| 1. |
- Ekestubbe, Sofia
(författare)
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Diagnosis, mortality and professional life in patients with heart failure
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Heart failure (HF) is a common and severe disease with an increasing incidence among young adults. An emerging composite endpoint is home-time. Little is known, on how living with HF affects professional life. Methods and results: In Paper I, we used medical records of 965 of patients 20-100 years with HF 2000-2012 to validate the diagnosis according to the European Society of Cardiology´s current guidelines. The diagnosis was validated as definite, probable, and miscoded HF in 601 (62.3%), 310 (32.1%) and 54 (5.6%) cases, respectively. In Paper II and III, we used the National patient register, the Cause of Death Register, and the Longitudinal integrated database for health insurance and labour market studies (LISA). In Paper II, home-time during 4-years follow-up was calculated for 388 775 patients 18-84 years, 1992-2012. Home-time increased over the study period for both age groups. Patients 18-64 years had more home-time than those 65-84 years (83.8% vs. 68.2%), mainly due to lower 4-year mortality rate (14.2% vs. 29.7%). In Paper III, time on sickness benefit during 2-year follow-up was estimated for patients and controls 18-60 years, 1995-2016. Sickness benefit time declined over the study period for both groups, with a steeper decline for patients. In Paper IV, patients 16-<55 years diagnosed with HF or dilated cardiomyopathy 1997-2016, had their records examined and 294 patients still alive and living nearby, participated. Two thirds of patients were male, mean BMI was elevated. Patients in blue-collar, compared to white-collar occupations were significantly more weighed down by thoughts of work at home, and had a lower working capacity in relation to physical demands, but were not more often on current sick leave. Conclusion: Validity of the HF-diagnosis was high, supporting the use of this register in HF-research. Patients with HF in Sweden had an increasing home-time over two decades and young patients had more home-time than older patients. Time on sickness-benefit was higher for HF-patients than for controls and decreased in both groups, but steeper in patients than controls. Most young adults with HF were male, had an elevated BMI and patients of blue-collar occupations reported more job strain than patients of white-collar occupations.
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| 2. |
- Ekestubbe, Sofia, et al.
(författare)
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Increasing home-time after a first diagnosis of heart failure in Sweden, 20 years trends
- 2022
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Ingår i: Esc Heart Failure. - : Wiley. - 2055-5822. ; 9:1, s. 555-563
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Tidskriftsartikel (refereegranskat)abstract
- Aims This study was performed to compare trends in home-time for patients with heart failure (HF) between those of working age and those of retirement age in Sweden from 1992 to 2012. Methods and results The National Inpatient Register (IPR) was used to identify all patients aged 18 to 84 years with a first hospitalization for HF in Sweden from 1992 to 2012. Information on date of death, comorbidities, and sociodemographic factors were collected from the Swedish National Register on Cause of Death, the IPR, and the longitudinal integration database for health insurance and labour market studies, respectively. The patients were divided into two groups according to their age: working age (<65 years) and retirement age (>= 65 years). Follow-up was 4 years. In total, following exclusions, 388 775 patients aged 18 to 84 years who were alive 1 day after discharge from a first hospitalization for HF were included in the study. The working age group comprised 62 428 (16%) patients with a median age of 58 (interquartile range, 53-62) years and 31.2% women, and the retirement age group comprised 326 347 (84%) patients with a median age of 77 (interquartile range, 73-81) years and 47.4% women. Patients of working age had more home-time than patients of retirement age (83.8% vs. 68.2%, respectively), mainly because of their lower 4 year mortality rate (14.2% vs. 29.7%, respectively). Home-time increased over the study period for both age groups, but the increase levelled off for older women after 2007, most likely because of less reduction in mortality in older women than in the other groups. Conclusions This nationwide study showed increasing home-time over the study period except for women of retirement age and older for whom the increase stalled after 2007, mainly because of a lower mortality reduction in this group. Efforts to improve patient-related outcome measures specifically targeted to this group may be warranted.
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| 3. |
- Schaufelberger, Maria, 1954, et al.
(författare)
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Validity of heart failure diagnoses made in 2000-2012 in western Sweden
- 2020
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Ingår i: ESC Heart Failure. - : WILEY PERIODICALS, INC. - 2055-5822. ; 7:1, s. 37-46
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Tidskriftsartikel (refereegranskat)abstract
- Aims The aim of this study is to validate a diagnosis of heart failure (HF) according to the European Society of Cardiology (ESC) guidelines among patients hospitalized at Sahlgrenska University Hospital, Gothenburg, Sweden, between 2000 and 2012. Methods and results In Sweden, it is mandatory to report all hospital discharge diagnoses to the Swedish national inpatient register. In total, 27 517 patients were diagnosed with HF at the Sahlgrenska University hospital between 2000 and 2012. Altogether, 1100 records with a primary (n = 550) or contributory (n = 550) diagnosis of HF were randomly selected. The diagnosis was validated according to the ESC guidelines from 1995, 2001, 2005, and 2008, and cases were divided into three groups: definite, probable, and miscoded. In total, 965 cases were validated, while 135 records were excluded for various reasons. Of the 965 records, the diagnosis was validated as definite in 601 (62.3%) and as probable in 310 (32.1%); only 54 (5.6%) of cases had been miscoded. Echocardiography, as an objective evidence of cardiac dysfunction, had been performed in 581 (96.7%) of the definite, 106 (34.2%) of the probable, and 31 (57.4%) of the miscoded cases. Among the probable cases, the main reason they had not been classified as a definitive diagnosis of HF was lack of examination by echocardiography (63.8%). Conclusions The overall validity of HF diagnosis at Sahlgrenska University Hospital is high. This may reflect a high diagnostic validity at the time of diagnosis in the national Swedish patient register, supporting the continued use of this register in epidemiological research.
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