Cohort Profile: the European Unified Registries On Heart care Evaluation and Randomised Trials (EuroHeart) - Acute Coronary Syndrome and Percutaneous Coronary Intervention.

AIMS: The European Unified Registries On Heart care Evaluation And Randomized Trials (EuroHeart) aims to improve the quality of care and clinical outcomes for patients with cardiovascular disease. The collaboration of acute coronary syndrome/percutaneous coronary intervention (ACS/PCI) registries is operational in seven vanguard European Society of Cardiology member countries. METHODS AND RESULTS: Adults admitted to hospitals with ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) are included, and individual patient-level data collected and aligned according to the internationally agreed EuroHeart data standards for ACS/PCI. The registries provide up to 155 variables spanning patient demographics and clinical characteristics, in-hospital care, in-hospital outcomes, and discharge medications. After performing statistical analyses on patient data, participating countries transfer aggregated data to EuroHeart for international reporting.Between 1st January 2022 and 31st December 2022, 40 021 admissions (STEMI 46.7%, NSTEMI 53.3%) were recorded from 192 hospitals in the seven vanguard countries: Estonia, Hungary, Iceland, Portugal, Romania, Singapore, and Sweden. The mean age for the cohort was 67.9 (standard deviation 12.6) years, and it included 12 628 (31.6%) women. CONCLUSION: The EuroHeart collaboration of ACS/PCI registries prospectively collects and analyses individual data for ACS and PCI at a national level, after which aggregated results are transferred to the EuroHeart Data Science Centre. The collaboration will expand to other countries and provide continuous insights into the provision of clinical care and outcomes for patients with ACS and undergoing PCI. It will serve as a unique international platform for quality improvement, observational research, and registry-based clinical trials.

Quality assessment of prostate cancer reports to the Danish Cancer Registry.

BACKGROUND: The Danish Cancer Registry (DCR) is the oldest nationwide population-based cancer registry in the Nordic countries. At the time of the study the DCR recorded date of diagnosis, tumor stage and initial treatment. The validity of the clinical information reported to the DCR has never been analyzed. MATERIAL AND METHODS: Patients diagnosed with prostate cancer from 1 May to 31 December 1997 and living in eight Danish counties were identified through the DCR. Clinical data was retrieved from hospital records where date of diagnosis, stage at diagnosis and treatment received were registered. RESULTS: The mean age at diagnosis was 74.6 years (s.d. 8.6 years). Diagnosis was verified histologically for 87% of cases. Overall 95% of the patients had a difference less than three months between the reported date of diagnosis and the date found in hospital records. Correction of dates of diagnosis had no impact on survival. Hospital records identified 86 patients with T1-2 disease without distant metastases (M0), but only 56 of these patients (65%) were reported to the DCR as having localized disease. According to hospital records a total of 242 patients were confirmed having distant metastases (M1) at diagnosis but only 139 of these cases (57%) were reported to the DCR as such. Considerable "over reporting" of curative treatment was observed. CONCLUSION: The DCR has been shown to be reliable in terms of new cases being reported. For the majority of cases there were insignificant differences concerning the date of diagnosis. However, the DCR information on stage and treatment was found to be inaccurate. Since 2004 the DCR registration process, including staging according to the TNM classification, has been carried out electronically from several registers. Future comparison between cohorts of different time intervals or international comparison should be interpreted with caution when clinical information is included.

An intracardial mass in a young Syrian refugee.

A 35-year-old previously healthy man presented with orogenital ulcerations, high fever, weight loss and leg thrombosis. Antibiotics were ineffective. His symptoms persisted and 3 years later he suffered from exertional dyspnoea. Inflammatory markers were elevated and all cultures were negative. CT of the thorax showed bilateral pulmonary embolism and a mass attached to the septum of the right ventricle, as well as an occluded vena cava inferior. Histology of the cardiac mass revealed a thrombus. The pulmonary embolisation progressed despite treatment with full-dose dalteparin. After being diagnosed with Behçet's disease, a multisystemic large-vessel vasculitis, and treated with high-dose prednisolone and cyclophosphamide, his ulcerations and his symptoms of dyspnoea disappeared.

Differences in survival from prostate cancer in Denmark, Iceland and Sweden.

INTRODUCTION: Register-based studies have shown large survival differences among prostate cancer patients in the Nordic countries. The aim of this study was to determine the background of such differences in Denmark, Iceland and Sweden. MATERIAL AND METHODS: Patients with prostate cancer were identified through population-based cancer registers in the three countries. Clinical findings at diagnosis were retrieved from hospital records. In Sweden, clinical information was gathered from regional population-based prostate cancer registers. Country-specific incidence and excess mortality rates were compared, with adjustment for prognostic factors. RESULTS: The relative survival in the cohorts was comparable to that in previous population-based studies. Significant differences in excess mortality rates were found across countries, which diminished or disappeared after adjustment for patient characteristics, i.e. metastatic status, clinical T stage and prostate-specific antigen level. A difference in the proportion of patients with metastatic disease was the main explanation of the differences in survival among countries, while the incidence rates of metastatic cancer were similar. DISCUSSION: Register-based studies of the relative survival of prostate cancer patients are influenced by national differences in clinical presentation at diagnosis. Differences in the proportion of patients with metastatic spread explained most of the difference in relative survival among patients in Denmark, Iceland and Sweden. Future country comparisons of relative survival should include adjustment for differences in patient characteristics, such as stage, prostate-specific antigen level and screening intensity.

[Prostate cancer in Denmark 1943-2002]. / Prostatacancer i Danmark 1943-2002.

INTRODUCTION: Previous studies in Denmark have reported an increase in prostate cancer (PC) incidence- and mortality rates. So far, it has not been possible to establish the rising incidence as a consequence of an increase in diagnostic procedures. This study reviews the trends in PC incidence and mortality rates in Denmark during the 60-year-period from 1943 to 2002. MATERIAL AND METHODS: Register-based study. RESULTS: The age-standardised (World Standard Population) rate of PC in Denmark increased from 11.4/100,00 in the period 1943-47 to 38.2/100,000 in the period 1998-2002. Mortality rate increased from 13.5/100,000 in 1953 to 19.1/100,000 in the period 1993-98. Within the last 10 years changes in age-distribution and clinical stage, especially among younger patients, indicate a shift towards a more active diagnostic policy. CONCLUSION: In concordance with other studies we found an increasing PC incidence. In the last 10-year-period studied from 1993 to 2002, our study found the rise in incidence most likely explained by an increase in diagnostic activity, presumably as unsystematic PSA-based "gray-zone screening". This development contrasts with the national recommendation for PSA-based screening for PC. The rising incidence will necessitate allocation of increased resources for evaluation, treatment, and follow-up of patients with PC.