The validity of the Finnish Hospital Discharge Register and Causes of Death Register data on coronary heart disease.

BACKGROUND AND DESIGN: The recent introduction of sensitive markers of myocardial injury is likely to affect the epidemiology of coronary heart disease (CHD). The American Heart Association together with other societies and research agencies have recently published a new definition on acute CHD to improve consistency in epidemiological and clinical studies (referred here as the '2003 definition'). METHODS: In this study we compare the data on CHD events in the Finnish National Hospital Discharge Register (HDR) and the Causes of Death Register (CDR) with the population-based myocardial infarction (MI) register, FINMONICA/FINAMI. The FINMONICA/FINAMI events were classified according to the 2003 definition. The relevant International Classification of Diseases (ICD) codes from the HDR and CDR were used. RESULTS: Using the 2003 definition as the reference, the overall sensitivity of the ICD codes for MI in the combined HDR and CDR was 83% and the positive predictive value (PPV) was 90%. When the ICD codes for unstable angina were added to the analyses, the sensitivity improved to 85% and the PPV declined to 83%. In the age group 35-74 the sensitivity of the MI codes improved over time, in men from 64% in 1988-1992 to 81% in 1998-2002, and in women from 61 to 78%, respectively. The oldest age group, 75 years or older, had sensitivity and PPV values comparable to those of the younger. CONCLUSION: Diagnoses of fatal and non-fatal CHD events in the Finnish HDR and Causes of Death register were reasonably valid indicators for hard CHD events when compared with the FINMONICA/FINAMI register data.     

Complications Requiring Hospital Admission and Causes of In-Hospital Death over Time in Alcoholic and Nonalcoholic Cirrhosis Patients

Background/Aims

Data on the epidemiology of alcoholic cirrhosis, especially in Asian countries, are limited. We compared the temporal evolution of patterns of alcoholic and nonalcoholic cirrhosis over the last decade.

Methods

We retrospectively examined the inpatient datasets of five referral centers during 2002 and 2011. The study included patients who were admitted due to specific complications of liver cirrhosis. We compared the causes of hospital admissions and in-hospital deaths between patients with alcoholic and nonalcoholic cirrhosis.

Results

Among the included 2,799 hospitalizations (2,165 patients), 1,496 (1,143 patients) were from 2002, and 1,303 (1,022 patients) were from 2011. Over time, there was a reduction in the rate of hepatic encephalopathy (HE) as a cause of hospitalization and an increase in the rate of hepatocellular carcinoma. Deaths that were attributable to HE or spontaneous bacterial peritonitis (SBP) significantly decreased, whereas those due to hepatorenal syndrome (HRS) significantly increased over time in patients with alcoholic cirrhosis. However, in patients with nonalcoholic cirrhosis, hepatic failure and HRS remained the principal causes of in-hospital death during both time periods.

Conclusions

The major causes of in-hospital deaths have evolved from acute cirrhotic complications, including HE or SBP to HRS in alcoholic cirrhosis, whereas those have remained unchanged in nonalcoholic cirrhosis during the last decade.     

Cost of gestational diabetes-related antenatal visits in health care based on the Finnish Medical Birth Register

The aim was to evaluate frequency and costs of antenatal health care visits related to risk of gestational diabetes (GDM) using Birth Register. Costs among all GDM risk groups were 10-41% larger than non-risk groups. Primary health care is needed to reduce special health care costs related to GDM.     

Electrocardiographic T Wave Abnormalities and the Risk of Sudden Cardiac Death: The Finnish Perspective

The identification of patients at risk for sudden cardiac death (SCD) is still a significant challenge to clinicians and scientists. Noninvasive identification of high‐risk patients has been of great interest, and several ventricular depolarization and repolarization abnormalities in the standard 12‐lead electrocardiogram (ECG) have been associated with increased vulnerability to lethal ventricular arrhythmias. Several benign and pathological conditions can induce changes in repolarization detected as alteration of the ST segment or T wave. Changes in the ST segment and T waves can be early markers of an underlying cardiovascular disease, and even minor ST‐T abnormalities have predicted reduced survival and increased risk of SCD in the adult population. In this review, we will discuss the current knowledge of the SCD risk with standard 12‐lead ECG T wave abnormalities in the general population, and possible T wave changes in various cardiac conditions predisposing to SCD.     

Comment on stroke with atrial fibrillation: data from the Austrian stroke registry.

We read with great interest the recent article by Steger et al.¹This report confirmed the important reality that stroke with     

Querying the ill-defined stroke diagnoses on death certificates and their effects on type-specific mortality in Taiwan

In Taiwan, the high proportion of stroke deaths of which the underlying causes of death (UCD) has been classified to ill-defined categories, has impeded valid type-specific mortality studies. The aim of this study was to assess the extent of changes in the distributions of stroke subtypes and mortality after querying the certifying physicians. There were 2632 death certificates issued from January through June 1998 in Taiwan of which the UCD was classified to ill-defined cerebrovascular disease categories (International Classification of Diseases, 9th Revision ICD-9 code 436 or 437.9). Staff of the Office of Statistics, Department of Health copied 2035 death certificates issued by hospitals and mailed them back to the certifying physicians to request more specific information on the stroke subtype. Responses were obtained for 1505 (74%) of the 2035 queries sent. Four fifths of these (1191/1505) resulted in a change to a more specific code. In most cases, the ICD-9 code was changed to 431 (cerebral hemorrhage, CH, 239/1505) or 433-4 (cerebral infarction, CI, 819/1505). After the querying, the percentage changes in the age-adjusted death rate (per 100,000 population) for CH were +16% for men and +20% for women; and for CI the percent changed were +100% for men and +130% for women. The changes increased as the age of the deceased increased. The changes in the CH/CI death ratios resulting from querying were greater in younger (less than 65 years old) age groups than in older age groups. Given the large gains of more specific information on stroke subtypes, querying is a useful method to improve the quality of cause of death statistics. However, the large changes in distributions and death rates of different stoke subtypes as a result of querying, show the non-querying mortality data are not suitable for type-specific analysis.     

Patterns of smoking cessation in the first 3 years after stroke: the South London Stroke Register.

BACKGROUND: Stroke survivors are at high risk of recurrent strokes and other vascular events. Smoking is an established risk factor for stroke, with cessation recommended for secondary prevention. Little is known about patterns of smoking cessation after stroke. DESIGN: A prospective cohort of patients was identified. METHODS: Data were derived from the population-based South London Stroke Register. Self-reported smoking status was measured at the time of stroke, at 3 months, and at 1 and 3 years after stroke. Stroke survivors, who were smoking at the time of stroke and were alive 3 years later, were included. Logistic regression was used to examine associations between age, sex, ethnicity, socioeconomic status, risk factors, stroke subtype, disability, and probability of attempting and maintaining smoking cessation. RESULTS: Complete smoking data were available for 363 survivors with strokes between 1995 and 2003. In all, 71% of the smokers had attempted to quit within 3 years; 30% had quit and maintained cessation at 1 and 3 years; 10% had quit immediately after stroke, but had subsequently relapsed (smoking again at 1 and 3 years); and 25% of the smokers had quit after 3 months. Black ethnicity [odds ratio (OR): 6.20; confidence interval (CI): 2.39-16.10] and more severe disability (P=0.035) were predictors of attempts to quit. Older age (OR: 0.30; CI: 0.13-0.71) and black ethnicity (OR: 0.30; CI: 0.15-0.60) reduced the likelihood of smoking at 3 years. Among those attempting cessation, being older predicted maintenance (OR: 4.50; CI: 1.50-13.51). CONCLUSION: The majority of smokers had attempted to quit after stroke; however, a minority achieved sustained cessation in the longer term. Cessation patterns are complex, and interventions should be targeted at multiple time points.     

The validity of the Finnish Diabetes Risk Score for the prediction of the incidence of coronary heart disease and stroke, and total mortality.

BACKGROUND: Cardiovascular disease shares several risk factors with type 2 diabetes. We tested whether the Finnish Diabetes Risk Score (FINDRISC), recently developed in a Finnish population to estimate the future risk of diabetes, would also identify individuals at high risk of coronary heart disease (CHD) and stroke, and total mortality in this same population. DESIGN: Independent risk factor surveys were conducted in 1987, 1992, and 1997 in Finland, comprising 8268 men and 9457 women aged 25-64 years and free of CHD and stroke at baseline. During the follow-up until the end of 2001, 699 incident acute CHD events, 324 acute stroke events, and 765 deaths occurred. METHODS: The data were analysed by using receiver operating characteristic (ROC) curves and the Cox-regression model. RESULTS: The areas under the ROC curves (AUC) were 71% for CHD, 73% for stroke, and 68% for total mortality in men and 78, 68, and 72% in women, respectively. The addition of systolic and diastolic blood pressures, total and high-density lipoprotein cholesterol, and smoking increased the AUC values modestly (the change of the absolute values from 2.6 to 6.5%), but the additional use of plasma glucose had only a slight effect on the AUC values for CHD and stroke. CONCLUSIONS: The FINDRISC is a reasonably good predictor of CHD, stroke and total mortality.     

External validation of the Finnish diabetes risk score in Venezuela using a national sample: The EVESCAM

AimsTo evaluate the performance of the Latin American Finnish Diabetes Risk Score (LA-FINDRISC) compared with the original O-FINDRISC in general population. To establish the best cut-off to detect unknown type 2 diabetes (uT2D) and prediabetes.MethodsThe EVESCAM was a national population-based, cross-sectional, randomized cluster sampling study, which assessed 3454 adults from July 2014 to January 2017. Those with self-report of diabetes were excluded; a total of 3061 subjects were analyzed. Waist circumference adapted for Latin America was the difference between the LA-FINDRISC and the O-FINDRISC. The area under the curve (AUC), sensitivity, and specificity were calculated.ResultsThe prevalence of uT2D and prediabetes were 3.3% and 38.5%. The AUC with the LA-FINDRISC vs. the O-FINDRISC were: for uT2D, 0.722 vs. 0.729 in men (p = 0.854) and 0.724 vs. 0.732 in women (p = 0.896); for prediabetes (impaired fasting glucose [IFG] + impaired glucose tolerance [IGT], 0.590 vs. 0.587 in men (p = 0.887) and 0.621 vs. 0.627 in women (p = 0.777); for IFG, 0.582 vs. 0.580 in men (p = 0.924) and 0.607 vs. 0.617 in women (p = 0.690); for IGT, 0.691 vs. 0.692 in men (p = 0.971) and 0.672 vs. 0.671 in women (p = 0.974). Using the LA-FINDRISC, the best cut-offs to detect uT2D were 9 in men and 10 in women and to detect IGT was 9 in both genders.ConclusionLA-FINDRISC has similar performance than O-FINDRISC in Venezuelan adults and showed a good performance to detect uT2D and IGT, but not IFG. The best cut-offs to detect glucose alterations were established.     

The validation of oxygen uptake efficiency slope in patients with stroke

To evaluate the real aerobic capacity is difficult due to impaired limbs function in stroke patients. Oxygen uptake efficiency slope (OUES) could represent the aerobic capacity in submaximal exercise test. Hence, we designed this observational study to investigate the application of the OUES for evaluating aerobic capacity in these patients.Thirty-seven stroke patients were classified into 2 groups according to their Brunnstrom stage of affected lower limbs. Patients underwent cardiopulmonary exercise testing to assess cardiorespiratory fitness. Minute ventilation and oxygen consumption were measured, and OUES was calculated, compared with healthy reference values, and correlated with the peak oxygen consumption. The predictive validity of submaximal OUES was derived.Study participants’ OUES (median 566.2 [IQR, 470.0-711.6]) was 60% of healthy reference values and correlated positively with the peak oxygen consumption (r = 0.835) (P < .01). The predictive validity of oxygen uptake efficiency slope at 50% of maximal exercise duration (OUES₅₀) and oxygen uptake efficiency slope at 75% of maximal exercise duration (OUES₇₅) for oxygen uptake efficiency slope at 100% of maximal exercise duration (OUES₁₀₀) was 0.877 and 0.973, respectively (P < .01). The OUES₅₀, OUES₇₅, and OUES₁₀₀ groups were not significantly different; agreement of submaximal and maximal OUES values was strong.OUES is a valuable submaximal index for evaluating cardiorespiratory fitness in stroke patients. Moderate-to-high concurrent validity of this parameter with peak oxygen consumption and the high predictive validity of OUES₅₀ and OUES₇₅ for OUES₁₀₀ suggest maximal exercise testing in stroke patients who cannot reach maximal exercise is unnecessary.     

Effect of Standardized Electronic Discharge Instructions on Post-Discharge Hospital Utilization

BACKGROUND  

Several physician organizations and the Centers for Medicare and Medicaid Services (CMS) support compliance measures for written discharge instructions. CMS has identified clear discharge instructions with specific attention to medication management as a necessary intervention.     

Pancytopenia induced by low-dose methotrexate. A study of the cases reported to the Finnish Adverse Drug Reaction Register From 1991 to 1999

OBJECTIVE: To study cases of low-dose methotrexate-induced pancytopenia with special reference to clinical outcome and factors predisposing to bone marrow suppression. METHODS: Patient files of 14 cases of methotrexate-induced pancytopenia reported to the National Agency for Medicines in Finland from 1991 to 1999 were reviewed. A review of four additional cases was included. RESULTS: Of the 18 patients (median age 72 years), 12 had rheumatoid arthritis, one psoriatic arthritis, five psoriasis without arthritis, and one pemphigus erythematosus. Major co-morbidity was recorded in 12 patients, and 16 patients used significant concomitant drugs. Eight patients had a mildly or moderately elevated serum creatinine concentration. In every patient the occurrence of cytopenia was abrupt. Eight patients (44%) died, and the most frequent cause of death was infection. CONCLUSIONS: Our data show that methotrexate-induced pancytopenia is associated with high mortality especially in cases with significant co-morbidity and concomitant medications.     

Quality of data on subsequent events in a routine Medical Birth Register

BACKGROUND: The maintenance of health registers has become routine. The main prerequisite for their use is that registers be complete and that their contents correspond to reality. METHODS: Data on all primiparous women who gave birth between 1987 and 1989 (N=73009) and on their second (N=55388) and third births (N=22904) in the 1987-1998 period were retrieved from the Finnish Medical Birth Register (MBR). The consistency of the MBR data on reproductive history and on previous Caesarean section was investigated by comparing the records on subsequent births. MAIN RESULTS: In total 98.5% of the information on reproductive history corresponded with the previous data in the MBR. Data quality decreased over time and with increasing parity. There were problems with the registration of rare cases, e.g. several extrauterine pregnancies or stillbirths. The quality deteriorated in the late 1990s, because no data on previous induced abortions and extrauterine pregnancies were collected between 1991 and 1995. The quality of data on previous Caesarean section was poor in 1987-1990, a period when the data were collected by using ICD-9 codes, but the quality improved after the introduction of a check-box format in 1991. CONCLUSIONS: Changes in question formats may change the quality of register data significantly. Check-boxes seem to improve quality compared to open-ended questions. The data on reproductive history and previous Caesarean sections could be combined routinely to improve the quality of the MBR.