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30-year nationwide trends in incidence of atrial fibrillation in Denmark and associated 5-year risk of heart failure, stroke, and death.

https://arctichealth.org/en/permalink/ahliterature286741
Source
Int J Cardiol. 2016 Dec 15;225:30-36
Publication Type
Article
Date
Dec-15-2016
Author
Morten Schmidt
Sinna Pilgaard Ulrichsen
Lars Pedersen
Hans Erik Bøtker
Jens Cosedis Nielsen
Henrik Toft Sørensen
Source
Int J Cardiol. 2016 Dec 15;225:30-36
Date
Dec-15-2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Atrial Fibrillation - epidemiology - mortality - therapy
Cohort Studies
Death
Denmark - epidemiology
Female
Follow-Up Studies
Heart Failure - epidemiology - mortality - therapy
Hospitalization - trends
Humans
Incidence
Male
Middle Aged
Population Surveillance - methods
Registries
Risk factors
Stroke - epidemiology - mortality - therapy
Time Factors
Abstract
Long-term nationwide trends in atrial fibrillation (AF) incidence and 5-year outcomes are rare.
We conducted a population-based cohort study using the Danish National Patient Registry covering all Danish hospitals. We computed standardized incidence rates during 1983-2012. We used Cox regression to estimate hazard ratios (HRs) of heart failure, stroke, and death within 5years, comparing 5-year calendar periods with the earliest period (1983-1987) as reference.
We identified 312,420 patients with first-time hospital-diagnosed AF. The incidence rate per 100,000person-years increased from 98 in 1983 to 307 in 2012. The mean annual increase during the 30-year study period was 4%, with a 6% increase annually until 2000 and a 1.4% increase annually thereafter. The incidence trends were most pronounced among men and persons above 70years. Among high-risk subgroups, AF incidence was consistently highest in patients with valvular heart disease or heart failure. The rate of heart failure following AF declined by 50% over the entire study period (HR: 0.49, 95% confidence interval (CI): 0.48-0.51) and the mortality rate declined by 40% (HR: 0.62, 95% CI: 0.61-0.63). Within the last two decades, the rate for ischemic stroke declined by 20% (HR 0.81, 95% CI: 0.78-0.84), but increased almost as much for haemorrhagic stroke (HR: 1.14, 95% CI: 1.01-1.29).
The long-term risk of heart failure, ischemic stroke, and death following onset of AF has decreased remarkably over the last three decades. Still, the threefold increased incidence of hospital-diagnosed AF during the same period is a major public health concern.
PubMed ID
27705839 View in PubMed
Less detail

Attitudes toward Catheter Ablation for Atrial Fibrillation: A Nationwide Survey among Danish Cardiologists.

https://arctichealth.org/en/permalink/ahliterature274490
Source
Pacing Clin Electrophysiol. 2015 Oct;38(10):1166-72
Publication Type
Article
Date
Oct-2015
Author
Henrik Vadmann
Susanne S Pedersen
Jens Cosedis Nielsen
Maria Rodrigo-Domingo
Steen Pehrson
Arne Johannessen
Peter Steen Hansen
Jens Brock Johansen
Sam Riahi
Source
Pacing Clin Electrophysiol. 2015 Oct;38(10):1166-72
Date
Oct-2015
Language
English
Publication Type
Article
Keywords
Age Distribution
Atrial Fibrillation - epidemiology - surgery
Attitude of Health Personnel
Cardiology - statistics & numerical data
Catheter Ablation
Clinical Competence - statistics & numerical data
Denmark
Female
Health Care Surveys
Humans
Male
Middle Aged
Patient Selection
Physicians - statistics & numerical data
Practice Patterns, Physicians' - statistics & numerical data
Quality of Life
Abstract
Catheter ablation for atrial fibrillation (AF) is an important but expensive procedure that is the subject of some debate. Physicians' attitudes toward catheter ablation may influence promotion and patient acceptance. This is the first study to examine the attitudes of Danish cardiologists toward catheter ablation for AF, using a nationwide survey.
We developed a purpose-designed questionnaire to evaluate attitudes toward catheter ablation for AF that was sent to all Danish cardiologists (n = 401; response n = 272 (67.8%)). There was no association between attitudes toward ablation and the experience or age of the cardiologist with respect to patients with recurrent AF episodes with a duration of 7 days and/or need for cardioversion. The majority (69%) expected a recurrence of AF after catheter ablation in more than 30% of the cases. For patients with persistent longstanding AF with a duration of >1 year, the attitude toward ablation for longstanding AF was more likely to be positive with increasing age (P 7 days, or those who needed medical/electrical conversion, but a more negative attitude toward treating longstanding AF patients.
PubMed ID
26096979 View in PubMed
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Catheter ablation for ventricular tachycardia in ischaemic heart disease; acute success and long-term outcome.

https://arctichealth.org/en/permalink/ahliterature256843
Source
Scand Cardiovasc J. 2014 Feb;48(1):27-34
Publication Type
Article
Date
Feb-2014
Author
Thibault Johan Mørk
Jens Kristensen
Jens Christian Gerdes
Henrik Kjærulf Jensen
Peter Lukac
Jens Cosedis Nielsen
Author Affiliation
Department of Cardiology, Aarhus University Hospital , Skejby , Denmark.
Source
Scand Cardiovasc J. 2014 Feb;48(1):27-34
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Aged
Catheter Ablation - adverse effects
Defibrillators, Implantable
Denmark
Electric Countershock - instrumentation
Female
Humans
Male
Middle Aged
Myocardial Ischemia - complications - diagnosis
Recurrence
Retrospective Studies
Tachycardia, Ventricular - diagnosis - etiology - surgery
Tertiary Care Centers
Time Factors
Treatment Outcome
Abstract
We conducted a study to assess the acute procedural success and the long-term effect of radiofrequency ablation (RFA) for ventricular tachycardia (VT) in patients with ischaemic heart disease.
We included 90 patients with ischaemic heart disease treated with RFA for VT in our institution. Data were obtained from patient files, and implantable cardioverter-defibrillator (ICD) discharges were recorded from in-house and remote follow-up data. Recurrence of VT during follow-up was noted as date of first ICD therapy for VT or first recurrence of symptomatic VT.
After the initial RFA procedure no VT was inducible in 42 patients (47%), non-clinical VT was inducible in 21 patients (23%), and the clinical VT was still inducible in 14 patients (16%). The procedural success was indefinable in 13 patients (14%). After a median follow-up of 33 months after the latest RFA, 38 patients (42%) stayed free from recurrent VT. The number of ICD shocks/year was significantly reduced from median 1.1 (interquartile range: 0.3-2.8) to 0 (0-0.4) (p
PubMed ID
24460505 View in PubMed
Less detail

CHADS2 and CHA2DS2-VASc score to assess risk of stroke and death in patients paced for sick sinus syndrome.

https://arctichealth.org/en/permalink/ahliterature115142
Source
Heart. 2013 Jun;99(12):843-8
Publication Type
Article
Date
Jun-2013
Author
Jesper Hastrup Svendsen
Jens Cosedis Nielsen
Stine Darkner
Gunnar Vagn Hagemann Jensen
Leif Spange Mortensen
Henning Rud Andersen
Author Affiliation
Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. hastrup@rh.dk
Source
Heart. 2013 Jun;99(12):843-8
Date
Jun-2013
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Cause of Death - trends
Denmark - epidemiology
Electrocardiography
Follow-Up Studies
Great Britain - epidemiology
Humans
Incidence
Magnetic Resonance Imaging, Cine
Pacemaker, Artificial
Predictive value of tests
Prospective Studies
Risk Assessment - methods
Risk factors
Severity of Illness Index
Sick Sinus Syndrome - complications - mortality - therapy
Stroke - diagnosis - etiology - mortality
Thromboembolism - complications - diagnosis - epidemiology
Tomography, X-Ray Computed
Treatment Outcome
Abstract
The risk of stroke in patients with atrial fibrillation (AF) can be assessed by use of the CHADS2 and the CHA2DS2-VASc score system. We hypothesised that these risk scores and their individual components could also be applied to patients paced for sick sinus syndrome (SSS) to evaluate risk of stroke and death.
Prospective cohort study.
All Danish pacemaker centres and selected centres in the UK and Canada.
Risk factors were recorded prior to pacemaker implantation in 1415 patients with SSS participating in the Danish Multicenter Randomized Trial on Single Lead Atrial Pacing versus Dual Chamber Pacing in Sick Sinus Syndrome (Danpace) trial. Development of stroke was assessed at follow-up visits and by evaluation of patient charts. Mortality was assessed from the civil registration system.
Patients were randomised to AAIR (N = 707) or DDDR pacing (N = 708).
Stroke and death during follow-up.
Mean follow-up was 4.3 ± 2.5 years. In the AAIR group 6.9% patients developed stroke versus 6.1% in the DDDR group (NS). There was a significant association between CHADS2 score and the development of stroke (HR 1.41; 95% CI 1.22 to 1.64, p
Notes
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PubMed ID
23539553 View in PubMed
Less detail

Complications after cardiac implantable electronic device implantations: an analysis of a complete, nationwide cohort in Denmark.

https://arctichealth.org/en/permalink/ahliterature259078
Source
Eur Heart J. 2014 May;35(18):1186-94
Publication Type
Article
Date
May-2014
Author
Rikke Esberg Kirkfeldt
Jens Brock Johansen
Ellen Aagaard Nohr
Ole Dan Jørgensen
Jens Cosedis Nielsen
Source
Eur Heart J. 2014 May;35(18):1186-94
Date
May-2014
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Aged, 80 and over
Cardiac Resynchronization Therapy Devices - adverse effects
Child
Child, Preschool
Cohort Studies
Defibrillators, Implantable - adverse effects
Denmark - epidemiology
Device Removal
Female
Humans
Infant
Infant, Newborn
Male
Middle Aged
Pacemaker, Artificial - adverse effects
Postoperative Complications - epidemiology
Prosthesis Failure
Risk factors
Sex Distribution
Young Adult
Abstract
Complications after cardiac implantable electronic device (CIED) treatment, including permanent pacemakers (PMs), cardiac resynchronization therapy devices with defibrillators (CRT-Ds) or without (CRT-Ps), and implantable cardioverter defibrillators (ICDs), are associated with increased patient morbidity, healthcare costs, and possibly increased mortality.
Population-based cohort study in all Danish patients who underwent a CIED procedure from May 2010 to April 2011. Data on complications were gathered on review of all patient charts while baseline data were obtained from the Danish Pacemaker and ICD Register. Adjusted risk ratios (aRRs) with 95% confidence intervals were estimated using binary regression. The study population consisted of 5918 consecutive patients. A total of 562 patients (9.5%) experienced at least one complication. The risk of any complication was higher if the patient was a female (aRR 1.3; 1.1-1.6), underweight (aRR 1.5; 1.1-2.3), implanted in a centre with an annual volume
Notes
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Comment In: Eur Heart J. 2014 May;35(18):1167-824482308
PubMed ID
24347317 View in PubMed
Less detail

Empiric versus imaging guided left ventricular lead placement in cardiac resynchronization therapy (ImagingCRT): study protocol for a randomized controlled trial.

https://arctichealth.org/en/permalink/ahliterature112937
Source
Trials. 2013;14:113
Publication Type
Article
Date
2013
Author
Anders Sommer
Mads Brix Kronborg
Steen Hvitfeldt Poulsen
Morten Böttcher
Bjarne Linde Nørgaard
Kirsten Bouchelouche
Peter Thomas Mortensen
Christian Gerdes
Jens Cosedis Nielsen
Author Affiliation
Department of Cardiology, Aarhus University Hospital, Brendstrupgaardsvej 100, Skejby DK-8200, Aarhus N, Denmark. a.sommer@dadlnet.dk
Source
Trials. 2013;14:113
Date
2013
Language
English
Publication Type
Article
Keywords
Cardiac Resynchronization Therapy - adverse effects - methods - mortality
Cardiac Resynchronization Therapy Devices
Clinical Protocols
Denmark
Diagnostic Imaging - methods
Disease Progression
Double-Blind Method
Echocardiography, Doppler
Exercise Test
Exercise Tolerance
Heart Failure - diagnosis - mortality - physiopathology - therapy
Hospitalization
Humans
Predictive value of tests
Prospective Studies
Recovery of Function
Research Design
Stroke Volume
Therapy, Computer-Assisted - instrumentation - methods
Time Factors
Tomography, Emission-Computed, Single-Photon
Tomography, X-Ray Computed
Treatment Outcome
Ventricular Dysfunction, Left - diagnosis - mortality - physiopathology - therapy
Ventricular Function, Left
Abstract
Cardiac resynchronization therapy (CRT) is an established treatment in heart failure patients. However, a large proportion of patients remain nonresponsive to this pacing strategy. Left ventricular (LV) lead position is one of the main determinants of response to CRT. This study aims to clarify whether multimodality imaging guided LV lead placement improves clinical outcome after CRT.
The ImagingCRT study is a prospective, randomized, patient- and assessor-blinded, two-armed trial. The study is designed to investigate the effect of imaging guided left ventricular lead positioning on a clinical composite primary endpoint comprising all-cause mortality, hospitalization for heart failure, or unchanged or worsened functional capacity (no improvement in New York Heart Association class and
Notes
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PubMed ID
23782792 View in PubMed
Less detail

Health economic evaluation of single-lead atrial pacing vs. dual-chamber pacing in sick sinus syndrome.

https://arctichealth.org/en/permalink/ahliterature260531
Source
Europace. 2014 Jun;16(6):866-72
Publication Type
Article
Date
Jun-2014
Author
Lars Oddershede
Sam Riahi
Jens Cosedis Nielsen
Søren Hjortshøj
Henning Rud Andersen
Lars Ehlers
Source
Europace. 2014 Jun;16(6):866-72
Date
Jun-2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cardiac Resynchronization Therapy Devices - economics - statistics & numerical data
Cost-Benefit Analysis - economics - statistics & numerical data
Denmark - epidemiology
Electrodes, Implanted - economics - statistics & numerical data
Equipment Design
Equipment Failure Analysis
Female
Health Care Costs - statistics & numerical data
Humans
Male
Prevalence
Risk assessment
Sick Sinus Syndrome - economics - mortality - prevention & control
Survival Analysis
Treatment Outcome
Abstract
The recent Danish Multicentre Randomized Trial on Single-Lead Atrial (AAIR) Pacing versus Dual-Chamber (DDDR) Pacing in Sick Sinus Syndrome (DANPACE) suggested DDDR pacing as standard care. However, previous findings supported the routine use of AAIR pacing. This study investigated the cost-effectiveness of DDDR pacing compared with AAIR pacing for sick sinus syndrome.
A decision-analytical model based on patient-level data from three randomized trials was designed from the Danish healthcare system's perspective. The main outcomes were lifetime costs, quality-adjusted lifeyears (QALYs), and net monetary benefit. Quality-adjusted lifeyears were calculated by utilizing community-based preferences. Costs were calculated by utilizing the extensive data on resource consumption, from the DANPACE trial. Data were pooled and adjusted for baseline differences. Dual-chamber pacing was shown to be cost-effective in all the analyses using a willingness-to-pay (WTP) threshold of £20,000/QALY, and most analyses using a WTP of £30,000/QALY. When pooling the data and adjusting for baseline differences, Monte Carlo simulations revealed a 51-71% probability of DDDR pacing being cost-effective at a WTP of £20,000/QALY, and a 42-58% probability at a WTP of £30,000/QALY. Dual-chamber pacing was most likely to be cost-effective among elderly patients with comorbidity. The expected value of perfect information was low and initiation of additional publicly funded Danish trials was discouraged.
Dual-chamber pacing is likely to be a cost-effective treatment for sick sinus syndrome patients.
PubMed ID
24451290 View in PubMed
Less detail

Implantable cardioverter-defibrillators and subsequent cancer risk: a nationwide population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature270244
Source
Europace. 2015 Jun;17(6):902-8
Publication Type
Article
Date
Jun-2015
Author
Susanne Bendesgaard Pedersen
Jens Cosedis Nielsen
Hans Erik Bøtker
Dóra Körmendiné Farkas
Morten Schmidt
Henrik Toft Sørensen
Source
Europace. 2015 Jun;17(6):902-8
Date
Jun-2015
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Cohort Studies
Colorectal Neoplasms - epidemiology - etiology
Defibrillators, Implantable - statistics & numerical data
Denmark - epidemiology
Esophageal Neoplasms - epidemiology - etiology
Female
Follow-Up Studies
Humans
Incidence
Infant
Infant, Newborn
Kidney Neoplasms - epidemiology - etiology
Lung Neoplasms - epidemiology - etiology
Male
Middle Aged
Myocardial Ischemia - epidemiology
Neoplasms - epidemiology
Registries
Risk factors
Stomach Neoplasms - epidemiology - etiology
Tobacco Use - adverse effects - epidemiology
Tracheal Neoplasms - epidemiology - etiology
Urinary Bladder Neoplasms - epidemiology - etiology
Young Adult
Abstract
Despite increasing use of implantable cardioverter-defibrillators (ICDs) and reports linking selected bio-implants with cancer, the cancer risk associated with implanted ICDs remains unknown. The objective of our study was to examine cancer risk among ICD recipients.
We conducted a population-based cohort study using medical registries covering the entire Danish population. We identified all first-time ICD recipients during the period of 2000-11 and determined their subsequent cancer incidence. Standardized incidence ratios (SIRs) were computed by comparing observed cancer incidence in the ICD cohort with expected cancer incidence based on national incidence rates according to age, sex, and year of diagnosis. A total of 6723 ICD recipients were followed for up to 12 years (median 2.8 years) and contributed a total of 23 254 person-years of follow-up. Compared with the general population, ICD recipients had a slightly elevated overall risk of cancer [SIR = 1.1 (95% confidence interval (CI): 1.0-1.2)]. This was driven by the cancer risk among patients with ischaemic heart disease (IHD) [SIR = 1.1 (95% CI: 1.0-1.3)], which, as expected, was particularly elevated for tobacco-related cancers [SIR = 1.4 (95% CI: 1.2-1.6)]. Importantly, ICD recipients without IHD were not at increased cancer risk [SIR = 1.0 (95% CI: 0.8-1.3)].
This nationwide population-based cohort study with up to 12-year follow-up did not indicate a causal relation between ICD implantation and cancer. However, more follow-up data are needed to entirely rule out risks for individual cancer types.
PubMed ID
25840286 View in PubMed
Less detail

Infection after pacemaker implantation: infection rates and risk factors associated with infection in a population-based cohort study of 46299 consecutive patients.

https://arctichealth.org/en/permalink/ahliterature137742
Source
Eur Heart J. 2011 Apr;32(8):991-8
Publication Type
Article
Date
Apr-2011
Author
Jens Brock Johansen
Ole Dan Jørgensen
Mogens Møller
Per Arnsbo
Peter Thomas Mortensen
Jens Cosedis Nielsen
Author Affiliation
Danish Pacemaker Register, Department of Cardiology, Odense University Hospital, DK 5000 Odense C, Denmark. brock@dadlnet.dk
Source
Eur Heart J. 2011 Apr;32(8):991-8
Date
Apr-2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Arrhythmias, Cardiac - surgery
Cardiac Pacing, Artificial - adverse effects
Denmark - epidemiology
Device Removal - statistics & numerical data
Female
Humans
Incidence
Kaplan-Meier Estimate
Male
Middle Aged
Pacemaker, Artificial - adverse effects
Prospective Studies
Prosthesis-Related Infections - epidemiology
Risk factors
Abstract
Infection is a serious complication of pacemaker (PM) systems. Although the rate of infection has been debated, the figures are largely unknown. We therefore studied the incidence of PM infection and its associated risk factors in the Danish population.
Since 1982, all PM implantation and removal procedures performed in Denmark have been prospectively recorded in the Danish Pacemaker Register. All patients (n = 46299) who underwent implantation between 1982 and 2007 were included. The total length of surveillance was 236,888 PM-years. The incidence of infection was calculated according to the total number of PM-years. The incidence of surgical site infection (= 365 days after PM implantation) was compared with later infection in first implant and replacement procedures. Multiple-record and multiple-event-per-subject proportional hazards analyses were used to identify the independent risk factors of PM infection. Surgical site infection occurred in 192 cases after first implantation (incidence rate 4.82/1000 PM-years), and in 133 cases after replacement (12.12/1000 PM-years). Infections occurring more than 365 days after the first implantation occurred in 153 cases (1.02/1000 PM-years), and in 118 cases after replacement (3.26/1000 PM-years). Independent factors associated with an increased risk of PM infection were a greater number of PM operations (including replacements), male sex, younger age, implantation during the earliest part of the study period, and absence of antibiotics (P
Notes
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PubMed ID
21252172 View in PubMed
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The Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation (MANTRA-PAF) trial: clinical rationale, study design, and implementation.

https://arctichealth.org/en/permalink/ahliterature150927
Source
Europace. 2009 Jul;11(7):917-23
Publication Type
Article
Date
Jul-2009
Author
Christian Jons
Peter Steen Hansen
Arne Johannessen
Gerhard Hindricks
Pekka Raatikainen
Ole Kongstad
Håkan Walfridsson
Steen Pehrson
Henrik Almroth
Juha Hartikainen
Anders Kirstein Petersen
Leif Spange Mortensen
Jens Cosedis Nielsen
Author Affiliation
Gentofte University Hospital, Copenhagen, Denmark.
Source
Europace. 2009 Jul;11(7):917-23
Date
Jul-2009
Language
English
Publication Type
Article
Keywords
Atrial Fibrillation - diagnosis - surgery
Catheter Ablation - adverse effects - methods
Germany
Humans
Postoperative Complications - diagnosis - etiology
Research Design
Sweden
Treatment Outcome
Abstract
No large randomized multicentre trial has evaluated the efficacy of radiofrequency ablation (RFA) vs. anti-arrhythmic drug (AAD) therapy as a first-line treatment of paroxysmal atrial fibrillation (AF).
The Medical ANtiarrhythmic Treatment or Radiofrequency Ablation (MANTRA-PAF) trial is a randomized, controlled, parallel group, multicentre study designed to test whether catheter-based RFA is superior to optimized AAD therapy in suppressing relapse within 24 months of symptomatic and/or asymptomatic AF in patients with paroxysmal AF without prior AAD therapy. The primary endpoint is cumulative AF burden on repeated 7 days Holter monitoring. Secondary endpoints are: thromboembolic events, hospitalization due to arrhythmia, pro-arrhythmic events, procedure/treatment-related side effects, health economics, quality of life, and change in left ventricular function. Ten centres in Scandinavia and Germany are participating in the study. Enrolment was started in 2005 and as of November 2008, 260 patients have been enrolled into the study. It is expected that enrolment will end by March 2009, when 300 patients have been included.
The MANTRA-PAF trial will determine whether catheter-based RFA is superior to optimized AAD therapy as a first-line treatment in suppressing long-term relapse of symptomatic and/or asymptomatic AF.
PubMed ID
19447807 View in PubMed
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