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Article History

Accepted: 3 November 2025

First Online: 19 November 2025

Declarations

:

: The authors have no competing interests to declare that are relevant to the content of this article.

: The initial, local data snapshots containing the centres’ pseudonymised patient data, i.e. the data from patients’ electronic medical records of routine inpatient care, cannot be shared, as the General Data Protection Regulation prohibits transfer to third parties without patient consent. However, researchers can apply for the data and related analysis via the German Portal for Medical Research Data ( Deutsches Forschungsdatenportal für Gesundheit , FDPG; ). All developed software components, including the R scripts, are available via the 'Health Atlas-Local Data Hub/Leipzig' at . The authors confirm that the complete meta-analysis results of this study are provided in this article and its supplementary materials.

: The primary ethics approval was granted by the Ethics Committee at the Medical Faculty of the University Leipzig (lead ethics committee). As applicable per local state laws, additional local votes, waivers or statements that no additional local vote was necessary were obtained for all other participating sites. The names of all relevant ethics committees and the respective reference numbers are provided in Supplementary Table S12 in the electronic supplementary material. Research was conducted in accordance with the Declaration of Helsinki.

: Informed patient consent was not required due to the retrospective, distributed analysis approach in POLAR_MI, where only anonymised data (i.e. summary statistics) not falling under the General Data Protection Regulation left the centres; processing of the patients’ electronic medical records data from routine inpatient care to obtain these summary statistics was done locally within the data integration centres and relied on research paragraphs of the respective hospital laws of the federal states, which do not require individual patient consent in this case. The ethics committees did not object to this approach and waived individual informed consent.

: Not applicable.

: Not applicable.

: Conceptualisation: LR, SS, PT. Methodology: LR, MK, BM, SG, MR, SS, PT. Formal analysis and investigation: LR, MK, BM, SG, MR, TT, FS, TP, AStr, SS, PT. Writing—original draft preparation: LR. Writing—review and editing: MK, BM, SG, MR, TT, FS, TP, AStr, DN, ASch, ML, SS, PT. Supervision: SS, PT. All authors read and approved the final version.