Validity of the diagnoses atrial fibrillation and atrial flutter in a Danish patient registry

Rix, Thomas Andersen; Riahi, Sam; Overvad, Kim; Lundbye‐Christensen, Søren; Schmidt, Erik Berg; Joensen, Albert Marni

doi:10.3109/14017431.2012.673728

Cited by 185 publications

(136 citation statements)

References 17 publications

Supporting

Mentioning

132

Contrasting

Order By: Relevance

“…The AF diagnosis has been shown to be accurate in Danish registries. 29 However, we were not able to distinguish between new-onset AF from carry-over diagnosis in relation to another condition (or 30 For the HF diagnosis, a validation study involving a single Danish hospital showed this diagnosis to be specific (99% specificity) but under-reported (29% sensitivity) 16 ; the extent to which these findings generalize to all hospitals in Denmark is unclear. In all, we cannot completely rule out misdiagnosis of HF nor underdiagnosis of AF (silent or asymptomatic).…”

Section: Limitationsmentioning

confidence: 87%

β-Blockers in Atrial Fibrillation Patients With or Without Heart Failure

Nielsen

Larsen

Gorst‐Rasmussen

et al. 2016

Circ: Heart Failure

View full text Add to dashboard Cite

Background— Recent data suggest that β-blockers are associated with prognostic advantages in heart failure (HF) patients without concomitant atrial fibrillation (AF), but not in HF patients with concomitant AF. We aimed to investigate associations between β-blocker treatment and cardiovascular outcome and mortality in AF patients with and without HF. Methods and Results— Three nationwide registries were used to identify patients with nonvalvular AF patients with or without concomitant HF. Patients were stratified into β-blocker users and β-blocker nonusers, and according to the presence of a HF diagnosis. We followed the patients ≤5 years after baseline. Six different cardiovascular outcomes were investigated, including all-cause mortality and fatal thromboembolic events. Crude event rates were ascertained and propensity-matched Cox regression was used to compare event rates according to β-blocker usage status. A total of 205 174 patients were included, where 39 741 patients had prevalent HF. In the latter subgroup of patients, the 1-year propensity-matched hazard ratio (HR) for all-cause mortality was 0.75 (95% confidence interval, 0.71–0.79; nontreated used as reference). For patients without concomitant HF, the propensity-matched HR for all-cause mortality was 0.78 (95% confidence interval, 0.71–0.76). Conclusions— In this large nationwide cohort study, evidence of a lower mortality with β-blocker therapy in AF patients with concomitant HF was observed. In addition, this association was accompanied with indications that β-blocker treatment is also associated with a better prognosis in AF patients without concomitant HF.

show abstract

Section: Limitationsmentioning

confidence: 87%

β-Blockers in Atrial Fibrillation Patients With or Without Heart Failure

Nielsen

Larsen

Gorst‐Rasmussen

et al. 2016

Circ: Heart Failure

View full text Add to dashboard Cite

show abstract

“…Some clinicians may confuse the diagnoses of AF and AFL, 36 reducing the validity of diagnostic coding for AFL. 37 This could potentially account for the differences in AF and AFL risk by race. Although our results are in agreement with previous investigations performed in well-characterized cohort studies (albeit limited to white and black patients) demonstrating a reduced risk of AF among blacks, it remains possible that blacks, Hispanics, and Asians more frequently seek hospital-based care for non-AF diagnoses compared with whites.…”

Section: Discussionmentioning

confidence: 99%

Incident Atrial Fibrillation Among Asians, Hispanics, Blacks, and Whites

et al. 2013

View full text Add to dashboard Cite

show abstract

“…We relied on hospital diagnoses to identify patients with atrial fibrillation, but the validity of this register-based diagnosis is high. 22 Similarly, the positive predictive value of a first diagnosis of diabetes mellitus is high (>95%). 23 We restricted our follow-up period to 5 years, as duration of diabetes mellitus inherently increases during follow-up.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…22 Incident cases of atrial fibrillation not habitually residing in Denmark were excluded, as were patients with a previous diagnosis of cancer and patients who died or were diagnosed with thromboembolism or transient ischemic attack on the day of admission ( Figure 1). …”

Section: Study Populationmentioning

confidence: 99%

Duration of Diabetes Mellitus and Risk of Thromboembolism and Bleeding in Atrial Fibrillation

Overvad

Skjøth

Lip

et al. 2015

Stroke

View full text Add to dashboard Cite

Background and Purpose-Guidelines advocate anticoagulant treatment to all patients with atrial fibrillation and concomitant diabetes mellitus. The potential refinement to thromboembolic risk stratification that may spring from subdividing diabetes mellitus is unexplored. The purpose was to investigate duration of diabetes mellitus as a predictor of thromboembolism and anticoagulant-related bleeding in patients with atrial fibrillation. Methods-Using nationwide Danish registries, we identified all patients discharged from hospital with an incident diagnosis of atrial fibrillation from 2000 to 2011. Hazard ratios with 95% confidence intervals for thromboembolism and bleeding according to years of diabetes mellitus duration in categories (0-4, 5-9, 10-14, and ≥15) and as a continuous variable using cubic splines were calculated by Cox regression. Results-The study population comprised 137 222 patients with atrial fibrillation, of which 12.4% had diabetes mellitus.Compared with patients without diabetes mellitus and after adjustment for anticoagulant treatment and CHA 2 DS 2 -VASc components (congestive heart failure, hypertension, age, previous stroke, vascular disease, and sex), the risk of thromboembolism was lowest in the 0 to 4 years duration category (hazard ratio, 1.11; 95% confidence interval, 1.03-1.20), and highest in the longest duration category of ≥15 years (hazard ratio, 1.48; 95% confidence interval, 1.29-1.70). When analyzed as a continuous variable, duration of diabetes mellitus was associated with risk of thromboembolism in a dose-response-dependent manner, but not with a higher risk of bleeding during anticoagulant treatment. Conclusions-In patients with atrial fibrillation, longer duration of diabetes mellitus was associated with a higher risk of thromboembolism, but not with a higher risk of anticoagulant-related bleeding. Considering the critical balance between preventing thromboembolism and avoiding bleeding, longer duration of diabetes mellitus may favor initiation of anticoagulant therapy.

show abstract

Validity of the diagnoses atrial fibrillation and atrial flutter in a Danish patient registry

Abstract: This study shows that the validity of the diagnosis of AF and/or AFL is high and may be used for registry-based studies. A specified diagnosis of AFL was rarely used and was not reliable to distinguish between cases of AF and AFL.

Cited by 185 publications

References 17 publications

β-Blockers in Atrial Fibrillation Patients With or Without Heart Failure

β-Blockers in Atrial Fibrillation Patients With or Without Heart Failure

Incident Atrial Fibrillation Among Asians, Hispanics, Blacks, and Whites

Duration of Diabetes Mellitus and Risk of Thromboembolism and Bleeding in Atrial Fibrillation

Contact Info

Product

Resources

About