Diuretics and renin–angiotensin–aldosterone system inhibitors are central in the treatment of hypertension, but may cause serum potassium abnormalities. We examined mortality in relation to serum ...potassium in hypertensive patients.
From Danish National Registries, we identified 44 799 hypertensive patients, aged 30 years or older, who had a serum potassium measurement within 90 days from diagnosis between 1995 and 2012. All-cause mortality was analysed according to seven predefined potassium levels: <3.5 (hypokalaemia), 3.5–3.7, 3.8–4.0, 4.1–4.4, 4.5–4.7, 4.8–5.0, and >5.0 mmol/L (hyperkalaemia). Outcome was 90-day mortality, estimated with multivariable Cox proportional hazard model, with the potassium interval of 4.1–4.4 mmol/L as reference. During 90-day follow-up, mortalities in the seven strata were 4.5, 2.7, 1.8, 1.5, 1.7, 2.7, and 3.6%, respectively. Adjusted risk for death was statistically significant for patients with hypokalaemia hazard ratio (HR): 2.80, 95% confidence interval (95% CI): 2.17–3.62, and hyperkalaemia (HR: 1.70, 95% CI: 1.36–2.13). Notably, normal potassium levels were also associated with increased mortality: K: 3.5–3.7 mmol/L (HR: 1.70, 95% CI: 1.36–2.13), K: 3.8–4.0 mmol/L (HR: 1.21, 95% CI: 1.00–1.47), and K: 4.8–5.0 mmol/L (HR: 1.48, 95% CI: 1.15–1.92). Thus, mortality in relation to the seven potassium ranges was U-shaped, with the lowest mortality in the interval of 4.1–4.4 mmol/L.
Potassium levels outside the interval of 4.1–4.7 mmol/L were associated with increased mortality risk in patients with hypertension.
Aims
To evaluate diabetic retinopathy (DR) screening incidence in a universal healthcare system.
Methods
Registry-based cohort study based on a Danish regional population from 2009 to 2018. ...Individuals with diabetes were identified by medication. Screening attendance was estimated by surrogate measures using local and nationwide databases reported by cumulative incidence.
Results
18,832 patients were included. By the end of the first year, the cumulative incidence of screening for DR was 60.2% and by the end of the second year 74.2%. The cumulative incidence was 93.9% overall, 97.7% for patients with type 1 diabetes (T1D) and 93.4% for patients with type 2 diabetes. Screening proportions per 1, 2 and 5 years were calculated. Females, patients with T1D, and patients attending screening at hospitals had a higher Hazard Ratio of 1.084, 1.157, and 1.573, respectively. The Cochran–Armitage trend test indicated increased screening frequency from 2009 to 2018. Validation of DR screening was done at hospitals with a mean positive predictive value of 86.78%. Cumulative incidence curves showed a small right shift when censoring the first, second and third screening visits.
Conclusions
Nearly all patients were screened for DR over a 5-year timespan. Female patients with T1D who attended screening at hospitals were significantly more likely to be screened. Validation of screening visits at hospitals was reported with a high mean positive predictive value. Most other studies, to the best of our knowledge, only report screening attendance for patients already enrolled in a DR screening programme. This study describes the overall screening attendance for the total eligible diabetes population.
ObjectiveTo examine the association between time from emergency medical service vehicle dispatch to hospital arrival and 1-day and 30-day mortality.DesignRegister-based cohort study.SettingNorth ...Denmark Region (≈8000 km2, catchment population ≈600 000).ParticipantsWe included all highest priority dispatched ambulance transports in North Denmark Region in 2006–2012.InterventionsUsing logistic regression and the g-formula approach, we examined the association between time from emergency dispatch to hospital arrival and mortality for presumed heart, respiratory, cerebrovascular and other presumed medical conditions, as well as traffic or other accidents, as classified by emergency dispatch personnel.Main outcome measures1-day and 30-day mortality.ResultsAmong 93 167 individuals with highest priority ambulances dispatched, 1948 (2.1%) were dead before the ambulance arrived and 19 968 (21.4%) were transported to the hospital under highest priority (median total prehospital time from dispatch to hospital arrival 47 min (25%–75%: 35–60 min); 95th percentile 84 min). Among 18 709 with population data, 1-day mortality was 10.9% (n=2038), and was highest for patients with dyspnoea (20.4%) and lowest for patients with traffic accidents (2.8%). Thirty-day mortality was 18.3% and varied between 36.6% (patients with dyspnoea) and 3.7% (traffic accidents). One-day mortality was not associated with total prehospital time, except for presumed heart conditions, where longer prehospital time was associated with decreased mortality: adjusted OR for >60 min vs 0–30 min was 0.61 (95% CI 0.40 to 0.91). For patients with dyspnoea, OR for >60 min vs 0–30 min was 0.90 (95% CI 0.56 to 1.45), for presumed cerebrovascular conditions OR 1.41 (95% CI 0.53 to 3.78), for other presumed medical conditions OR 0.84 (95% CI 0.70 to 1.02), for traffic accidents OR 0.65 (95% CI 0.29 to 1.48) and for other accidents OR 0.84 (95% CI 0.47 to 1.51). Similar findings were found for 30-day mortality.ConclusionsIn this study, where time from emergency dispatch to hospital arrival mainly was <80 min, there was no overall relation between this prehospital time measure and mortality.
Abstract
Background
Chronic cough, more than 8 weeks, can either be without co-morbidity called unexplained chronic cough (UCC) or with co-morbidity called refractory chronic cough (RCC). Using ...datasets from the Danish National Prescription Registry (Prescription Registry) and Danish National Patient Registry (Patient Registry) we wanted to investigate the prevalence and factors of importance of cough in a Nationwide registry.
Material and methods
Inclusion criteria were patients 18–90 years with at least one final cough diagnosis (ICD-10 DR05/DR059) in Patient registry or patients who have redeemed ≥2 prescriptions for relevant cough-medication within a 90-day harvest in the Prescription registry from 2008 to 2017. To validate this study’s chosen proxy on chronic cough an analysis of the Patient registry sub-population with a contact of ≥8 weeks and then final diagnosis code DR05/DR059 was also performed. The population was divided into UCC and RCC.
Results
Of the 104,216 patients from the Prescription registry, 52,727 were classified as having UCC and 51,489 were classified with RCC. From the Patient registry 34,260 were included, of whom 12,278 had UCC and 21,982 had RCC. Cough were frequently found among females (
p
< 0.0001). Both genders were around 2 years older in RCC than UCC (
p
< 0.0001) Spirometry was performed in 69 and 57%, X-ray in 73 and 58% and asthma challenge test performed in 13 and 5% (UCC and RCC, respectively, p < 0.0001). The frequency of co-morbidities such as heart failure, rheumatologic disease, pulmonary embolism, and diabetes was < 10%.
Conclusion
Many patients suffer from chronic cough or cough requiring medications, with or without co-morbidity; frequently found among menopausal women. Most patients had a substantial work-up performed. The high frequency and the resources consuming work-up program call for systematic coding of disease, systematic patient evaluation and more specific treatment options. The study was approved (ID: no. P-2019-191).
Oral corticosteroids (OCS) are commonly prescribed for acute, self‐limited conditions, despite studies demonstrating toxicity. Studies evaluating longitudinal OCS prescribing in the general ...population are scarce and do not compare use across countries. This study investigated and compared OCS prescription patterns from 2009 to 2018 in the general populations of the United States, Taiwan, and Denmark. This international population‐based longitudinal cohort study used nationwide claims databases (United States: Optum Clinformatics Data Mart; de‐identified; Taiwan: National Health Insurance Research Database; and Denmark: National Prescription and Patient Registries/Danish National Patient Registry) to evaluate OCS prescribing. We classified annual OCS duration as short‐term (1–29 days), medium‐term (30–89 days), or long‐term (≥90 days). Longitudinal change in annual prevalence of OCS use and physician prescribing patterns were reported. Among 54,630,437 participants, average annual percentage of overall OCS use was 6.8% in the United States, 17.5% in Taiwan, and 2.2% in Denmark during 2009–2018. Prevalence of OCS prescribing increased at an average annual rate of 0.1%–0.17%, mainly driven by short‐term prescribing to healthy adults. One‐quarter to one‐fifth of OCS prescribing was associated with a diagnosis of respiratory infection. Family practice and internal medicine physicians were among the highest OCS prescribers across countries and durations. Age‐ and sex‐stratified trends mirrored unstratified trends. This study provides real‐world evidence of an ongoing steady increase in OCS use in the general populations of the United States, Taiwan, and Denmark. This increase is largely driven by short‐term OCS prescribing to healthy adults, a practice previously viewed as safe but recently shown to incur substantial population‐level risk.
To present an overview of animal models of retinal artery occlusion (RAO).
Through a systematic literature search in PubMed and Embase, papers describing methods of inducing RAO in animal models were ...included. The identified methodologic approaches were presented in a narrative synthesis and compared with RAO in humans.
In total, 83 papers reporting on 88 experiments were included. Six different species were used with rodents and monkeys being the most common, and a minority were performed using cats, dogs, rabbits, or pigs. The anatomy of pigs and monkeys resemble that of humans most closely. The two most frequently used methods were laser-induced occlusion or ligation of the arteries. Other methods included raised intraocular pressure, arterial clamping, administration of vasoconstricting agents, the use of an occluder, embolization, and endovascular approaches to induce occlusion. In general, occlusions lasted for only 30 to 90 minutes, often followed by reperfusion.
Although a broad range of methods have previously been used, they all have limitations. Preferably, the methods should imitate the human disease as closely as possible and avoid damaging other structures. Therefore, monkeys followed by pigs are to be preferred and ligation or clamping may be a suitable model in larger animals as there is a potential to isolate and occlude the retinal artery only. Being less invasive, laser-induced occlusion is another suitable approach.
This review aims at assisting researchers in deciding on the most ideal experimental setting, and thereby increase the translational value to human disease.
To examine the real-world performance of a support vector machine learning software (RetinaLyze) in order to identify the possible presence of diabetic retinopathy (DR) in patients with diabetes via ...software implementation in clinical practice.
1001 eyes from 1001 patients-one eye per patient-participating in the Danish National Screening Programme were included. Three independent ophthalmologists graded all eyes according to the International Clinical Diabetic Retinopathy Disease Severity Scale with the exact level of disease being determined by majority decision. The software detected DR and no DR and was compared to the ophthalmologists' gradings.
At a clinical chosen threshold, the software showed a sensitivity, specificity, positive predictive value and negative predictive value of 84.9% (95% CI: 81.8-87.9), 89.9% (95% CI: 86.8-92.7), 92.1% (95% CI: 89.7-94.4), and 81.0% (95% CI: 77.2-84.7), respectively, when compared to human grading. The results from the routine screening were 87.0% (95% CI: 84.2-89.7), 85.3% (95% CI: 81.8-88.6), 89.2% (95% CI: 86.3-91.7), and 82.5% (95% CI: 78.5-86.0), respectively. AUC was 93.4%. The reference graders Conger's Exact Kappa was 0.827.
The software performed similarly to routine grading with overlapping confidence intervals, indicating comparable performance between the two groups. The intergrader agreement was satisfactory. However, evaluating the updated software alongside updated clinical procedures is crucial. It is therefore recommended that further clinical testing before implementation of the software as a decision support tool is conducted.
Identification of risk factors for venous thromboembolism (VTE) is of utmost importance to improve current prophylactic regimes and treatment guidelines. The extent to which a family history ...contributes to the risk of VTE needs further exploration.
To examine the relative rate of VTE in first-degree relatives compared with the general population.
By crosslinking Danish nationwide registries we identified patients with VTE between 1978 and 2012, and their familial relations. The first member in a family to acquire VTE was defined as the proband. All first-degree relatives to probands were followed from the VTE date of the proband and until an event (VTE), death, emigration, 100 year birthday or end of study: 31st of December 2012, whichever came first. The relative rate of VTE was estimated by standardized incidence ratios (SIR) using time-dependent Poisson regression models, with the general population as a fixed reference.
We identified 70,767 children of maternal probands, 66,065 children of paternal probands, and 29,183 siblings to sibling probands. Having a maternal proband or a paternal proband were associated with a significantly increased VTE rate of 2.15 (CI: 2.00-2.30) and 2.06 (CI: 1.92-2.21), respectively. The highest estimate of VTE was observed among siblings (adjusted SIR of 2.60 CI: 2.38-2.83). Noteworthy, the rate of VTE increased for all first-degree relatives when the proband was diagnosed with VTE in a young age (≤ 50 years).
A family history of VTE was associated with a significantly increased rate of VTE among first-degree relatives compared with the general population.
Does menopausal hormone therapy (HT) with exogenous oestrogens and progestogens change the use of inhaled anti-asthma medications in women with asthma?
In a population-based matched cohort study ...using the Danish registries, we included women with asthma aged 45-65 years from 1 June 1995 to 30 June 2018. We investigated whether HT with oestrogen and/or progestogens was associated with changes in use of inhaled anti-asthma therapies in the 12 months following initiation. We used exposure density matching to match exposed subjects with unexposed subjects on age, household income and level of education. An exposed subject was defined as receiving HT. We calculated mean dose of medications and odds ratios of increases in the 12 months following HT initiation.
We included 139 483 women with asthma, of whom 116 014 (83.2%) were unexposed subjects and 23 469 (16.8%) exposed subjects. Mean±sd age was 53.0±5.2 years. Initiation of HT was not consistently associated with increased mean doses of inhaled corticosteroids (ICS), or long- and short-acting β
-agonists. Women receiving systemic oestrogens had increased odds ratios of large increases (>100 µg) in ICS at 6 months (OR 1.09; 95% CI 1.04-1.13; p<0.001) and 9 months (OR 1.07; 95% CI 1.03-1.12; p<0.001). Progestogens were protective against increases in ICS at 6 and 9 months (OR 0.87; 95% CI 0.82-0.93; p<0.001; and OR 0.86; 95% CI 0.81-0.91; p<0.001).
Initiation of HT did not change the use of inhaled medications in asthma. However, detrimental effects of oestrogen, as well as beneficial effects of progestogens, cannot be excluded.
Bioprosthetic aortic valves degenerate over time, and differences between brands could be expected. We compared 2 brands implanted in 3 different centers serving 3.3 million people. Between 2000 and ...2014, we identified 1241 bioprosthetic aortic valve replacements using Mitroflow (Sorin, Milan, Italy) and 3212 using Perimount (Edwards Lifesciences, Irvine, CA) covering 88% of all aortic valve replacements in the region. Average differences in t-year mortality were derived from Cox regression. The complete case analyses included 881 Mitroflow replacements and 2488 Perimount replacements. The median follow-up time and 25/75 percentiles were 5.0 years (3.3–7.2) and 8.4 years (5.1–10.6) for Perimount and Mitroflow, respectively. Multiple Cox regression analyses demonstrated significantly higher mortality with Mitroflow valves compared with Perimount (hazard ratio 1.27; 95% CI: 1.1–1.5; P < 0.001). Average risk of death within 5 years was 25.0% with Mitroflow and 20.4% with Perimount. Average difference in 5-year mortality based on Cox regression was 4.60% in favor of Perimount (95% CI: 1.02–8.02%; P = 0.01) and the number needed to harm was 21.9 (95% CI: 12.7–80.5) within 5 years. Propensity matching confirmed 2-year survival differences 4.6% in favor of Perimount (95% CI: 1.2–7.9%; P = 0.004), and further confirmed in a series of subgroups and a double robust analysis that takes into account both propensity for treatment and covariate relation to outcome. Mitroflow valves were associated with a significantly increased risk of death when compared to Perimount valves.
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