The validity of the diagnosis of heart failure (I50.0-I50.9) in the Danish National Patient Register.

INTRODUCTION: National discharge registers are important and cost-effective data sources for administrative and research purposes, but their value depends much on the validity of the registered data. The objective of this study was to assess the validity of heart failure (HF) diagnoses (ICD10: I50.0-I50.9) in the Danish National Patient Register (DNPR). METHODS: We reviewed medical records from a random sample of 500 patients with either a primary or a secondary discharge diagnosis of HF registered in the DNPR from any department in Northern Denmark in 2007. We noted symptoms, objective signs, diagnostic imaging and biomarkers and used the European Society of Cardiology definition of HF to categorise patients into definite, probable or non-verified HF. RESULTS: We classified 305 patients as having definite HF and 113 patients as having probable HF. The remaining cases were classified as non-verified HF. Thus, the positive predictive value (PPV) for definite and probable HF was 83.6% (95% confidence interval (CI): 80.1-86.7%).
The PPV increased to 88.0% (95% CI: 84.4-91.0%) when we restricted analyses to primary diagnoses and to 95.2% (95% CI: 89.2-98.4%) when we restricted analyses to HF diagnoses established at cardiology units. CONCLUSIONS: The HF diagnoses (I50.0-I50.9) in the DNPR should be used with caution if validation is not possible. However, restricting analyses to patients registered with a primary diagnosis of HF or patients discharged from cardiology units may be a useful alternative in population-based studies. FUNDING: none. TRIAL REGISTRATION: not relevant.

Accuracy of angina pectoris and acute coronary syndrome in the Danish National Patient Register.

INTRODUCTION: 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. METHODS: 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. RESULTS: 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%). CONCLUSIONS: 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. FUNDING: none. TRIAL REGISTRATION: not relevant.

[Amyloidosis is a rare cause of heart failure]. / Amyloidose er en sjælden årsag til hjertesvigt.

Light-chain amyloidosis (AL) is the most common form of systemic amyloidosis and is associated with an underlying plasma cell dyscrasia. The disease is often difficult to recognize because of its broad range of manifestations and often vague symptoms. The clinical symptoms include proteinuria, hepatomegaly, heart failure and autonomic or sensory neuropathy. A 70-year-old man with a past medical history of sacroidosis and heart failure was admitted to hospital. He had breathlessness and swelling of his lower extremities. Among other symptoms the combination of transthoracic echo-cardiogram findings and low voltage on the ECG led to the diagnosis AL.

Rare cause of ventricular tachycardia: Pheochromocytoma.

Pheochromocytoma is known from a wide range of clinical manifestations and can mimic other disorders which can lead to delay in diagnosis. We report a case of a young female presenting with chest pain, electrocardiographic changes, and episodes of ventricular tachycardia, finally diagnosed with this catecholamine-producing tumor. .