Validation of myocardial infarction diagnosis in patients with congenital heart disease in Sweden

Abstract

Background The population of adults with congenital heart disease (CHD) is growing, and increasingly more patients with CHD reach older ages. Patients with CHD are at an increased risk of myocardial infarction (MI) with increased age. Diagnosing MI in patients with CHD can be challenging in clinical practice owing to a high prevalence of aberrant electrocardiograms, ventricular hypertrophy, and heart failure, among other factors. The National Swedish Patient Register (NPR) is widely used in epidemiological studies; however, MI diagnoses specifically in patients with CHD have never been validated in the NPR. Methods We contacted hospitals and medical archive services to request medical records for 249 patients, born during 1970–2012, with both CHD and MI diagnoses and who were randomly selected from the NPR by the Swedish National Board of Health and Welfare. Follow-up was until 2015. We performed a medical chart review to validate the MI diagnoses; we also validated CHD diagnoses to ensure that only patients with confirmed CHD diagnoses were included in the MI validation process. Results We received medical records for 96.4% (n = 238/249) of patients for validation of CHD diagnoses. In total, 74.8% (n = 178/238) had a confirmed CHD diagnosis; of these, 70.2% (n = 167) had a fully correct CHD diagnosis in the NPR; a further 4.6% (n = 11) had a CHD diagnosis, but it was misclassified. MI diagnoses were validated in 167 (93.8%) patients with confirmed CHD. Of the patients with confirmed CHD, 88.0% (n = 147/167) had correct MI diagnoses. Patients with non-complex CHD diagnoses had more correct MI diagnoses than patients with complex CHD (91.0%, n = 131 compared with 69.6%, n = 16). The main cause for incorrect MI diagnoses was typographical error, contributing to 50.0% of the incorrect diagnoses. Conclusions The validity of MI diagnoses in patients with confirmed CHD in the NPR is high, with nearly 9 of 10 MI diagnoses being correct (88.0%). MI in patients with CHD can safely be studied using the NPR.

Risk of cancer in young and older patients with congenital heart disease and the excess risk of cancer by syndromes, organ transplantation and cardiac surgery: Swedish health registry study (1930–2017)

“… 22 In a recent study by Fedchenko et al, CHD diagnosis in the National Swedish Patient Register was validated for patients with both CHD and myocardial infarction diagnoses and showed a positive predictive value for CHD of 74·8%, similar to findings in other studies that have validated other diagnoses in the National Swedish Patient Register. 30 …”

Impact of Down Syndrome on Survival Among Patients With Congenital Heart Disease

“…However, a previous study of patients with CHD with myocardial infarction showed only slightly lower validity of the CHD diagnosis compared with that in the previous study. 20 …”

No Increased Risk of Cardiac Birth Defects in Infants of Mothers With Celiac Disease: A Population and Sibling Comparison

“…However, data from Swedish registries have been shown to be highly accurate (14). Although data on validation of cardiac defects are limited, a study from Denmark, with a similar health care system as Sweden, reported a positive predictive value of 90% for cardiac birth defects (34) and a Swedish study assessing congenital cardiac defects in patients with myocardial infarction found a 74.8% accuracy specifically regarding diagnosis of congenital cardiac defects (35). Although we did not have data on folic acid supplementation or serum levels during pregnancy, as well as severity of CeD or adherence to a gluten-free diet, these variables would have been of greater importance had we detected a positive association between maternal CeD and congenital birth defects (which we did not).…”