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25 year trends in first time hospitalisation for acute myocardial infarction, subsequent short and long term mortality, and the prognostic impact of sex and comorbidity: a Danish nationwide cohort study.

https://arctichealth.org/en/permalink/ahliterature127603
Source
BMJ. 2012;344:e356
Publication Type
Article
Date
2012
Author
Morten Schmidt
Jacob Bonde Jacobsen
Timothy L Lash
Hans Erik Bøtker
Henrik Toft Sørensen
Author Affiliation
Department of Clinical Epidemiology, Aarhus University Hospital, Denmark. msc@dce.au.dk
Source
BMJ. 2012;344:e356
Date
2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Cohort Studies
Comorbidity
Denmark - epidemiology
Female
Hospitalization - statistics & numerical data
Humans
Incidence
Male
Middle Aged
Myocardial Infarction - mortality
Prognosis
Risk factors
Sex Factors
Survival Rate
Time Factors
Abstract
To examine 25 year trends in first time hospitalisation for acute myocardial infarction in Denmark, subsequent short and long term mortality, and the prognostic impact of sex and comorbidity.
Nationwide population based cohort study using medical registries.
All hospitals in Denmark.
234,331 patients with a first time hospitalisation for myocardial infarction from 1984 through 2008.
Standardised incidence rate of myocardial infarction and 30 day and 31-365 day mortality by sex. Comorbidity categories were defined as normal, moderate, severe, and very severe according to the Charlson comorbidity index, and were compared by means of mortality rate ratios based on Cox regression.
The standardised incidence rate per 100,000 people decreased in the 25 year period by 37% for women (from 209 to 131) and by 48% for men (from 410 to 213). The 30 day, 31-365 day, and one year mortality declined from 31.4%, 15.6%, and 42.1% in 1984-8 to 14.8%, 11.1%, and 24.2% in 2004-8, respectively. After adjustment for age at time of myocardial infarction, men and women had the same one year risk of dying. The mortality reduction was independent of comorbidity category. Comparing patients with very severe versus normal comorbidity during 2004-8, the mortality rate ratio, adjusted for age and sex, was 1.96 (95% CI 1.83 to 2.11) within 30 days and 3.89 (3.58 to 4.24) within 31-365 days.
The rate of first time hospitalisation for myocardial infarction and subsequent short term mortality both declined by nearly half between 1984 and 2008. The reduction in mortality occurred for all patients, independent of sex and comorbidity. However, comorbidity burden was a strong prognostic factor for short and long term mortality, while sex was not.
Notes
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Comment In: Nat Rev Cardiol. 2012 Apr;9(4):18622348972
Comment In: BMJ. 2012;344:d780922279112
PubMed ID
22279115 View in PubMed
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30-year mortality after venous thromboembolism: a population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature257922
Source
Circulation. 2014 Sep 2;130(10):829-36
Publication Type
Article
Date
Sep-2-2014
Author
Kirstine Kobberøe Søgaard
Morten Schmidt
Lars Pedersen
Erzsébet Horváth-Puhó
Henrik Toft Sørensen
Author Affiliation
From the Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. kks@clin.au.dk.
Source
Circulation. 2014 Sep 2;130(10):829-36
Date
Sep-2-2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cohort Studies
Databases as Topic - statistics & numerical data
Denmark - epidemiology
Female
Humans
Longitudinal Studies
Male
Middle Aged
Regression Analysis
Retrospective Studies
Risk factors
Survival Rate
Venous Thromboembolism - epidemiology - mortality
Abstract
Studies on long-term mortality after venous thromboembolism (VTE) are sparse.
Using Danish medical databases, we conducted a 30-year nationwide population-based cohort study of 128 223 patients with first-time VTE (1980-2011) and a comparison cohort of 640 760 people from the general population (without VTE) randomly matched by sex, year of birth, and calendar period. The mortality risks for patients with deep venous thrombosis (DVT) and pulmonary embolism (PE) were markedly higher than for the comparison cohort during the first year, especially within the first 30 days (3.0% and 31% versus 0.4%). Using Cox regression, we assessed mortality rate ratios (MRRs) with 95% confidence intervals (CIs). The overall 30-year MRR was 1.55 (95% CI, 1.53-1.57) for DVT and 2.77 (95% CI, 2.74-2.81) for PE. The 30-day MRR was 5.38 (95% CI, 5.00-5.80) for DVT and 80.87 (95% CI, 76.02-86.02) for PE. Over time, the 30-day MRR was consistently 5- to 6-fold increased for DVT, whereas it improved for PE from 138 (95% CI, 125-153) in 1980 to 1989 to 36.08 (95% CI, 32.65-39.87) in 2000 to 2011. The 1- to 10-year and 11- to 30-year MRRs remained 25% to 40% increased after both DVT and PE but were 3- to 5-fold increased after DVT and 6- to 11-fold increased after PE when VTE was considered the immediate cause of death.
Patients with VTE are at increased risk of dying, especially within the first year after diagnosis, but also during the entire 30 years of follow-up, with VTE as an important cause of death. Although 30-day mortality after DVT remained fairly constant over the last 3 decades, it improved markedly for PE.
Notes
Comment In: Nat Rev Cardiol. 2014 Sep;11(9):49625027484
Comment In: Nat Rev Cardiol. 2014 Sep;11(9):49725027486
PubMed ID
24970783 View in PubMed
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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
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Acute kidney injury treated with renal replacement therapy and 5-year mortality after myocardial infarction-related cardiogenic shock: a nationwide population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature274241
Source
Crit Care. 2015;19:452
Publication Type
Article
Date
2015
Author
Marie Dam Lauridsen
Henrik Gammelager
Morten Schmidt
Thomas Bøjer Rasmussen
Richard E Shaw
Hans Erik Bøtker
Henrik Toft Sørensen
Christian Fynbo Christiansen
Source
Crit Care. 2015;19:452
Date
2015
Language
English
Publication Type
Article
Keywords
Acute Kidney Injury - epidemiology - etiology - mortality - therapy
Aged
Cohort Studies
Denmark - epidemiology
Dialysis - statistics & numerical data
Female
Humans
Male
Middle Aged
Mortality - trends
Myocardial Infarction - complications - mortality
Renal Replacement Therapy - statistics & numerical data - utilization
Shock, Cardiogenic - complications - epidemiology - etiology - mortality
Abstract
Myocardial infarction-related cardiogenic shock is frequently complicated by acute kidney injury. We examined the influence of acute kidney injury treated with renal replacement therapy (AKI-RRT) on risk of chronic dialysis and mortality, and assessed the role of comorbidity in patients with cardiogenic shock.
In this Danish cohort study conducted during 2005-2012, we used population-based medical registries to identify patients diagnosed with first-time myocardial infarction-related cardiogenic shock and assessed their AKI-RRT status. We computed the in-hospital mortality risk and adjusted relative risk. For hospital survivors, we computed 5-year cumulative risk of chronic dialysis accounting for competing risk of death. Mortality after discharge was computed with use of Kaplan-Meier methods. We computed 5-year hazard ratios for chronic dialysis and death after discharge, comparing AKI-RRT with non-AKI-RRT patients using a propensity score-adjusted Cox regression model.
We identified 5079 patients with cardiogenic shock, among whom 13% had AKI-RRT. The in-hospital mortality was 62% for AKI-RRT patients, and 36% for non-AKI-RRT patients. AKI-RRT remained associated with increased in-hospital mortality after adjustment for confounders (relative risk=1.70, 95% confidence interval (CI): 1.59-1.81). Among the 3059 hospital survivors, the 5-year risk of chronic dialysis was 11% (95% CI: 8-16%) for AKI-RRT patients, and 1% (95% CI: 0.5-1%) for non-AKI-RRT patients (adjusted hazard ratio: 15.9 (95% CI: 8.7-29.3). The 5-year mortality was 43% (95% CI: 37-53%) for AKI-RRT patients compared with 29% (95% CI: 29-31%) for non-AKI-RRT patients. The adjusted 5-year hazard ratio for death was 1.55 (95% CI: 1.22-1.96) for AKI-RRT patients compared with non-AKI-RRT patients. In patients with comorbidity, absolute mortality increased while relative impact of AKI-RRT on mortality decreased.
AKI-RRT following myocardial infarction-related cardiogenic shock predicted elevated short-term mortality and long-term risk of chronic dialysis and mortality. The impact of AKI-RRT declined with increasing comorbidity suggesting that intensive treatment of AKI-RRT should be accompanied with optimized treatment of comorbidity when possible.
Notes
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PubMed ID
26715162 View in PubMed
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Adult height and risk of ischemic heart disease, atrial fibrillation, stroke, venous thromboembolism, and premature death: a population based 36-year follow-up study.

https://arctichealth.org/en/permalink/ahliterature105680
Source
Eur J Epidemiol. 2014 Feb;29(2):111-8
Publication Type
Article
Date
Feb-2014
Author
Morten Schmidt
Hans Erik Bøtker
Lars Pedersen
Henrik Toft Sørensen
Author Affiliation
Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus, Denmark, morten.schmidt@dadlnet.dk.
Source
Eur J Epidemiol. 2014 Feb;29(2):111-8
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Adult
Atrial Fibrillation - complications - diagnosis - epidemiology
Body Height
Body mass index
Denmark - epidemiology
Follow-Up Studies
Humans
Incidence
Life expectancy
Male
Middle Aged
Mortality, Premature
Myocardial Ischemia - complications - diagnosis - mortality
Population Surveillance
Proportional Hazards Models
Risk factors
Stroke - complications - diagnosis - epidemiology
Venous Thromboembolism - complications - diagnosis - epidemiology
Abstract
Few studies have associated height with cardiovascular diseases other than myocardial infarction. We conducted a population-based 36-year cohort study of 12,859 men born in 1955 or 1965 whose fitness for military service was assessed by Draft Boards in Northern Denmark. Hospital diagnoses for ischemic heart diseases, atrial fibrillation, stroke, and venous thromboembolism were obtained from the Danish National Patient Registry, covering all Danish hospitals since 1977. Mortality data were obtained from the Danish Civil Registration System. We began follow-up on the 22nd birthday of each subject and continued until occurrence of an outcome, emigration, death, or 31 December 2012, whichever came first. We used Cox regression to compute hazard ratios (HRs) with 95 % confidence intervals (CIs). Compared with short stature, the education-adjusted HR among tall men was 0.67 (95 % CI 0.54-0.84) for ischemic heart disease (similar for myocardial infarction, angina pectoris, and heart failure), 1.60 (95 % CI 1.11-2.33) for atrial fibrillation, 1.05 (95 % CI 0.75-1.46) for stroke, 1.04 (95 % CI 0.67-1.64) for venous thromboembolism, and 0.70 (95 % CI 0.58-0.86) for death. In conclusion, short stature was a risk factor for ischemic heart disease and premature death, but a protective factor for atrial fibrillation. Stature was not substantially associated with stroke or venous thromboembolism.
PubMed ID
24337942 View in PubMed
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Clopidogrel discontinuation within the first year after coronary drug-eluting stent implantation: an observational study.

https://arctichealth.org/en/permalink/ahliterature259840
Source
BMC Cardiovasc Disord. 2014;14:100
Publication Type
Article
Date
2014
Author
Troels Thim
Martin Berg Johansen
Gro Egholm Chisholm
Morten Schmidt
Anne Kaltoft
Henrik Toft Sørensen
Leif Thuesen
Steen Dalby Kristensen
Hans Erik Bøtker
Lars Romer Krusell
Jens Flensted Lassen
Per Thayssen
Lisette Okkels Jensen
Hans-Henrik Tilsted
Michael Maeng
Source
BMC Cardiovasc Disord. 2014;14:100
Date
2014
Language
English
Publication Type
Article
Keywords
Aged
Coronary Thrombosis - etiology - mortality - prevention & control
Denmark
Drug Administration Schedule
Drug Prescriptions
Drug-Eluting Stents
Female
Humans
Male
Medication Adherence
Middle Aged
Myocardial Infarction - etiology - mortality - prevention & control
Percutaneous Coronary Intervention - adverse effects - instrumentation - mortality
Platelet Aggregation Inhibitors - administration & dosage
Registries
Retrospective Studies
Risk assessment
Risk factors
Ticlopidine - administration & dosage - analogs & derivatives
Time Factors
Treatment Outcome
Abstract
The impact of adherence to the recommended duration of dual antiplatelet therapy after first generation drug-eluting stent implantation is difficult to assess in real-world settings and limited data are available.
We followed 4,154 patients treated with coronary drug-eluting stents in Western Denmark for 1 year and obtained data on redeemed clopidogrel prescriptions and major adverse cardiovascular events (MACE, i.e., cardiac death, myocardial infarction, or stent thrombosis) from medical databases.
Discontinuation of clopidogrel within the first 3 months after stent implantation was associated with a significantly increased rate of MACE at 1-year follow-up (hazard ratio (HR) 2.06; 95% confidence interval (CI): 1.08-3.93). Discontinuation 3-6 months (HR 1.29; 95% CI: 0.70-2.41) and 6-12 months (HR 1.29; 95% CI: 0.54-3.07) after stent implantation were associated with smaller, not statistically significant, increases in MACE rates. Among patients who discontinued clopidogrel, MACE rates were highest within the first 2 months after discontinuation.
Discontinuation of clopidogrel was associated with an increased rate of MACE among patients treated with drug-eluting stents. The increase was statistically significant within the first 3 months after drug-eluting stent implantation but not after 3 to 12 months.
Notes
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PubMed ID
25125079 View in PubMed
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Clopidogrel use and short-term mortality after peptic ulcer bleeding: a population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature136976
Source
Am J Ther. 2013 Jan;20(1):13-20
Publication Type
Article
Date
Jan-2013
Author
Morten Schmidt
Anders H Riis
Christian F Christiansen
Timothy L Lash
Henrik T Sørensen
Author Affiliation
Department of Clinical Epidemiology, Aarhus University Hospital, DK-8200, Aarhus N, Denmark. msc@dce.au.dk
Source
Am J Ther. 2013 Jan;20(1):13-20
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Atherosclerosis - complications - drug therapy - mortality
Cohort Studies
Denmark - epidemiology
Female
Humans
Male
Middle Aged
Peptic Ulcer Hemorrhage - chemically induced - complications - diagnosis - mortality
Platelet Aggregation Inhibitors - adverse effects - therapeutic use
Prognosis
Proportional Hazards Models
Registries
Ticlopidine - adverse effects - analogs & derivatives - therapeutic use
Abstract
Clopidogrel therapy increases bleeding risk, but whether it influences short-term mortality after peptic ulcer bleeding (PUB) is unknown. The objective was to examine whether clopidogrel use at the time of PUB increases 30-day mortality. We conducted this cohort study in northern Denmark (population 1.7 million). We used the Danish National Patient Registry, covering all hospitals, to identify all patients with a first-ever inpatient diagnosis of endoscopically or surgically confirmed PUB between 1998 and 2008 and their comorbidities. From the prescription database in the region, we ascertained the use of clopidogrel at the time of admission (current use) or before admission (former use) and use of concurrent medications. We obtained mortality data from the Danish Civil Registration System. We used regression modeling to compute mortality rate ratios (MRRs) with 95% confidence intervals (CIs), controlling for potential confounders. We identified 6951 patients with bleeding peptic ulcers. At admission, 122 (1.8%) were current users of clopidogrel, 143 (2.1%) were former users, and 6686 (96.2%) were nonusers. Thirty-day mortality was 5.7% for current users, 7.0% for former users, and 8.0% for nonusers. The adjusted 30-day MRR was reduced in both current and former users, compared with nonusers (MRR = 0.72, 95% CI 0.34, 1.52 and MRR = 0.71, 95% CI 0.38, 1.32, respectively). There was no notable modification of the association within gender or age strata. Although the use of clopidogrel increases the risk of PUB, former use and current use of clopidogrel were not associated with increased short-term mortality after admission for this condition.
PubMed ID
21326084 View in PubMed
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34 records – page 1 of 4.