Population based research studies such as those from Framingham have produced and validated risk stratification scores and models for various cardiovascular diseases.7., 8., 9. However, despite the increasing volume and sophistication of echocardiographic data being collected in clinical practice, the potential value of echocardiography in this regard remains unfulfilled.8., 9., 10., 11., 12.

It was on this basis we established the National Echocardiography Database Australia (NEDA). The primary

Ethics

Conforming to relevant ethical standards,¹³ and the Declaration of Helsinki (2013),¹⁴ NEDA has obtained ethical approvals across Australia from a variety of institutional, university and government Human Research Ethics Committees (HREC). Individual laboratories are invited to participate in NEDA by the NEDA Steering Group (the authors of this paper), and data is extracted after laboratory informed consent has been obtained. For retrospective data (i.e. the first backup database copy), a

Preliminary results

In late 2017, the first batch of retrospectively collated echocardiographic data from 14 Australian clinical laboratories (no pediatric centers at this point) was used to build the first iteration of the NEDA Master Database. With echocardiographic data spanning the 30-year period from 26/6/1997 to 13/6/2017, a total of 166,811 men (mean age 60.2 ± 18.8 years) and 154,704 women (mean age 60.6 ± 19.8 years) with around 20 million measurements from >530,000 investigations, form the first NEDA

Discussion

To our knowledge, NEDA is the largest echocardiography database in the world and shows enormous promise in helping us to better understand a broad range of cardiac disease states. As such, with a combination of retrospective echocardiographic data still being entered into NEDA (increasing total investigations beyond 750,000, as of June 2018) and prospective data now being collected for the foreseeable future, we are poised to fulfill our “big data” goal of linking findings from

Acknowledgements

We acknowledge the significant work done by Melissa Farthing in HREC applications. We also acknowledge the financial support from GlaxsoSmithKline, Bayer and Actelion Pharmaceuticals Australia.

References (14)

K. Okrah et al.
Trends in echocardiography utilization in the Veterans Administration Healthcare System
Am Heart J
(2010)
P.P. Sengupta
Intelligent platforms for disease assessment: novel approaches in functional echocardiography
JACC Cardiovasc Imaging
(2013)
E.J. Benjamin et al.
Determinants of Doppler indexes of left ventricular diastolic function in normal subjects (the Framingham Heart Study)
Am J Cardiol
(1992)
A.M.M.S. Minino
National Center for Health Statistics, Centers for Disease Control and Prevention. Death in the United States
(2012)
D. Mozaffarian et al.
Heart disease and stroke statistics--2015 update: a report from the American Heart Association
Circulation
(2015)
P. Beth A Virnig et al.
Trends in the use of echocardiography, 2007 to 2011
(2014)
B.A. Virnig
Toward a better understanding of the role of geography in intensity of end-of-life care: must we first come to an understanding of end-of-life care?
Med Care
(2007)

There are more references available in the full text version of this article.

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Research LetterThe National Echocardiography Database Australia (NEDA): Rationale and methodology

Section snippets

Rationale and aim of the National Echocardiography Database Australia (NEDA)

Ethics

Preliminary results

Discussion

Acknowledgements

Am Heart J

JACC Cardiovasc Imaging

Am J Cardiol

National Center for Health Statistics, Centers for Disease Control and Prevention. Death in the United States

Heart disease and stroke statistics--2015 update: a report from the American Heart Association

Circulation

Trends in the use of echocardiography, 2007 to 2011

Toward a better understanding of the role of geography in intensity of end-of-life care: must we first come to an understanding of end-of-life care?

Med Care

Research Letter
The National Echocardiography Database Australia (NEDA): Rationale and methodology