The Danish National Patient Register (DNPR)is widely used for research and administrative purposes. However, its usability is highly dependent of the validity of the registered data. We therefore aimed to determine the positive predictive value (PPV) of angina pectoris and acute coronary syndrome (ACS) in the DNPR.
We selected a random sample of 500 patients registered with angina pectoris and a random sample of 500 patients registered with ACS among all hospitalisations at any department in Northern Denmark between 1 January 2007 and 31 December 2007. We reviewed the medical records of the sample patients and recorded whether the angina pectoris and the ACS diagnoses were valid, based on the European Society of Cardiology criteria.
The PPV of definite and probable angina pectoris was 45.9% (95% confidence interval (CI): 41.3-50.6%), whereas the PPV of verified ACS was 86.6% (95% CI: 83.3-89.5%). Stratification by hospital department revealed significantly higher PPVs for diagnoses received in a cardiology unit for both angina pectoris (61.7%; 95% CI: 53.4-69.6%) and ACS (95.5%; 95% CI: 91.3-98.0%). Stratification by gender showed a significantly higher PPV among men registered with angina pectoris (51.2%; 95% CI: 45.3-57.1%).
The angina pectoris and ACS data contained in the DNPR should be used with caution in register studies if validation is not possible. Restricting analyses of ACS data to patients discharged from cardiology wards may be a useful option in register-based studies.
Correction of the metabolic link of the natural course of ischemic heart disease (IHD) was found out to be a real reserve of enhancement of therapy efficiency in treating this condition. A total of 137 IHD patients were examined, presenting with functional class II-III exertional angina, their age ranging between 67 to 86 years. Kinds of metabolic complexes to be used in IHD treatment included amino acids, antioxidants, cofactors, energy-providing compounds that enhance efficiency of basic methods of IHD therapy. A positive therapeutic effect of metabolic correction treatments was evidenced by earlier dispelling of electrocardiographic signs of myocardial ischemia, higher tolerance to physical load, improvement in parameters characterizing cardio-hemodynamics.
A number of psychosomatic studies have suggested that alexithymia, impairment in identifying and expressing inner feelings, might somehow affect the course of various illnesses. However, none of these studies have distinguished between an impact of alexithymia on actual pathophysiological change versus an impact only on illness behavior. In the present study, a population-based random sample of 2297 middle-aged men from Eastern Finland was evaluated for alexithymia using the Finnish version of the self-report Toronto Alexithymia Scale (TAS). Although high TAS scores were associated with prior diagnosis of coronary heart disease (CHD), they were not associated with greater prevalence of ischemia on an exercise tolerance test. The results of B-mode ultrasonography of the carotid artery for those who had a CHD diagnosis showed that carotid atherosclerosis actually decreased significantly as alexithymia increased. An interaction analysis indicated that alexithymia was related to increased probability of being diagnosed with CHD only among those who had mildly or moderately progressed carotid atherosclerosis, and not among those with the most severe progression. Alexithymia was associated with higher perceived exertion, and to some extent, with more self-reported symptoms during the exercise tolerance test. The findings support the hypothesis that alexithymia relates to increased symptom reporting rather than pathophysiological changes in CHD. The results also suggest that alexithymic men may get diagnosed earlier, perhaps because of their different illness behavior.
To analyze prevalence of ischemic heart disease (IHD), main IHD risk factors and mortality in the population of males aged 70-79 and over 80 years.
The study included 209 males aged 70-79 years and 96 males over 80. All the males were examined for IHD and 3 main risk factors: blood hypertension, hyperlipidemia and smoking.
Incidence of IHD was about similar in both age groups. For 3.5 years of follow-up in the group of 80-year-olds mortality was 2 times that of the group of 70-79-year-olds. The presence of IHD in the groups was directly related to the presence of 2 or 3 risk factors, especially in the group aged 70-79 years. In the group of 80-year-olds and older combination of IHD with affection of cerebral vessels was a poor prognosis sign.
Factors deteriorating prognosis in males over 70 were: macrofocal myocardial infarction in anamnesis, atherosclerosis of the coronary and cerebral arteries.