| 1. |
- Basic, Carmen, 1975, et al.
(författare)
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High validity of cardiomyopathy diagnoses in western Sweden (1989-2009)
- 2018
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Ingår i: ESC heart failure. - : Wiley. - 2055-5822. ; 5:2, s. 233-240
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Tidskriftsartikel (refereegranskat)abstract
- AIM: Hospital discharges with a diagnosis of cardiomyopathy have more than doubled in Sweden since 1987. We validated the cardiomyopathy diagnoses over this time period to investigate that the increase was real and not a result of improved recognition of the diagnosis and better diagnostic methods. METHODS AND RESULTS: Every fifth year from 1989 to 2009, records for all patients with a cardiomyopathy diagnosis were identified by searching the local registers in three hospitals in Vastra Gotaland, Sweden. The diagnoses were validated according to criteria defined by the European Society of Cardiology from 2008. The population comprised 611 cases with cardiomyopathy diagnoses [mean age 58.9 (SD 15.5) years, 68.2% male], divided into three major groups: dilated, hypertrophic, and other cardiomyopathies. Hypertrophic cardiomyopathy and hypertrophic obstructive cardiomyopathy were analysed as a group. Cardiomyopathies for which there were few cases, such as restrictive, arrhythmogenic right ventricular, left ventricular non-compaction, takotsubo, and peripartum cardiomyopathies, were analysed together and defined as 'other cardiomyopathies'. Relevant co-morbidities were registered. The use of echocardiography was 99.7%, of which 94.6% was complete echocardiography reports. The accuracy rates of the diagnoses dilated cardiomyopathy, hypertrophic cardiomyopathy, and other cardiomyopathies were 85.5%, 87.5%, and 100%, respectively, with no differences between the three hospitals or years studied; nor did the prevalence of co-morbidities differ. CONCLUSIONS: The accuracy rate of the cardiomyopathy diagnoses from in-hospital records from >600 patients in western Sweden during a 20 year period was 86.6%, with no significant trend over time, strengthening epidemiological findings that this is likely due to an actual increase in cardiomyopathy diagnoses rather than changes in coding practices. The use of echocardiography was high, and there was no significant difference in co-morbidities during the study period. The accuracy rate of the cardiomyopathy diagnoses during the 20 year period was high. The use of diagnostic tools did not increase under the study period, and once cardiomyopathy diagnoses were suspected, echocardiography was performed in almost all cases. In this study, the occurrence of cardiomyopathy was increasing over time without significant increase of co-morbidity, supporting that an actual increase of cardiomyopathy has occurred.
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| 2. |
- Björck, Lena, 1959, et al.
(författare)
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Trends in survival of Swedish men and women with heart failure from 1987 to 2014: a population-based case-control study
- 2022
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Ingår i: Esc Heart Failure. - : Wiley. - 2055-5822. ; 9:1, s. 486-495
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Tidskriftsartikel (refereegranskat)abstract
- Aims To compare trends in short-term and long-term survival of patients with heart failure (HF) compared with controls from the general population. Methods and results We used data from the Swedish National Inpatient Registry to identify all patients aged >= 18 years with a first recorded diagnosis of HF between 1 January 1987 and 31 December 2014 and compared them with controls matched on age and sex from the Total Population Register. We included 702 485 patients with HF and 1 306 183 controls. In patients with HF aged 18-64 years, short-term (29 days to 6 months) and long-term mortality (>11 years) decreased from 166 and 76.6 per 1000 person-years in 1987 to 2000 to 99.6 and 49.4 per 1000 person-years, respectively, in 2001 to 2014. During the same period, mortality improved marginally, in those aged >= 65 years: short-time mortality from 368.8 to 326.2 per 1000 person-years and long-term mortality from 219.6 to 193.9 per 1000 person-years. In 1987-2000, patients aged <65 years had more than three times higher risk of dying at 29 days to 6 months, with an hazard ratio (HR) of 3.66 [95% confidence interval (CI) 3.46-3.87], compared with controls (P < 0.0001) but substantially higher in 2001-2014 with an HR of 11.3 (95% CI 9.99-12.7, P < 0.0001). HRs for long-term mortality (6-10 and >11 years) increased moderately from 2.49 (95% CI 2.41-2.57) and 3.16 (95% CI 3.07-3.24) in 1987-2000 to 4.35 (95% CI 4.09-4.63) and 4.11 (95% CI 3.49-4.85) in 2001-2014, largely because survival among controls improved more than that among patients with HF (P < 0.0001). Conclusions Absolute survival improved in HF patients aged <65 years, but only marginally so in those aged >= 65 years. Compared with controls, both short-term and long-term relative risk of dying increased, especially in younger patients with HF.
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| 3. |
- 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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| 4. |
- Hjalmarsson, Clara, 1969, et al.
(författare)
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Risk of stroke in patients with heart failure and sinus rhythm: data from the Swedish Heart Failure Registry.
- 2021
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Ingår i: ESC heart failure. - : Wiley. - 2055-5822. ; 8:1, s. 85-94
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Tidskriftsartikel (refereegranskat)abstract
- We investigated the 2year rate of ischaemic stroke/transient ischaemic attack (IS) in patients with heart failure (HF) who were in sinus rhythm (HF-SR) and aimed to develop a score for stratifying risk of IS in this population.A total of 15425 patients (mean age 71.5years, 39% women) with HF-SR enrolled in the Swedish Heart Failure Register were included; 28815 age-matched and sex-matched controls, without a registered diagnosis of HF, were selected from the Swedish Population Register. The 2year rate of IS was 3.0% in patients and 1.4% in controls. In the patient group, a risk score including age (1p for 65-74years; 2p for 75-84years; 3p for ≥85years), previous IS (2p), ischaemic heart disease, diabetes, hypertension, kidney dysfunction, and New York Heart Association III/IV class (1p each) was generated. Over a mean follow-up of 20.1 (SD 7.5)months, the cumulative incidences (per 1000 person-years) of IS in patients with score 0 to ≥7 were 2.2, 5.3, 8.9, 13.2, 15.7, 20.4, 26.4, and 33.0, with hazard ratios for score 1 to ≥7 (with 0 as reference): 2.4, 4.1, 6.1, 7.2, 9.4, 12.2, and 15.3. The risk score performed modestly (area under the curve 63.7%; P=0.4711 for lack of fit with a logistic model; P=0.7062 with Poisson, scaled by deviance).In terms of absolute risk, only 27.6% of patients had an annual IS incidence of ≤1%. To which extent this would be amenable to anticoagulant treatment remains conjectural. A score compiling age and specific co-morbidities identified HF-SR patients with increased risk of IS with modest discriminative ability.
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| 5. |
- Kontogeorgos, Silvana, 1977, et al.
(författare)
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A nationwide study of temporal trends of cause-specific hospital readmissions in patients with heart failure.
- 2023
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Ingår i: ESC heart failure. - 2055-5822. ; 10:5, s. 2973-81
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Tidskriftsartikel (refereegranskat)abstract
- The impact of hospital readmissions on the outcomes of heart failure (HF) patients is well known. However, data on temporal trends of cause-specific hospital readmissions in these patients are limited.From 1987 to 2014, we identified and followed up for 1year 608135 patients ≥18years hospitalized with HF according to the International Classification of Diseases (ICD) 9 and 10 from the National Inpatient Register. Readmissions for cardiovascular (CVD) and non-CVD causes and co-morbidities were defined according to ICD-9 and ICD-10 codes. We analysed trends in the incidence rate of readmissions, the median time to the first rehospitalization, and the time to readmission, stratified by sex, age groups and cause of rehospitalization using linear regression. During our study, 1year all-cause mortality decreased (β=-4.93, P<0.0001), but the incidence rate of readmissions per 1000 person-years remained unchanged. The readmission rate for CVD causes decreased; in contrast, the readmission rate increased across all age and sex groups for non-CVD causes. Analysing the patients by study periods (1987-1997, 1998-2007 and 2008-2014), CVD and non-CVD co-morbidities had a statistically significant increasing trend (P<0.001). The median time in hospital decreased and the median time to the first readmission were almost unchanged.Contrary to a declining mortality rate, the incidence rate of readmissions saw no change, possibly because of divergent trends in cause-specific readmissions. An increasing rate of readmissions for non-CVD causes underscores the importance of optimising multimorbidity management to reduce the risk of readmissions in patients with HF.
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| 6. |
- Lindgren, Martin, et al.
(författare)
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Elevated resting heart rate in adolescent men and risk of heart failure and cardiomyopathy.
- 2020
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Ingår i: ESC heart failure. - : Wiley. - 2055-5822. ; 7:3, s. 1178-1185
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Tidskriftsartikel (refereegranskat)abstract
- This study aims to investigate the association of resting heart rate (RHR) measured in late adolescence with long-term risk of cause-specific heart failure (HF) and subtypes of cardiomyopathy (CM), with special attention to cardiorespiratory fitness.We performed a nation-wide, register-based cohort study of all Swedish men enrolled for conscription in 1968-2005 (n=1008363; mean age=18.3years). RHR and arterial blood pressure were measured together with anthropometrics as part of the enlistment protocol. HF and its concomitant diagnoses, as well as all CM diagnoses, were collected from the national inpatient, outpatient, and cause of death registries. Risk estimates were calculated by Cox-proportional hazards models while adjusting for potential confounders. During follow-up, there were 8400 cases of first hospitalization for HF and 3377 for CM. Comparing the first and fifth quintiles of the RHR distribution, the hazard ratio (HR) for HF associated with coronary heart disease, diabetes, or hypertension was 1.25 [95% confidence interval (CI)=1.13-1.38] after adjustment for body mass index, blood pressure, and cardiorespiratory fitness. The corresponding HR was 1.43 (CI=1.08-1.90) for HF associated with CM and 1.34 (CI=1.16-1.54) for HF without concomitant diagnosis. There was an association between RHR and dilated CM [HR=1.47 (CI=1.27-1.71)] but not hypertrophic, alcohol/drug-induced, or other cardiomyopathies.Adolescent RHR is associated with future risk of HF, regardless of associated aetiological condition. The association was strongest for HF associated with CM, driven by the association with dilated CM. These findings indicate a causal pathway between elevated RHR and myocardial dysfunction that warrants further investigation.
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| 7. |
- Lundberg, Christina, et al.
(författare)
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Surgical treatment of obesity and excess risk of developing heart failure in a controlled cohort study
- 2022
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Ingår i: Esc Heart Failure. - : Wiley. - 2055-5822. ; 9:3, s. 1844-1852
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Tidskriftsartikel (refereegranskat)abstract
- Aim We aim to assess the risk of heart failure in patients with obesity with and without gastric bypass surgery compared with population controls. Methods and results This cohort study included all patients aged 20-65 years with a first ever registered principal diagnosis of obesity in the Swedish Patient Register in 2001-2013. These patients were matched by age, sex, and region with two population controls from the general Swedish population without obesity diagnosis. The obesity cohort was divided into two groups: 27 882 patients who had undergone gastric bypass surgery within 2 years of obesity diagnosis and 39 564 patients who had not undergone such surgery. These groups were compared with 55 149 and 78 004 matched population controls, respectively. Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI), adjusted for age, education, and sex. During follow-up (maximum 10 years, median 4.4 years, and interquartile range 2.5-7.2 years), 1884 participants were hospitalized for heart failure. Compared with population controls, gastric bypass patients had no excess risk of heart failure during the initial 0-<= 4 years of follow-up (HR = 1.35 [95% CI = 0.96-1.91]) but a marked increased risk during the final >4-10 years of follow-up (HR = 3.28 [95% CI = 2.25-4.77]). Non-operated patients with obesity had a marked excess risk of heart failure throughout the study period compared with population controls. Conclusions Gastric bypass for obesity seems to reduce the risk of heart failure to levels similar to the general population during the initial 4 years after surgery, but not thereafter.
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| 8. |
- 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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| 9. |
- Wideqvist, Maria, et al.
(författare)
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Ten year age- and sex-specific temporal trends in incidence and prevalence of heart failure in Västra Götaland, Sweden.
- 2022
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Ingår i: ESC heart failure. - : Wiley. - 2055-5822. ; 9:6, s. 3931-3941
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Tidskriftsartikel (refereegranskat)abstract
- Heart failure (HF) is predominantly a disorder of the elderly. During the last decades, cardiovascular primary and secondary prevention and life expectancy have improved. Accordingly, trends in incidence and prevalence of HF are dynamic and may differ over time by age and gender. We aim to investigate the overall and age-specific and sex-specific trends, in incidence, prevalence, and the proportion with co-morbidities of HF over a 10year period in Region Västra Götaland, Sweden.The VEGA database is an administrative database of all patients managed in hospital and/or in primary care (private and public) living in Region Västra Götaland. All patients with a main or contributory diagnosis of HF (I50) aged 18years or older between 2008 and 2017 were included. Incidence and prevalence of HF were calculated based on the entire adult population of Region Västra Götaland. The adult population in Region Västra Götaland increased by 8% from 2008 (n=1234609) to 2017 (n=1338906). Half the population was female and 69%<60years of age, both constant over time. In total, 62228 incident cases of HF were identified. In 2008, we identified 6464 cases, mean age 78.7 (11.5) years, and 49.8% (n=3222) men, while in 2017, 5727 cases were identified, mean age 78.3 (11.8) years, and 52.5% (n=3006) men. The overall yearly incidence rate of HF decreased by 3%, RR 0.97 (95% CI 0.96-0.97) per year, P<0.0001, mainly driven by the age categories >75years. A constantly higher incidence of HF was seen for men compared with women in all age categories, RR 1.46 (95% CI 1.44-1.49), P<0.0001. During the same period, we observed a steady increase in overall prevalence from 1.8% for women and 2.0% for men in 2008, to 2.4% in women and 2.8% in men in 2017, particularly in those >85years of age who had a prevalence of 16.5% (men) and 14.6% (women) in 2008 and 23.5% (men) and 21.5% (women) in 2017. The overall 1year mortality rate was 22.7%. When adjusted for age, women had a lower risk for death by 13% compared with men [hazard ratio 0.87 (95% CI 0.84-0.90, P<0.0001)].We saw a decrease in overall incidence, but incidence of HF remains high, particularly in the oldest age groups. Prevalence of HF keeps increasing particularly in those aged >85years. Our findings emphasize the need for implementation of effective preventive strategies for HF.
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