Validity of diagnoses of major coronary events in national registers of hospital diagnoses and deaths in Finland

We validated diagnoses of acute myocardial infarction (AMI) and death from coronary heart disease (CHD) found in the Finnish National Hospital Discharge Register and the Register of Causes of Death from a sample of the 29,133 men participating in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. The cases were traced to hospitals and institutes performing medico-legal death cause examinations and all relevant information was collected. The cardiac events were re-evaluated according to the diagnostic criteria of the Finnish contribution to the WHO MONICA project, i.e. the FINMONICA criteria. Altogether 408 cases of non-fatal AMI (n = 217) and death from CHD (n = 191) were reviewed. In the re-evaluation 94% of them (95% confidence interval 92--96%) were diagnosed as either definite (57%) or possible (37%) AMI. Non-fatal cases were more often classified definite AMI in the review, whereas fatal cases were more often classified possible AMI. Age or trial supplementation group did not affect classification, and no secular trend was observed. In conclusion, the diagnoses of AMI and death from CHD in the registers were highly predictive of a true major coronary event defined by strict criteria, thus their use in endpoint assessment in epidemiological studies and clinical trials is justified.     

2001-2013年金昌队列人群冠心病死亡趋势及疾病负担研究

目的 了解金昌队列人群冠心病（coronary heart disease,CHD）的死亡趋势,以及冠心病对该人群造成的疾病负担。方法 利用建立的大型随访队列人群的资料,应用死亡率、潜在减寿年数（potential years of life lost,PYLL）、潜在工作损失年数（working years of potential life lost,WYPLL）等指标,分析2001-2013年该队列人群的冠心病死亡趋势和疾病负担现状,运用平均增长速度描述疾病负担的变化趋势。结果 2001-2013年金昌队列人群冠心病粗死亡率为40.47/10万,其中男性标化死亡率随年份有增长趋势,但是70~79岁组冠心病的死亡率随年份呈下降趋势。女性因冠心病造成的人均潜在减寿年数（average potential years of life lost,APYLL）（15.33年/人）是男性（6.95年/人）的2.21倍。人均潜在工作损失年（average working years of potential life lost,AWYPLL）女性（5.59年/人）是男性（3.42年/人）的1.63倍,其中人均潜在工作损失年和男性人均潜在寿命损失年随年份呈下降趋势。结论 2001-2013年金昌队列人群的冠心病死亡率有上升趋势,并对该人群造成沉重的疾病负担,应该对该人群展开进一步的冠心病防治措施。     

Physical activity and cause-specific mortality in men: further evidence from the Whitehall study

Reports of studies relating physical activity to stroke and cancer sub-types indicate inconsistent findings. Some are hampered by low statistical power, owing to a low number of events, and a failure to adjust for potential confounding variables. The purpose of this study was to relate physical activity to 12 mortality endpoints in a prospective cohort study of 11,663 men aged 40–64 years who responded to an enquiry about travel activity during a baseline medical examination conducted between 1967 and 1969. During 25 years of follow-up there were 4672 deaths. Travel activity was inversely related to mortality attributable to all-causes, coronary heart disease, respiratory disease and lung cancer, whereas the association with stroke was positive. There was evidence for attenuation of some of these associations on adjustment for potentially confounding variables. Our simplistic measure of physical activity may, in part, explain the weak associations seen.     

The validity of hospital discharge register data on coronary heart disease in Finland

We studied the validity of the Finnish hospital discharge register data on coronary heart disease (CHD) for the purposes of epidemiologic studies and health services research. The Finnish nationwide hospital discharge register (HDR) was linked with the FINMONICA acute myocardial infarction (AMI) register for the years 1983–1990. The frequency of errors in the HDR was assessed separately. Between 8% and 13% of hospitalized AMI events registered in the AMI Register were not found in the HDR with an ICD code for CHD. Problems with the register linkage and the use of some ICD code other than one of the codes for CHD explained these missing events. The frequency of errors in the personal identification number was about 5% in the early 1980s. After 1986 errors were found only occasionally. The diagnosis recorded in the HDR was the same as that in the discharge sheet in about 95% of hospitalizations. The positive predictive value of the ICD code 410 (AMI), compared with the FINMONICA definite+possible AMI category, was very high and stable, about 90% in all areas and all hospitals, but it sensitivity varied from 50% at local hospitals to 80% at central hospitals. In summary, data on CHD obtained from the Finnish hospital discharge register give, on average, a correct picture on changes in the occurrence of AMI in Finland and can, with necessary caution, be used in epidemiological studies and health services research. However, the classification of individual cases is not standardized in the HDR, but varies over time, between geographical areas and the levels of care. Therefore, these data should not be used without confirmation in studies where correct classification of individual outcomes is of crucial importance, such as follow-up studies and case-control studies.     

Gender and drug treatment as determinants of mortality in a cohort of heart failure patients

Aim: We assessed gender differences in the risk of mortality in heart failure (HF) patients and evaluated the association between HF drug treatment and mortality. Methods and Results: We identified a cohort of 820 patients with newly diagnosed HF in 1996 in UK general practices. The diagnosis of HF was confirmed by the general practitioner. Fifty per cent were females and 27% were less than 70 years old. During a mean follow-up of 2 years, 172 patients died. We used computerized records to assess risk factors and drugs prescribed as treatment. The information on severity was assessed through a questionnaire. We performed a nested case–control analysis, and observed that men had twice the risk of dying than females, however the effect of age on mortality was stronger in females than males. We found a similar interaction between HF severity and sex. Data on use of some cardiovascular drugs such as diuretics, -blockers ACE-inhibitors and calcium channel blockers were suggestive of a reduced mortality risk. Current use of nitrates and glycosides carried an increased risk. Conclusion: Older age, male sex and severity of HF were the main predictors of mortality among HF patients. Long-term use of -blockers was associated with a significantly reduced risk of mortality.     

基于年龄-时期-队列模型分析2006—2020年中国冠心病死亡趋势

目的 分析2006—2020年间中国城市和农村15～84岁人群冠心病死亡率变化趋势及年龄、时期、出生队列对冠心病死亡率的影响,为预防冠心病的死亡提供科学依据和策略。方法 基于2006—2020年城乡冠心病死亡率数据,建立连接点回归模型描述冠心病死亡率的阶段性变化趋势;通过构建年龄-时期-队列模型（age-period-cohort model,APC）,估算我国城市和农村冠心病死亡率的年龄、时期及队列效应。结果 2006—2020年间,我国城市冠心病死亡率从85.66/10万增长到126.91/10万,农村死亡率从63.55/10万上升到135.88/10万,年平均变化百分比（average annual percentage change,AAPC）分别为2.85%,5.89%。APC模型分析显示,2006—2020年冠心病死亡风险随年龄增加而增大,其中城市人群年龄效应系数为：-1.60～2.53,农村为-2.05～2.34;时期效应随着时期的增加而逐渐上升,城市效应系数为：-0.29～0.23,农村：-0.17～0.14;队列效应显示,随着出生队列的推移死亡风险下降趋势明显,城市：...     

基于随机森林的冠心病合并心力衰竭患者PCI术后死亡风险预测研究

目的  采用随机森林算法分析冠状动脉粥样硬化性心脏病(简称冠心病)合并心力衰竭(简称心衰)患者接受经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)术后1年内死亡的影响因素。方法  连续入选2014年1月至2019年7月,于山西医科大学第一医院及山西省心血管病医院心内科住院的冠心病合并心衰并在本次住院期间接受PCI的患者1 078例,随访1年,以死亡为终点事件。利用随机森林算法构建预后模型,分析PCI患者术后1年内死亡的影响因素。结果  随机森林模型显示,红细胞分布宽度(red blood cell distribution width, RDW)、心率、GLU、白蛋白和氨基末端脑钠肽前体(N-terminal pro-B-type natriuretic peptide, NT-proBNP)是患者死亡的前五位影响因素。结论  RDW、心率、GLU、白蛋白和NT-proBNP是PCI患者术后1年内死亡的前五位影响因素。这为临床评估患者获益与风险、选择最佳治疗方案提供理论依据。     

郑州市社区老年冠心病患者衰弱现状及影响因素分析

目的 了解郑州市社区老年冠心病患者衰弱现状及主要影响因素。方法 采用一般资料调查表、Tilburg衰弱量表等工具,对郑州市2个社区821例老年冠心病患者衰弱现状进行调查,采用多因素logistic回归分析筛查影响因素。结果 老年冠心病患者衰弱发生率为24.0%;logistic回归分析显示,年龄(60～69)岁(OR = 0.348, 95%CI: 0.159～0.764)、不服药(OR = 0.247, 95%CI:0.134～0.456)、认知正常(OR = 0.511,95%CI:0.283～0.923)、不抑郁(OR = 0.177,95%CI:0.096～0.327)、高握力(OR = 0.686,95%CI:0.634～0.742)、高BMI(OR = 0.830,95%CI:0.765～0.900)是社区老年冠心病患者衰弱的保护因素(P＜0.05),缺乏运动(OR = 3.392,95%CI: 1.948～5.904)、空腹血糖(OR = 2.293,95%CI:1.745～3.015)、心率(OR = 1.035,95%CI: 1.012～1.060)、甘油三酯(OR = 1.418, 95%CI:1.096～1.834)、低密度脂蛋白胆固醇(OR = 3.447,95%CI:2.268～5.238)是社区老年冠心病患者衰弱的危险因素(P＜0.05)。结论 郑州市社区老年冠心病患者衰弱发生率高,并且受多种可控因素的影响,应予以重视。     

The feasibility of routine mortality and morbidity register data linkage to study the occurrence of acute coronary heart disease events in Finland

Validated population-based data on the occurrence of coronary heart disease in Finland have previously been obtained from myocardial infarction (MI) registers. Such registers cannot, however, cover large areas. Therefore, the Finnish Cardiovascular Diseases Registers (CVDR) Project was set up to obtain data for the whole of Finland. The CVDR Project is based on routine mortality and morbidity data linkage. We report here the overall approach used in the project, the results of the feasibility study and the first main results. In Finland, data on all hospitalizations are registered in the nationwide Hospital Discharge Register. Also, data on all deaths are collected in the nationwide Causes of Death Register. The unique personal identification number assigned to all persons residing in Finland was used for data linkage. Data have been validated using the FINMONICA MI registers. Sensitivity analyses showed that the data were robust and consistent between different geographical areas. Coronary heart disease (CHD) mortality as well as the incidence and event rates showed the same very clear geographical pattern, dividing Finland to a southwest area with a lower occurrence and a northeast area with nearly twice higher occurrence. Case fatality did not differ much between the areas and did not follow this Southwest–Northeast division. The differences between northeast and southwest Finland may be related to differences in risk factor levels but also to socioeconomic and genetic differences. The CVDR Project data will be instrumental in further research addressing these issues.     

重组人脑利钠肽对冠心病心力衰竭患者治疗效果的研究

目的 探讨重组人脑利钠肽(rhBNP)对冠心病心力衰竭患者的治疗效果.方法 将96例冠心病心力衰竭患者按随机数字表法分为观察组(48例)和对照组(48例),两组均给予冠心病心力衰竭常规治疗,观察组在常规治疗基础上采用rhBNP治疗,对照组在常规治疗基础上采用硝酸甘油治疗.比较两组的疗效、左室射血分数(LVEF)及尿量改善情况.结果 治疗24 h后,观察组总有效率为93.75％(45/48),对照组总有效率为81.25％ (39/48),两组比较差异有统计学意义(P＜0.05).两组治疗后LVEF及尿量均高于治疗前[观察组:(57.7±3.9)％比(32.5±3.1)％,(70.5±31.1)ml/h比(34.5±13.7) ml/h;对照组:(52.2±3.3)％比(33.4±2.9)％,(53.6±23.4) ml/h比(33.8±13.4)ml/h,P＜0.05],且观察组治疗后LVEF及尿量均高于同期对照组(P＜0.05).观察组不良反应发生率明显低于对照组[ 18.75％(9/48)比35.42％(17/48),P＜0.05].结论 rhBNP治疗冠心病心力衰竭疗效确切,不良反应少,可明显改善患者的全身状况.     

不同剂量卡维地络干预对心力衰竭幼鼠心功能和心肌细胞凋亡的影响

目的探讨不同剂量卡维地络(CAR)对心力衰竭幼鼠模型心功能改善作用和心肌细胞凋亡的影响。方法建立腹主动脉狭窄所致心力衰竭幼鼠模型,随机分为①心衰组(CHF组,n=8),②小剂量卡维地络组(LCAR组,0.1mg/(kg·d),n=8),③大剂量卡维地络组(HCAR组,10mg/(kg·d),n=10),同时设假手术组(SH组,n=8)。药物干预4周,检测各组血流动力学指标、心室质量指数、凋亡指数。结果心衰组心功能指标恶化(P<0.05,P<0.01),LVMI及RVMI显著增加(P<0.01),凋亡增加。大小剂量CAR治疗组心功能均有改善,LVMI、RVMI下降,凋亡减少,但大剂量组显著。结论CAR可改善心力衰竭幼鼠心功能,减少心肌细胞凋亡,防治CHF,效果以大剂量明显。这种心功能的改善作用可能通过减少心肌细胞凋亡获得。     

老年冠心病合并心力衰竭患者症状群及对生活质量的影响研究

目的 研究老年冠心病合并心力衰竭患者症状群及对生活质量的影响。方法 以2021年1月至2022年6月入院确诊的老年冠心病合并心力衰竭患者为研究对象,获取其基本资料包括性别、年龄、文化程度、冠心病病程、心功能分级,借助中文版Memorial心力衰竭症状评估量表（MSAS-HF）调查患者症状出现及严重程度,并应用探索性因子分析方法探讨症状群类型及构成,采用基于中国文化改良明尼苏达心力衰竭生存质量量表（C-MLHF）评估生活质量,分析老年冠心病合并心力衰竭患者症状群及对生活质量的影响。结果 纳入有效研究对象1 228例,有效率96.01%。症状发生率高的是气短（71.99%）、平躺时呼吸困难（66.69%）、疲乏（64.50%）、心悸（61.89%）等,症状严重程度高的是平躺时呼吸困难[（2.95±0.63）分]、气短[（2.92±0.59）分]、睡眠困难[（2.90±0.65）分]、疲乏[（2.89±0.52）分]等。探索性因子分析得到5种症状群,分别为疲倦症状群（疲乏、出汗、易困）、呼吸困难症状群（呼吸困难、夜间睡眠憋醒、平躺时呼吸困难）、缺血症状群（心悸、头晕、胸痛、手脚麻木感）、淤血...     

右室间隔部起搏对心衰犬心室同步性及心功能的影响

目的 评价右室间隔部起搏方式纠正心衰的疗效.方法 12只心衰犬,采用自身对照方法随机行右心房-右室心尖部(RVA)、右心房-右室间隔部(RVS)、右心房-双室(Bi-V)起搏,每种方式起搏前及起搏稳定15 min后行彩色多普勒超声心动图检查,测定左心室舒张末期直径(LVEDd)、左室射血分数(LVEF)、室间机械延迟(IVMD)、室间隔与左室后壁运动延迟(SPWMD)、左心室12个节段达峰时问的标准差(Ts-SD).结果 右室间隔部起搏时:(1)与起搏前及右室心尖部起搏相比,LVEDd、IVMD、SPWMD、Ts-SD减小,LVEF增加,差异有统计学意义(P＜0.05).(2)与双室起搏相比,LVEDd、IVMD、SPWMD、Ts-SD增加,LVEF减小,差异有统计学意义(P＜0.05).结论 右室间隔部起搏一定程度上改善了心室的同步性及心功能,疗效优于右室心尖部但不及双室起搏,还不能成为心脏再同步化治疗(CRT)心衰的备选模式.     

Registry based analysis of cost-of-illness study among stage C heart failure patients at Hospital Queen Elizabeth II,Sabah, Malaysia

Background

Numerous cost-of-illness studies of heart failure (HF) have been published in developed countries, but such knowledge is lacking in Malaysia. To fill the gap, this study estimated the cost of HF in Hospital Queen Elizabeth II (HQEII).

2001-2010年上海市卢湾区居民心脑血管疾病死亡动态分析

目的 分析上海市卢湾区居民心脑血管疾病死亡变化及趋势,为进一步制定心脑血管疾病防治策略提供科学依据.方法 统计分析2001-2010年卢湾区户籍人口心脑血管疾病死亡及人口监测资料.2001年的死因分类按国际疾病分类法ICD-9,2002-2010年按国际疾病分类法ICD-10标准进行分类.用2000年全国人口构成进行标化率计算,进一步计算心脑血管疾病潜在减寿年数.结果 2001-2010年,上海市卢湾区户籍人口心脑血管疾病死亡率总体呈波动性下降趋势,其中脑血管疾病死亡率下降趋势较为明显,但随年龄增长呈几何级数增高.10年间,心脑血管疾病一直占据全人群死因顺位的第1位,死因减寿顺位的第2、3位.结论 心脑血管疾病已成为上海市卢湾区居民的主要死亡原因,全社会必须重视这类慢性病的预防.同时,应重点加强对60岁以上这部分年龄组人群心脑血管疾病的控制和预防.     

南京市某医院城乡冠心病患者相关研究

目的探讨城市与农村冠心病患者的危险因素和冠脉造影结果差异,评价生活习惯、环境因素、精神因素等与冠心病的关系。方法入选冠心病患者566例,按城市居民和农村居民分组,对各组危险因素特点及冠脉造影结果进行分析,再按不同年龄分组,比较2组患者的Gensini积分。结果城市居民组高血脂（15．O％）、吸烟（45．9％）、饮酒（26．6％）及心肌梗死患者（34．4％）比例均明显高于农村居民组（8．5％、33．7％、19．1％、25．2％）,城市居民组冠脉造影3支病变发生率（32．8％）明显大于农村居民组（22．8％）,按年龄分组,小于50岁组城市居民组Gensini积分（57±37．7）明显大于农村居民组（31．2±13．7）。结论城市与农村冠心病人群的危险因素、冠脉血管病变特点存在明显差异,生活习惯、环境因素和精神因素对城市冠心病人群的影响更大,对人群进行冠心病危险因素干预时应考虑城乡差异。     

加速康复外科理念护理的女性生殖系统疾病患者出院准备度的现状调查及影响因素分析

目的探讨加速康复外科理念护理的女性生殖系统疾病患者出院准备度现状并分析其影响因素,为提高女性生殖系统疾病患者出院准备度提供临床依据。方法采用一般资料调查表、出院准备度量表、出院指导质量量表对江苏省人民医院妇科218例女性生殖系统疾病患者进行调查。结果女性生殖系统疾病患者的出院准备度总分为(98.55±15.30)分,处于较高水平。多元线性回归分析显示影响出院准备度的主要因素是工作状态、照顾者、医疗费用支付方式、诊断结果和出院指导质量。结论女性生殖系统疾病患者出院准备度处于较高水平,诊断结果、工作状态、照顾者、医疗费用支付方式、出院指导质量都会影响患者的出院准备度,护理人员应根据女性生殖系统疾病患者的具体情况给予针对性的干预措施,以确保出院指导质量,保障患者出院后的安全。     

The association of the number of comorbidities and complications with length of stay,hospital mortality and LOS high outlier,based on administrative data

Objectives With greater concern for efficient resource allocation and profiling of medical care, a case-mix classification was applied for the per-diem payment system in Japan. Many questions remain, one of which is the role of comorbidity and complication (CC) in grouping logic. We examined the association of the number of CC with the length of hospital stay (LOS) and hospital mortality as well as the proportion of LOS high outliers in 19 major diagnostic categories (MDCs). Methods This study was a secondary data analysis embedded in a government research project, including anonymous claims and clinical data during a 4-month period from July 2002. Every 19 MDC, LOS, hospital mortality or proportion of LOS high outliers was compared by the number of CC and presence of any procedures. Results From 82 special function hospitals, 241,268 patients were enrolled in this study. Among all patients, 50.5% were identified without any CCs, 32.4% with one or two, 13.4% with three or four, and 3.7% with over five CCs. The overall mean LOS was 22.15 days and hospital mortality 26.05 cases per 1,000 admissions. In any MDC, LOS and the proportion of outliers increased as the number of CC rose. The mortality rate increased prominently in the respiratory system and the hematology system. Conclusions This study demonstrated that the occurrence of more CC caused longer LOS and higher mortality in some major disease categories. Further study will clarify the association of the weighted CC with resource use through controlling procedures specific for MDC.