Prediction of first cardiovascular disease event in 2.9 million individuals using Danish administrative healthcare data:a nationwide, registry-based derivation and validation study

AIMS: The aim of this study was to derive and validate a risk prediction model with nationwide coverage to predict the individual and population-level risk of cardiovascular disease (CVD). METHODS AND RESULTS: All 2.98 million Danish residents aged 30–85 years free of CVD were included on 1 January 2014 and followed through 31 December 2018 using nationwide administrative healthcare registries. Model predictors and outcome were pre-specified. Predictors were age, sex, education, use of antithrombotic, blood pressure-lowering, glucose-lowering, or lipid-lowering drugs, and a smoking proxy of smoking-cessation drug use or chronic obstructive pulmonary disease. Outcome was 5-year risk of first CVD event, a combination of ischaemic heart disease, heart failure, peripheral artery disease, stroke, or cardiovascular death. Predictions were computed using cause-specific Cox regression models. The final model fitted in the full data was internally-externally validated in each Danish Region. The model was well-calibrated in all regions. Area under the receiver operating characteristic curve (AUC) and Brier scores ranged from 76.3% to 79.6% and 3.3 to 4.4. The model was superior to an age-sex benchmark model with differences in AUC and Brier scores ranging from 1.2% to 1.5% and −0.02 to −0.03. Average predicted risks in each Danish municipality ranged from 2.8% to 5.9%. Predicted risks for a 66-year old ranged from 2.6% to 25.3%. Personalized predicted risks across ages 30–85 were presented in an online calculator (https://hjerteforeningen.shinyapps.io/cvd-risk-manuscript/). CONCLUSION: A CVD risk prediction model based solely on nationwide administrative registry data provided accurate prediction of personal and population-level 5-year first CVD event risk in the Danish population. This may inform clinical and public health primary prevention efforts

Nationwide cardiovascular disease admission rates during a second COVID-19 lockdown

Societal lockdowns during the first wave of the COVID-19 pandemic were associated with decreased admission rates for acute cardiovascular conditions worldwide. In this nationwide Danish study of the first five weeks of a second pandemic lockdown, incidence of new-onset heart failure and atrial fibrillation remained stable, but there was a significant drop in new-onset ischemic heart disease and ischemic stroke during the fourth week of lockdown, which normalized promptly. The observed drops were lower compared to the first Danish lockdown in March 2020; thus, our data suggest that declines in acute CVD admission rates during future lockdowns are avoidable

Short‐ and Long‐Term Mortality for Patients With and Without a Cancer Diagnosis Following Pulmonary Embolism in Denmark, 2000 to 2020: A Nationwide Study

Background New treatment regimens have been introduced in the past 20 years, which may influence the short‐ and long‐term prognosis for patients with and without a cancer diagnosis following pulmonary embolism. However, newer studies investigating these trends are lacking. Therefore, we aimed to investigate the 30‐ and 31‐ to 365‐day mortality following pulmonary embolism. Methods and Results Using the Danish nationwide registries, patients with a diagnosis of pulmonary embolism between 2000 and 2020 were included. Age‐ and sex‐standardized 30‐ and 31‐ to 365‐day mortality was calculated and stratified by cancer status. In total, 60 614 patients (29.6% with recent cancer; mean age, 68.2 years) were included. The 30‐day mortality for patients with no recent cancer decreased from 19.1% (95% CI, 17.9%–20.4%) in 2000 to 7.3% (95% CI, 6.7%–8.0%) in 2018 to 2020 (hazard ratio [HR], 0.36 [95% CI, 0.32–0.40]; P<0.001). The 30‐day mortality for patients with recent cancer decreased from 32.2% (95% CI, 28.8%–36.6%) to 14.1% (95% CI, 12.7%–15.5%) (HR, 0.38 [95% CI, 0.33–0.44]; P<0.001). The 31‐ to 365‐day mortality for patients with no recent cancer decreased from 12.5% (95% CI, 11.4%–13.6%) to 9.4% (95% CI, 8.6%–10.2%) (HR, 0.73 [95% CI, 0.64–0.83]; P<0.001).The 31‐ to 365‐day mortality for patients with recent cancer remained stable: 39.4% (95% CI, 35.1%–43.7%) to 38.3% (95% CI, 35.9%–40.6%) (HR, 0.97 [95% CI, 0.84–1.12]; P=0.69). Conclusions From 2000 to 2020, improvements were observed in 30‐day mortality following pulmonary embolism regardless of cancer status. For patients with recent cancer, 31‐ to 365‐day mortality did not improve, whereas a minor improvement was observed for patients without recent cancer

Frailty, Treatments, and Outcomes in Older Patients With Myocardial Infarction: A Nationwide Registry‐Based Study

Background Guidelines recommend that patients with myocardial infarction (MI) receive equal care regardless of age. However, withholding treatment may be justified in elderly and frail patients. This study aimed to investigate trends in treatments and outcomes of older patients with MI according to frailty. Methods and Results All patients aged ≥75 years with first‐time MI during 2002 to 2021 were identified through Danish nationwide registries. Frailty was categorized using the Hospital Frailty Risk Score. One‐year risk and hazard ratios (HRs) for days 0 to 28 and 29 to 365 were calculated for all‐cause death. A total of 51 022 patients with MI were included (median, 82 years; 50.2% women). Intermediate/high frailty increased from 26.7% in 2002 to 2006 to 37.1% in 2017 to 2021. Use of treatment increased substantially regardless of frailty: for example, 28.1% to 48.0% (statins), 21.8% to 33.7% (dual antiplatelet therapy), and 7.6% to 28.0% (percutaneous coronary intervention) for high frailty (all P‐trend <0.001). One‐year death decreased for low frailty (35.1%–17.9%), intermediate frailty (49.8%–31.0%), and high frailty (62.8%–45.6%), all P‐trend <0.001. Age‐ and sex‐adjusted 29‐ to 365‐day HRs (2017–2021 versus 2002–2006) were 0.53 (0.48–0.59), 0.62 (0.55–0.70), and 0.62 (0.46–0.83) for low, intermediate, and high frailty, respectively (P‐interaction=0.23). When additionally adjusted for treatment, HRs attenuated to 0.74 (0.67–0.83), 0.83 (0.74–0.94), and 0.78 (0.58–1.05), respectively, indicating that increased use of treatment may account partially for the observed improvements. Conclusions Use of guideline‐based treatments and outcomes improved concomitantly in older patients with MI, irrespective of frailty. These results indicate that guideline‐based management of MI may be reasonable in the elderly and frail

Frailty and Recurrent Hospitalization After Transcatheter Aortic Valve Replacement

Background For frail patients with limited life expectancy, time in hospital following transcatheter aortic valve replacement is an important measure of quality of life; however, data remain scarce. Thus, we aimed to investigate frailty and its relation to time in hospital during the first year after transcatheter aortic valve replacement. Methods and Results From 2008 to 2020, all Danish patients who underwent transcatheter aortic valve replacement and were alive at discharge were included. Using the validated Hospital Frailty Risk Score, patients were categorized in the low, intermediate, and high frailty groups. Time in hospital and mortality up to 1 year are reported according to frailty groups. In total, 3437 (57.6%), 2277 (38.1%), and 257 (4.3%) were categorized in the low, intermediate, and high frailty groups, respectively. Median age was ≈81 years. Female sex and comorbidity burden were incrementally higher across frailty groups (low frailty: heart failure, 24.1%; stroke, 7.2%; and chronic kidney disease, 4.5%; versus high frailty: heart failure, 42.8%; stroke, 34.2%; and chronic kidney disease, 29.2%). In the low frailty group, 50.5% survived 1 year without a hospital admission, 10.8% were hospitalized >15 days, and 5.8% of patients died. By contrast, 26.1% of patients in the high frailty group survived 1 year without a hospital admission, 26.4% were hospitalized >15 days, and 15.6% died within 1 year. Differences persisted in models adjusted for sex, age, frailty, and comorbidity burden (excluding overlapping comorbidities). Conclusions Among patients undergoing transcatheter aortic valve replacement, frailty is strongly associated with time in hospital and mortality. Prevention strategies for frail patients to reduce hospitalization burden could be beneficial