2372Causes of death and effect of co-morbidities on mortality in young patients with heart failure. Data from the Swedish Heart Failure, Cause of Death and National Patient Registers

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Basic ◽  
A Rosengren ◽  
U Dahlstrom ◽  
M Edner ◽  
T Zverkova Sandstrom ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cause Of Death ◽  
Causes Of Death ◽  
Young Patients ◽  
Mortality Data ◽  
Quality Register ◽  
Co Morbidity ◽  
National Patient ◽  
Age And Sex ◽  
Observation Period

Abstract Background The last two decades incidence and prevalence of heart failure (HF) among young patients have increased in Sweden. Up to the beginning of the 21st century mortality in patients with HF has decreased but causes of death and the effects of co-morbidity on mortality in young patients with HF are not well studied. Purpose To address causes of death and the effect of co-morbidity at baseline on mortality during the last decade in young patients with HF. Methods The Swedish Heart Failure Register (SwedeHF,) a nationwide quality register, was introduced in Sweden in 2003. All hospital discharge diagnoses are recorded in the National Patient Register (NPR) and deaths are registered in the Cause of Death Register. All patients ≥18 and <55 years with a HF diagnosis in SwedeHF were included and linked to the Cause of Death Register and NPR with the personal identification number. ICD 10-codes for all comorbidities and principal cause of death were identified during the observation period from 2003 to 2016. Besides, comorbidity and mortality data were compared with age and sex matched controls from the general population, database from Statistics Sweden (SCB). Results We identified 3752 (6.2%) patients <55 years from the total SwedeHF population (n=60,962) and added 7573 age and sex matched controls. There were 971 (25.9%) women and 2781 (74.1%) men mean age 44.9 (8.4) and 46.4 (7.3) years respectively. Among the young 604 (16.1%) patients died vs. 162 (2.2%) among matched controls (p<0.001) during the observation period. Principal cause of death was HF in 2.7% of the young patients (in men 3% vs. 1.4% in women (p=0.221)), other cardiovascular diseases 48.7% (27.7% in men vs. 20% in women (p=0.05)), congenital heart disease 4% (3% in men vs. 6.9% in women (p=0.077)), cancer 12.9% (9.6% in men vs. 23.6% in women (p=0.003)), neurologic disease 4.5% (5.4% in men vs. 1.4% in women (p=0.028)) suicide 0.8% (0.7% in men vs 1.4% in women (p=0.47)) and other causes 15.1% (15.9% in men vs 12.5% in women (p=0.179)) vs. 0, 26.5%, 1.2%, 32.7%, 1.2%, 9.9% and 18.5% in matched controls (all p<0.0001). The effect of co-morbidity at baseline on mortality in young patients with HF is presented in Figure 1. Effect of co-morbidity on mortality Conclusion Compared to matched controls young patients with HF had worse survival. Almost one quarter of women with HF had cancer as a principal cause of death. Men with AF, obesity and depression at baseline had higher risk to die than women. Women with HF and hypertension, PAH or kidney disease at baseline had higher risk to die than men with HF and the same co-morbidities. Acknowledgement/Funding Swedish state under the agreement concerning research and education of doctors, The Swedish Heart and Lung Foundation, Västra Götaland Region grants

scholarly journals Mortality risk and life years lost in young patients with heart failure according ejection fraction. Data from the Swedish Heart failure, National Patient, Cause of Death and Population Registers

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Basic ◽  
A.R Rosengren A ◽  
U.D Dahlstrom ◽  
M.E Edner ◽  
T.Z.S Zverkova Sandstrom ◽  
...  
Keyword(s):  
Heart Failure ◽  
General Population ◽  
Life Expectancy ◽  
Ejection Fraction ◽  
Cause Of Death ◽  
Mortality Risk ◽  
Young Patients ◽  
Life Years ◽  
National Patient ◽  
Life Years Lost

Abstract Background There is a lack of data evaluating excess mortality risk (over that of the general population) and life-years lost in young patients with different heart failure (HF) phenotypes. Purpose To study excess risk for all-cause mortality in patients &lt;55 years by their ejection fraction (EF) categories and estimate lost “life years” compared to the general population in Sweden. Methods All patients ≥18 years registered in the national quality register SwedeHF from 2003 to 2014 were included. Patients were divided into ≥55 years and &lt;55 years. For each patient two controls without a HF diagnosis, matched for age, sex and county, were identified from the Swedish Population Register. The use of personal identification number enabled linkage to other registers. All somatic hospital discharge diagnoses are recorded in the National Patient Register (NPR). Time of death and causes of death were obtained from the Cause of Death Register. International Classification of Disease ICD 9 and ICD 10-codes for all co-morbidities were identified in NPR and for underlying causes of death during the observation period from the 1st January 2003 to 31st December 2015. Life expectancy tables from Statistics Sweden were used as reference to the conditional life expectancy for controls calculated at the age 20, 25, 30, 35 and 40 years. Life-years lost were calculated as the difference between conditional life expectancy and conditional survival for patients with HF &lt;55 years presented as median. Results In total 60,962 patients, out of whom 3752 &lt;55 years and 7425 controls &lt;55 years were identified. Total observation time was 12 years; median 4.89 years. There were 2549 (67.9%) patients with ejection fraction (EF) &lt;40% and 357 (9.5%) with EF &gt;50%. Patients with HF&lt;40% were more likely to be men (78.2% vs. 56.3%), to have ischemic heart disease (16.9% vs. 2.3%) and dilated cardiomyopathy (38.1% vs. 29.7%) whereas patients with EF &gt;50% more often had hypertension (40.6% vs. 29.8%), hypertrophic cardiomyopathy (11.5% vs. 0.7%) and congenital heart disease (7.6% vs. 2.7%), all p&gt;0.001. Cardiovascular death was the most common cause of death in all EF categories (about 55%). In a Cox proportional hazard model, patients with EF &gt;50% had hazard ratio (HR) (95% CI) 10.6 (5.71–19.8), those with EF 40–49% 6.83 (4.43–10.5) and patients with EF&lt;40% 7.97 (6.45–9.85) for all-cause mortality (NS). According to the conditional survival analysis patients aged 20, 25, 30, 35 and 40 years with EF&lt;40% lost a median of 28.5, 26.6, 24.7, 22.2 and 20.1 “life years” whereas patients with EF&gt;50% lost 32.3, 28.7, 26.1, 26.3 and 21.6 “life years” as presented in figure 1. Conclusion HF patients &lt;55 years with EF&gt;50% had different coexisting conditions and higher mortality risk, although not significant when compared to patients with EF &lt;40%. Moreover, compared to the general population patients with EF&gt;50% lost more life years than patients with EF&lt;40%. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Redistribution of heart failure deaths using two methods: linkage of hospital records with death certificate data and multiple causes of death data

2019 ◽  
Vol 35 (5) ◽  
Author(s):  
Ana Luiza Bierrenbach ◽  
Gizelton Pereira Alencar ◽  
Cátia Martinez ◽  
Maria de Fátima Marinho de Souza ◽  
Gabriela Moreira Policena ◽  
...  
Keyword(s):  
Heart Failure ◽  
Causes Of Death ◽  
Kidney Diseases ◽  
Heart Diseases ◽  
National Study ◽  
Mortality Data ◽  
Multiple Causes Of Death ◽  
Underlying Causes ◽  
Garbage Code ◽  
Multiple Causes

Heart failure is considered a garbage code when assigned as the underlying cause of death. Reassigning garbage codes to plausible causes reduces bias and increases comparability of mortality data. Two redistribution methods were applied to Brazilian data, from 2008 to 2012, for decedents aged 55 years and older. In the multiple causes of death method, heart failure deaths were redistributed based on the proportion of underlying causes found in matched deaths that had heart failure listed as an intermediate cause. In the hospitalization data method, heart failure deaths were redistributed based on data from the decedents’ corresponding hospitalization record. There were 123,269 (3.7%) heart failure deaths. The method with multiple causes of death redistributed 25.3% to hypertensive heart and kidney diseases, 22.6% to coronary heart diseases and 9.6% to diabetes. The total of 41,324 heart failure deaths were linked to hospitalization records. Heart failure was listed as the principal diagnosis in 45.8% of the corresponding hospitalization records. For those, no redistribution occurred. For the remaining ones, the hospitalization data method redistributed 21.2% to a group with other (non-cardiac) diseases, 6.5% to lower respiratory infections and 9.3% to other garbage codes. Heart failure is a frequently used garbage code in Brazil. We used two redistribution methods, which were straightforwardly applied but led to different results. These methods need to be validated, which can be done in the wake of a recent national study that will investigate a big sample of hospital deaths with garbage codes listed as underlying causes.

scholarly journals Redistributing Ill-defined Causes of Death – A Case Study from the Burden 2020-Project in Germany

2020 ◽  
Author(s):  
Annelene Wengler ◽  
Heike Gruhl ◽  
Dietrich Plaß ◽  
Janko Leddin ◽  
Alexander Rommel ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Cause Of Death ◽  
Burden Of Disease ◽  
Causes Of Death ◽  
Respiratory Infections ◽  
Large Numbers ◽  
Icd Codes ◽  
High Share

Abstract Background The cause of death statistics in Germany include a relatively high share (26% in 2017) of ill-defined deaths (IDD). To make use of the cause of death statistics for Burden of Disease calculations we redistribute those IDD to valid causes of death.Methods The process of proportional redistribution is described in detail. It makes use of the distribution of the valid ICD-codes in the data. We use examples of stroke, diabetes, and heart failure to illustrate how IDD are reallocated. ResultsThe largest increases for both women and men can be found for lower respiratory infections, diabetes mellitus, and stroke. The numbers of deaths for these causes more than double after redistribution. ConclusionThis is the first comprehensive redistribution of IDD within the German cause of death statistics. Performing a redistribution is necessary, otherwise there would be an underreporting of certain causes of death or large numbers of deaths coded to residual or unspecific codes.

scholarly journals P903Trends in mortality in young patients with heart failure. Data from the swedish heart failure and cause of death registers

2018 ◽  
Vol 39 (suppl_1) ◽  
Author(s):  
C Basic ◽  
A Rosengren ◽  
U Dahlstrom ◽  
M Edner ◽  
T Zverkova Sandstrom ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cause Of Death ◽  
Young Patients ◽  
Failure Data ◽  
Patients With Heart Failure

scholarly journals Development of heart failure in young patients with congenital heart disease: a nation-wide cohort study

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e000858 ◽  
Author(s):  
Thomas Gilljam ◽  
Zacharias Mandalenakis ◽  
Mikael Dellborg ◽  
Georgios Lappas ◽  
Peter Eriksson ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Young Patients ◽  
Cumulative Probability ◽  
Congenital Heart Malformations ◽  
National Patient ◽  
Probability Of Death

ObjectiveHeart failure (HF) is a common cause of hospitalisation and death in adults with congenital heart disease (CHD). However, the risk of HF in young patients with CHD has not been determined.MethodsBy linkage of national patient registers in Sweden, we identified 21 982 patients with CHD born between 1970 and 1993, and compared these with 10 controls per case. Follow-up data were collected from birth until 2011 or death.ResultsOver a mean follow-up of 26.6 years in patients with CHD and 28.5 years in controls, 729 (3.3%) and 75 (0.03%) developed HF, respectively. The cumulative incidence of HF in all CHD was 6.5% and in complex CHD 14.8% up to age 42 years. Thus, one patient in 15 with CHD runs the risk of developing HF before age 42 years, a risk that is 105.7 times higher (95 % CI 83.2 to 134.8) compared with controls. For patients with complex CHD (such as conotruncal defects, univentricular hearts, endocardial cushion defects), one in seven will develop HF, a HR of 401.5; 95% CI 298 to 601 as compared with controls. The cumulative probability of death in patients with CHD, after HF diagnosis, was 63.4% (95% CI 57.5 to 69.3).ConclusionsAn extremely high risk of developing HF (more than 100-fold) was found in patients with CHD, compared with matched controls, up to the age of 42 years. Patients with complex congenital heart malformations carried the highest risk and have to be considered as the main risk group for developing HF.

scholarly journals Improving quality of medical certification of causes of death in health facilities in Tanzania 2014–2019

2021 ◽  
Vol 21 (S1) ◽  
Author(s):  
Trust Nyondo ◽  
Gisbert Msigwa ◽  
Daniel Cobos ◽  
Gregory Kabadi ◽  
Tumaniel Macha ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Health Policy ◽  
Cause Of Death ◽  
Causes Of Death ◽  
Health Facilities ◽  
Mortality Data ◽  
Medical Certification ◽  
Specific Mortality ◽  
Icd 10

Abstract Background Monitoring medically certified causes of death is essential to shape national health policies, track progress to Sustainable Development Goals, and gauge responses to epidemic and pandemic disease. The combination of electronic health information systems with new methods for data quality monitoring can facilitate quality assessments and help target quality improvement. Since 2015, Tanzania has been upgrading its Civil Registration and Vital Statistics system including efforts to improve the availability and quality of mortality data. Methods We used a computer application (ANACONDA v4.01) to assess the quality of medical certification of cause of death (MCCD) and ICD-10 coding for the underlying cause of death for 155,461 deaths from health facilities from 2014 to 2018. From 2018 to 2019, we continued quality analysis for 2690 deaths in one large administrative region 9 months before, and 9 months following MCCD quality improvement interventions. Interventions addressed governance, training, process, and practice. We assessed changes in the levels, distributions, and nature of unusable and insufficiently specified codes, and how these influenced estimates of the leading causes of death. Results 9.7% of expected annual deaths in Tanzania obtained a medically certified cause of death. Of these, 52% of MCCD ICD-10 codes were usable for health policy and planning, with no significant improvement over 5 years. Of certified deaths, 25% had unusable codes, 17% had insufficiently specified codes, and 6% were undetermined causes. Comparing the before and after intervention periods in one Region, codes usable for public health policy purposes improved from 48 to 65% within 1 year and the resulting distortions in the top twenty cause-specific mortality fractions due to unusable causes reduced from 27.4 to 13.5%. Conclusion Data from less than 5% of annual deaths in Tanzania are usable for informing policy. For deaths with medical certification, errors were prevalent in almost half. This constrains capacity to monitor the 15 SDG indicators that require cause-specific mortality. Sustainable quality assurance mechanisms and interventions can result in rapid improvements in the quality of medically certified causes of death. ANACONDA provides an effective means for evaluation of such changes and helps target interventions to remaining weaknesses.

scholarly journals Infant mortality by cause of death

Stanovnistvo ◽  
1998 ◽  
Vol 36 (1-2) ◽  
pp. 105-124
Author(s):  
Jasna Milankovic
Keyword(s):  
Health Care ◽  
Infant Mortality ◽  
Health Services ◽  
Respiratory Distress ◽  
Cause Of Death ◽  
Infant Death ◽  
Congenital Anomalies ◽  
Premature Birth ◽  
Causes Of Death ◽  
Observation Period

Infant mortality is still a major problem in our country as its level has remained relatively high by European standards. This points to the need for better preventive measures particularly as regards infant mortality and other adverse consequences of pregnancy, as key indicators of health and health care for mother and child. Namely, the analysis of movement in infant mortality in low mortality countries shows that it can be decreased relatively easily if certain social and health care measures are undertaken. For that reason, it is necessary to engage in permanent organized research to explain and measure both the relative impact of individual factors or groups of factors in our country which are significant in terms of infant mortality and their mutual relationships. We should also try to gain from the experiences of other countries which had already made progress in this respect. One of the elements of prevention is certainly the analysis of causes of infant morbidity and mortality primarily during the pre-natal period with the aim of specifying the most frequent causes of death to enable their elimination and to induce a subsequent decline in infant mortality. Besides showing the efficiency of health service activities, data on causes of infant death also point to the specific measures that should be undertaken and may be used as a base for planning and programming the development of health services, i.e. implementation of health policy as part of the population policy. With the decline in infant mortality in our country there has also been registered a change in the composition of diseases as the most frequent cause of death. During the initial observation period when the general level of infant mortality was exceptionally high, the share of infectious diseases and those of the respiratory system was very large. These deaths were mainly induced by exogenous factors, that is the diseases which the society in general and health services in particular could most easily have checked both by measures to improve the general living conditions and by preventive and curative health care measures. The period from 1989 to 1996 is characterized by endogenous causes of infant mortality primarily during the neonatal period and have to do with the constitutional features of the live-born children, congenital anomalies, premature birth, respiratory distress, etc. Thus, from the socio-medical point of view, the primary causes of infant mortality in this period are genetically induced or can be attributed to the mother in labour birth which modern men and modern medicine cannot influence to a larger extent. The analysis of infant death frequency by group of causes of death points that there still exist possibilities of eliminating the exogenous causes of death (as the same causes prevail in the socio-economically least developed regions of the country). Besides, some improvement can also be expected in the area of endogenous mortality (improvement in pre-natal diagnostics and other measures of health care for pregnant women and those who have just given birth, better conditions for child delivery and application of modern techniques to care for the prematurely born children. The semanatal mortality is probably the major socio-medical problem in our country both because it accounts for the highest percentage in neo-natal mortality and because it displays an almost negligible downward tendency. This justifies another request - for a more extensive and comprehensive analysis of this problem as well as for participation of other scientific disciplines besides medicine. Among the leading causes of semanatal mortality in the most recent observation period are premature birth, congenital anomalies, respiratory distress syndrome and intrauterine hypoxia and asphyxia at birth.

P4150Causes of death in a heart failure clinic in Spain along 17 years

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Moliner ◽  
J Lupon ◽  
M De Antonio ◽  
M Domingo ◽  
E Santiago-Vacas ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sudden Death ◽  
Cause Of Death ◽  
Causes Of Death ◽  
Linear Increase ◽  
Unexpected Death ◽  
Peripheral Ischemia ◽  
Heart Failure Clinic ◽  
Clinical Records ◽  
Mode Of Death

Abstract Background Advances in heart failure (HF) treatment have achieved a reduction of death in HF patients in the last two decades. Indeed, not only mortality has been reduced but also the mode of death might have been modified through these years. Purpose To assess the causes of death in outpatients attended in a HF Unit since the year 2002 up to the year 2018. Methods Causes of death were classified as follows: progression of HF (worsening HF or treatment-resistant HF, in the absence of another cause); sudden death (any unexpected death, witnessed or not, of a previously stable patient with no evidence of worsening HF or any other known cause of death); acute myocardial infarction; stroke; procedural (post-diagnostic or post-therapeutic); other cardiovascular causes (e.g., rupture of an aneurysm, peripheral ischemia, or aortic dissection), and non-cardiovascular. Patients who died of unknown cause were excluded from the analysis. Fatal events were identified from the clinical records of patients with HF, hospital wards, the emergency room, general practitioners, or by contacting the patient's relatives. Furthermore, data were verified from the databases of the Catalan and Spanish Health Systems. Trends on every cause of death were assessed by linear regression. Results Since August 2001 to May 2018, 2295 HF patients were admitted to the HF clinic (age 66.4±12.8 years, 71% men, 49% from ischemic aetiology, mean LVEF 35.2% ± 14). During the 17 years of the study, 1201 deaths were recorded. Seventy-eight patients (6.5% of deaths) were excluded due to unknown cause of death. The evolution in the mode of death by years is shown in the figure. Two trends were observed: a decrease in sudden death (p=0.05) and a very significant linear increase in non-cardiovascular causes of death (p<0.001). The decrease of sudden death was mainly driven from changes observed in the first 10 years (p=0.014); thereafter the incidence of sudden death remained stable (p=0.18). Remarkably we did not observe significant changes in HF progression as mode of death (p=0.17). Conclusions During the 17 years of the study, a very significant trend towards higher percentage of non-cardiovascular deaths was progressively observed. On the other hand, percentage of sudden death showed a gradual decrease, mainly driven from the changes observed in the first 10 years.

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