title: The regional myocardial infarction registry of Saxony-Anhalt (RHESA) in Germany - rational and study protocol.
abstract: BACKGROUND
  In 2012 the age-standardized acute myocardial infarction (AMI) mortality rate was in the federal state Saxony-Anhalt 67 deaths per 100.000 whereas in Germany the AMI-rate was 47 deaths per 100.000. The rate in Saxony-Anhalt was therefore 43 % above the national average. Many factors may explain this above-average AMI mortality rate: First, the prevalence of cardiovascular risk factors (e.g. arterial hypertension, diabetes mellitus, smoking) in Saxony-Anhalt is the highest among all the Federal States of Germany. Second, structural health care for patients with AMI is potentially deficient (e.g. insufficient number of percutaneous coronary intervention-centers or deficits in the pre-hospital logistics of care). Third, the pre- and in-hospital process quality of health care for patients with AMI is possibly insufficient (e.g. time to reperfusion therapy). In July 2013 we established the regional myocardial infarction registry of Saxony-Anhalt (Regionales Herzinfarktregister in Sachsen-Anhalt, RHESA). RHESA is a population-based registry in the eastern part of Germany. Aims of RHESA are to calculate the AMI morbidity and mortality rates. Furthermore we study the factors that may potentially influence these rates in Saxony-Anhalt.
  
  
  METHODS
  RHESA is a population-based registry of patients with fatal or non-fatal AMI that was established in July 2013. The registry population comprises inhabitants aged 25 years or more of the city of Halle (Saale) (n = 179.000) and inhabitants of the rural district Altmark (n = 165.000) in the federal state Saxony-Anhalt, Germany.
  
  
  CONCLUSIONS
  The main objectives of RHESA are to provide detailed estimates of the burden of AMI in Saxony-Anhalt which is the federal state with the highest AMI mortality rate in Germany and to investigate factors that influence morbidity and mortality rates due to AMI. Data collected in RHESA enable us to assess different levels of quality of health care of patients with AMI (structural, process and outcome). RHESA provides for the first time estimates of the burden of AMI in Saxony-Anhalt, and therefore contributes considerably to an improvement of the German Health Monitoring that strives for a more valid extrapolation of the nationwide morbidity and mortality rates of AMI.
authors.affiliation: Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany. stefanie.bohley@medizin.uni-halle.de.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Bohley
authors.affiliation: Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany. pietro.trocchi@uk-halle.de.
authors.forename: Pietro
authors.initials: P
authors.lastname: Trocchi
authors.affiliation: Institute of Social Medicine and Health Economics, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany. Bernt-Peter.Robra@med.ovgu.de.
authors.forename: Bernt-Peter
authors.initials: BP
authors.lastname: Robra
authors.affiliation: Institute of Rehabilitation Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany. wilfried.mau@medizin.uni-halle.de.
authors.forename: Wilfried
authors.initials: W
authors.lastname: Mau
authors.affiliation: Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, Germany. Andreas.Stang@uk-essen.de.|Department of Epidemiology, School of Public Health, Boston University, Boston, USA. Andreas.Stang@uk-essen.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Stang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002309:Cardiology; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D004632:Emergency Medical Services / Q000592:standards; D005260:Female; D005858:Germany / Q000453:epidemiology; D006297:Health Services Accessibility; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy; D062645:Percutaneous Coronary Intervention; D015995:Prevalence; D011446:Prospective Studies; D011787:Quality of Health Care; D012042:Registries; D012307:Risk Factors; D012424:Rural Population; D012907:Smoking / Q000453:epidemiology; D061665:Time-to-Treatment / Q000592:standards; D014505:Urban Population