179 General discussion 7 be visible. SURF CHD II has been designed to be feasible in centers with low resources and has successfully been conducted in low-income regions and low complexity centers (24,60). Specifically, SURF CHD II is a short survey that can be completed in less than 5 minutes per patient, and data can be collected using different supports simply through a link to the online survey. The data entered in the survey is routinely collected in clinical practice, which reduces administrative requirements to participate in the study. Small and rural centers receive a limited number of eligible patients, and in SURF CHD II broad data collection timelines were set to allow registration of the required number of patients. However, this survey still encountered challenges in the inclusion of small and rural centers, related to the difficulties to reach out and insufficient resources and incentives to participate in a research study. The use of existing (real-world) data, and the linkability of surveys to these data, has the potential to further reduce the resources needed to run surveys on secondary prevention. For example, some surveys conduct specific physical measurements and laboratory analysis, while others use the information available in patient files at the time of the interview. Data from medical records is often requested by surveys and can potentially be extracted directly. Although these methods increase data management and analysis efforts, these can be centralized, substantially reducing the time and resources needed for the data collection centers. Data mining can help extracting data on lipids and smoking status (61,62) from structured and structured information in medical records. The ability of natural language processing models to directly obtain cardiovascular risk factor data from medical records is being studied (63), with great potential to optimize data collection in surveys. Implementation of electronic medical records is however lagging and not well established in several lowermiddle income countries (64). During the transition to a widespread and established use of electronic medical records in these settings, secondary prevention surveys are a useful tool to provide structured data and insights on secondary prevention. SURF CHD II included data from existing registries and data available from medical records (65,66) (Chapter 6) as a proof of concept, showing some limitations (mainly related to incomplete overlap of data collected) but feasibility of using existing data in secondary prevention surveys. Furthermore, representativeness can be improved by collaboration with international and local actors. In SURF CHD II, collaboration with the European Society of Cardiology and active involvement of local partners in center recruitment supported the inclusion of centers in multiple countries and diverse regions within countries. Quality Quality assurance during all phases of research is key to provide reliable and comparable results, and surveys in secondary prevention have implemented diverse quality assurance methods. In EUROASPIRE, PURE, and REACH, interviewers are specifically trained, measurements are performed with standardized methods, and blood samples are analyzed and centrally (11,45,46). These standardization in data collection is not feasible in pragmatic surveys that largely use pre-existing data. However, quality promotion and checks can be performed with project and data management efforts, such as regular controls of key indicators in the data entered and automatic validation during data entry to help avoiding
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