Expanding the impact of a longstanding Canadian cardiac registry through data linkage: challenges and opportunities

The Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) began as a province-wide inception cohort of all adult Alberta residents undergoing cardiac catheterization for ischemic heart disease. Strengths of the APPROACH initiative include the prospective collection of detailed clinical, procedural, and treatment information, measured at point-of-care. While this aspect of APPROACH provides data users with several advantages over use of typical administrative data, the ability to link APPROACH with data from multiple other sources has provided several unique opportunities to measure cardiovascular care and outcomes. As of June 2018, clinical information has been collected by APPROACH on over 240,000 adult Alberta residents. Linkage of this rich clinical data to administrative health data (eg. Vital statistics, hospitalizations, ambulatory events, prescription medications), secondary use clinical data (e.g. laboratory, ECG, rehabilitation, EMR, imaging) and other data sources (eg. Geospatial, crime data, meteorological) allows better study of the determinants of a patient's health trajectory. This paper describes applied examples of work that has leveraged the potential of linking several datasets with the APPROACH registry.