Madelaire Christian, Gustafsson Finn, Køber Lars, Torp-Pedersen Christian, Andersson Charlotte, Kristensen Søren Lund, Gislason Gunnar, Schou Morten
Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark.
Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Clin Epidemiol. 2020 Jun 8;12:589-594. doi: 10.2147/CLEP.S251710. eCollection 2020.
In Danish administrative registers, ejection fraction (EF) is not recorded, which is a considerable limitation for correct subclassification of patients with heart failure (HF). We hypothesized that a diagnosis of HF combined with the recorded prescription of both renin-angiotensin system (RAS) inhibitors and beta- blockers () within 120 days could identify patients with HF and reduced ejection fraction (EF ≤40%) (HFrEF).
On two sites, we identified all patients with a first-time registration of HF as primary hospital discharge diagnosis (ICD-10: I50) between June 1, 2016, and May 31, 2018 in inpatient or outpatient settings. Patients were included if they survived the initial 120 days after discharge. Reviewing patient records, we identified patients with HFrEF, based on EF ≤ 40% and reported HF symptoms. We registered the use of at 120 days and calculated sensitivity, specificity and predictive values.
A total of 704 consecutive patients with a primary diagnosis of HF were included, of whom 541 (77%) fulfilled the HFrEF criteria. Patients with HFrEF confirmed from patient records were younger (median age 73 compared to 79 years) and less frequently women (31% compared to 56%) compared to non-HFrEF patients. At baseline, 24 (4%) of HFrEF patients were treated with compared to 22 (14%) of non-HFrEF patients. At 120 days, 460 (85%) of HFrEF patients received as compared to 25 (15%) of non-HFrEF patients. This resulted in a positive predictive value of 95%, sensitivity of 85% and specificity of 85%.
In Denmark, the ICD-10 HF diagnosis combined with recorded treatment by 120 days after discharge has high positive predictive value and can accurately be used to identify patients with HFrEF.
在丹麦的行政登记中，射血分数（EF）未被记录，这对于心力衰竭（HF）患者的正确亚分类是一个相当大的限制。我们假设，HF诊断结合在120天内记录的肾素 - 血管紧张素系统（RAS）抑制剂和β受体阻滞剂（）的处方，可以识别出患有HF且射血分数降低（EF≤40%）（HFrEF）的患者。
在两个地点，我们识别出2016年6月1日至2018年5月31日期间在住院或门诊环境中首次将HF登记为主要出院诊断（ICD - 10：I50）的所有患者。如果患者在出院后的最初120天内存活，则纳入研究。通过查阅患者记录，我们根据EF≤40%和报告的HF症状识别出HFrEF患者。我们记录了120天时的使用情况，并计算了敏感性、特异性和预测值。
总共纳入了704例以HF为主要诊断的连续患者，其中541例（77%）符合HFrEF标准。与非HFrEF患者相比，经患者记录证实的HFrEF患者更年轻（中位年龄73岁，而非HFrEF患者为79岁），女性比例更低（31%，而非HFrEF患者为56%）。在基线时，24例（4%）HFrEF患者接受了治疗，而非HFrEF患者为22例（14%）。在120天时，460例（85%）HFrEF患者接受了治疗，而非HFrEF患者为25例（15%）。这导致阳性预测值为95%，敏感性为85%，特异性为85%。
在丹麦，ICD - 10 HF诊断结合出院后120天记录的治疗具有较高的阳性预测值，可准确用于识别HFrEF患者。
