Prevalence of Cardioprotective Medication Use in Coronary Heart Disease Patients in South America: Systematic review and Meta-Analysis.

Background: Coronary heart disease (CHD) is the most common cause of death globally, and clinical guidelines recommend cardioprotective medications for patients with established CHD. Suboptimal use of these medications has been reported, but information from South America is scarce. Methods: We conducted a systematic review on prevalence of secondary prevention medication in South America. We pooled prevalence estimates, analysed time-trends and guideline compliance, and identified factors associated with medication use with meta-regression models. Results: 73 publications were included. Medication prevalence varied by class: beta-blockers 73.4%(95%CI 66.8%-79.1%), ACEI/ARBs 55.8%(95%CI 49.7%-61.8), antiplatelets 84.6%(95%CI 79.6%-88.5%), aspirin 85.1%(95%CI 79.7%-89.3%) and statins 78.9%(95%CI 71.2%-84.9%). The use of beta-blockers, ACEI/ARBs and statins increased since 1993. Ten publications reported low medication use and nine reported adequate use. Medication use was lower in community, public and rehabilitation settings compared to tertiary centres. Conclusion: Cardioprotective medication use has increased, but could be further improved particularly in community settings.

Mortality after hospital admission for heart failure: improvement over time, equally strong in women as in men.

BACKGROUND: To assess the trend in age- and sex-stratified mortality after hospitalization for heart failure (HF) in the Netherlands. METHODS: Two nationwide cohorts of patients, hospitalized for new onset heart failure between 01.01.2000-31.12.2002 and between 01.01.2008-31.12.2010, were constructed by linkage of the Dutch Hospital Discharge Registry and the National Cause of Death registry. 30-day, 1-year and 5 -year overall and cause-specific mortality rates stratified by age and sex were assessed and compared over time. RESULTS: We identified 40,230 men and 41,582 women. In both cohorts, men were on average younger than women (74-75 and 78-79 years, respectively) and more often had comorbid conditions (37 and 30%, respectively). In the 2008-10 cohort, mortality rates for men were 13, 32 and 64% for respectively 30-day, 1-year and 5-year mortality and 14, 33 and 66% for women. Mortality rates increased considerably with age similarly in men and women (e.g. from 10.5% in women aged 25-54 to 46.1% in those aged 85 and older after 1 year). Between the two time periods, mortality rates dropped across all ages, equally strong in women as in men. The 1-year absolute risk of death declined by 4.0% (from 36.1 to 32.1%) in men and 3.2% (from 36.2 to 33.0%) in women. CONCLUSIONS: Mortality after hospitalization for new onset HF remains high, however, both short-term and long-term survival is improving over time. This improvement was similar across all ages and equally strong in women as in men.

Cardiovascular and all-cause mortality in patients with intermittent claudication and critical limb ischaemia.

BACKGROUND: The aim of this study was to evaluate absolute mortality risks and to determine whether changes in mortality risk occurred in patients with intermittent claudication (IC) or critical limb ischaemia (CLI) in the Netherlands between 1998 and 2010. METHODS: Data for patients treated between 1998 and 2010 were obtained from Dutch nationwide registers: the Hospital Discharge Register, Population Register and Cause of Death Register. The registers were used to obtain information regarding IC and CLI hospitalizations, co-morbidities, demographic factors, and date and cause of death. The cohort was split into two time intervals for comparison: 1998-2004 (period 1) and 2005-2010 (period 2). Thirty-day mortality was excluded to eliminate per-admission complications. One- and 5-year cardiovascular and all-cause mortality rates were compared with those of a representative sample of the general Dutch population (28 494 persons) by Cox proportional hazards models. RESULTS: Some 47 548 patients were included, 34 078 with IC and 13 470 with CLI. In patients with IC, the age-adjusted 5-year mortality risk for cardiovascular disease decreased significantly in period 2 (14·1 per cent) compared with that in period 1 (16·1 per cent) in men only (5-year adjusted hazard ratio (HR) 0·76, 95 per cent c.i. 0·69 to 0·83; P < 0·001). In patients with CLI, the cardiovascular mortality risk decreased significantly only in women, with the 5-year risk reducing from 31·2 per cent in period 1 to 29·2 per cent in period 2 (adjusted HR 0·84, 0·74 to 0·94; P = 0·004). Compared with the general population, the mortality risk in patients with IC was increased between 1·70 (1·58 to 1·83) and 3·20 (2·69 to 3·81) times, and in those with CLI the risk was increased between 2·24 (2·09 to 2·40) and 5·19 (4·30 to 6·26) times. CONCLUSION: The risk of premature death in patients with IC and CLI declined significantly in the Netherlands, in a sex-specific manner, over the period from 1998 to 2010. The absolute risk of cardiovascular mortality remains high in these patients.

Trends in risk factors for coronary heart disease in the Netherlands.

BACKGROUND: Favourable trends in risk factor levels in the general population may partly explain the decline in coronary heart disease (CHD) morbidity and mortality. Our aim was to present long-term national trends in established risk factors for CHD. METHODS: Data were obtained from five data sources including several large scale population based surveys, cohort studies and general practitioner registers between 1988 and 2012. We applied linear regression models to age-standardized time trends to test for statistical significant trends. Analyses were stratified by sex and age (younger <65 and older ≥65 years adults). RESULTS: The results demonstrated favourable trends in smoking (except in older women) and physical activity (except in older men). Unfavourable trends were found for body mass index (BMI) and diabetes mellitus prevalence. Although systolic blood pressure (SBP) and total cholesterol trends were favourable for older persons, SBP and total cholesterol remained stable in younger persons. CONCLUSIONS: Four out of six risk factors for CHD showed a favourable or stable trend. The rise in diabetes mellitus and BMI is worrying with respect to CHD morbidity and mortality.

Differential FDG-PET Uptake Patterns in Uninfected and Infected Central Prosthetic Vascular Grafts.

OBJECTIVE: (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) scanning has been suggested as a means to detect vascular graft infections. However, little is known about the typical FDG uptake patterns associated with synthetic vascular graft implantation. The aim of the present study was to compare uninfected and infected central vascular grafts in terms of various parameters used to interpret PET images. METHODS: From 2007 through 2013, patients in whom a FDG-PET scan was performed for any indication after open or endovascular central arterial prosthetic reconstruction were identified. Graft infection was defined as the presence of clinical or biochemical signs of graft infection with positive cultures or based on a combination of clinical, biochemical, and imaging parameters (other than PET scan data). All other grafts were deemed uninfected. PET images were analyzed using maximum systemic uptake value (SUVmax), tissue to background ratio (TBR), visual grading scale (VGS), and focality of FDG uptake (focal or homogenous). RESULTS: Twenty-seven uninfected and 32 infected grafts were identified. Median SUVmax was 3.3 (interquartile range [IQR] 2.0-4.2) for the uninfected grafts and 5.7 for the infected grafts (IQR 2.2-7.8). Mean TBR was 2.0 (IQR 1.4-2.5) and 3.2 (IQR 1.5-3.5), respectively. On VGS, 44% of the uninfected and 72% of the infected grafts were judged as a high probability for infection. Homogenous FDG uptake was noted in 74% of the uninfected and 31% of the infected grafts. Uptake patterns of uninfected and infected grafts showed a large overlap for all parameters. CONCLUSION: The patterns of FDG uptake for uninfected vascular grafts largely overlap with those of infected vascular grafts. This questions the value of these individual FDG-PET-CT parameters in identifying infected grafts.

Cumulative incidence of graft infection after primary prosthetic aortic reconstruction in the endovascular era.

OBJECTIVE: The introduction of endovascular techniques has had a major impact on the case mix of patients that undergo open aortic reconstruction. Hypothetically, this may also have increased the incidence of aortic graft infection (AGI). The aim of this study was to report on the short and mid-term incidence of AGI after primary open prosthetic aortic reconstruction in the endovascular era. METHODS: From 2000 to 2010, all 514 patients in a tertiary referral university hospital, undergoing primary open prosthetic aortic reconstruction for aneurysmal or occlusive aortic disease with at least one aortic anastomosis were included. Data were obtained by retrospectively analyzing the medical records, by contacting patients or their general practitioner by telephone, and by merging the dataset with the national Cause of Death Register. AGI was defined as proven by cultures or clinically in combination with positive imaging results. The 30 day, 1 year, and 2 year incidence rates were computed using life table analysis and expressed as percentages with 95% confidence intervals (CI). RESULTS: AGI was diagnosed in 23 of the 514 included patients. 56% of the patients underwent elective surgery and 86% underwent surgery for an abdominal aortic aneurysm. The 30 day incidence was 1.6% (95% CI 0.4-2.8%), 1 year incidence was 3.6% (95% CI 1.7-5.5%), and 2 year incidence for AGI was 4.5% (95% CI 2.4-6.6%). The total number of person years (1058) yielded an AGI rate of 2.2 per 100 person years. CONCLUSION: The 2 year cumulative incidence of AGI following primary, open aortic procedures with at least one aortic anastomosis is considerable, at around 1 in 20.

The validity of national hospital discharge register data on dementia: a comparative analysis using clinical data from a university medical centre.

BACKGROUND: Most information on the incidence and prognosis of dementia comes from small studies with limited precision and generalisability. Nationwide registers can be an alternative source of information, but only when the diagnosis is validly recorded. We assessed the validity of the Dutch Hospital Discharge Register (HDR). METHODS: HDR data on dementia diagnoses (ICD-9 codes 290.0; 290.1; 290.3; 290.4; 294.1; 331.0; 331.1; 331.82) in a university medical centre in the Netherlands were collected. Diagnoses were verified by using hospital medical records. Positive predictive values (PPVs) were calculated. Multivariate logistic regression models were used to evaluate determinants of inaccuracy in discharge diagnoses. RESULTS: A sample of the HDR data was used for this study (n = 340). PPV was 93.2% for overall dementia, indicating confirmation of 93.2% of HDR dementia diagnoses by the medical records. The accuracy of the diagnosis of overall dementia in patients aged ≥ 65 years was significantly higher compared with younger patients (PPV 95.5 % vs. 67.9%; p = 0.0001). There was no difference in the accuracy of the diagnosis between men and women and accuracy was not influenced by type of admission, comorbidity and polypharmacy. CONCLUSION: The results of this study show a high validity of the diagnosis of overall dementia in the HDR, making this register of great value for further nationwide research on dementia.

Prognosis after a first hospitalisation for acute myocardial infarction and congestive heart failure by country of birth.

OBJECTIVE: To investigate differences in 28-day and 5-year mortality and 5-year readmission after a first hospitalisation for acute myocardial infarction (AMI) and congestive heart failure (CHF) between first generation ethnic minority groups (henceforth, migrants) and the ethnic Dutch population. METHODS: Nationwide prospective cohorts of first hospitalised AMI (N=213 630) and CHF patients (N=189 069) between 1998 and 2010 were built. Differences in 28-day and 5-year mortality and in 5-year AMI/CHF readmission between migrants (Surinamese, Moroccan, Turkish, Antillean, Indonesian, Chinese and South Asian) and the ethnic Dutch population were investigated using Cox proportional hazard regression models. RESULTS: After the first AMI hospitalisation, mortality and AMI/CHF readmission were higher in the majority of migrant groups compared with ethnic Dutch. For example, HRs (adjusted for age, sex, marital status, degree of urbanisation and year of event) with 95% CIs among Surinamese (mainly of African or South-Asian origin) were 1.16 (1.02 to 1.32) for 28-day mortality, 1.44 (1.30 to 1.60) for 5-year mortality, 1.33 (1.08 to 1.63) for AMI readmission and 2.09 (1.82 to 2.40) for CHF readmission. After a first CHF hospitalisation, mortality rates among migrants were more diverse, with lower 28-day mortality among Moroccan and Turkish migrants and higher 5-year mortality among Surinamese, Chinese and South Asians. Readmission after CHF was often higher among migrant groups. CONCLUSIONS: Prognosis after a first AMI hospitalisation was worse among most migrant groups compared with the ethnic Dutch population. Ethnic inequalities in prognosis after a first CHF hospitalisation were more diverse. Efforts should be made to disentangle the underlying factors of the results.

Incidence of first acute myocardial infarction over time specific for age, sex, and country of birth.

OBJECTIVES: To study the age- and sex-specific incidence rates of first acute myocardial infarction (AMI) among first-generation ethnic minority groups (henceforth, migrant groups) and the Dutch majority population in the Netherlands during two time periods (2000-2004 and 2005-2010). METHODS: Through linkage of Dutch nationwide registers, first AMI events in the Dutch majority population and the major migrant groups living in the Netherlands were identified from 2000-2004 and 2005-2010. Absolute incidence rates were calculated within each age-sex-period-country of birth group. RESULTS: Regardless of ethnic background, AMI incidence rates were higher in men than in women and increased with age. Incidence significantly declined over time among the Dutch majority population (men: -26.8%, women: -26.7%), and among most migrant groups under study. It was only in Moroccan migrants that AMI incidence significantly increased over time (men: 25.2%, women: 41.7%). Trends differed between age categories, but did not show a consistent pattern. The higher AMI incidence in Surinamese men and women and Turkish and Indonesian men compared with the Dutch majority population persisted over time, but decreased with age and became absent after 70 years of age. Moroccans had a significantly lower incidence compared with the Dutch majority population during 2000-2004, which disappeared during 2005-2010. CONCLUSION: Primary preventive strategies should focus on Surinamese men and women and Turkish and Indonesian men below 70 years of age. Future research is necessary to unravel the factors that provoke the increasing AMI incidence over time among Moroccans.

Downward trends in acute myocardial infarction incidence: how do migrants fare with the majority population? Results from a nationwide study.

AIMS: In previous decades, a steep decline in acute myocardial infarction (AMI) incidence occurred in Western countries. We assessed whether this decline was also present in migrant groups living in the Netherlands. METHODS AND RESULTS: Nationwide registers were linked between 1998 and 2007. Poisson regression analyses were used to calculate the biannual percentage change in AMI incidence within major non-Western migrant groups, and the differences in these changes with the Dutch majority population. Within the Dutch majority population, AMI incidence significantly declined in men (-12%) and women (-9.5%). Incidence also declined among most migrant groups under study, ranging from -12 to -4.0% in men, and from -16 to -9.5% in women. Only in Turkish women and Moroccan men the AMI incidence remained stable over time (-0.3 and 2.8%, respectively). There were no statistically significant trend differences between the Dutch majority population and the migrant groups under study. The higher AMI incidence in Turkish men and Surinamese men and women, and the lower AMI incidence in Moroccan men persisted over time. CONCLUSIONS: There was a declining AMI incidence rate within the Dutch majority population as well as within most of the major migrant groups living in the Netherlands, except in Turkish women and Moroccan men. Trend patterns among migrant groups did not significantly differ from the Dutch majority population. To reduce ethnic inequalities, primary preventive strategies should be targeted at those migrant groups with a persisting higher incidence.

Socioeconomic inequalities in acute myocardial infarction incidence in migrant groups: has the epidemic arrived? analysis of nation-wide data.

OBJECTIVES: We assessed socioeconomic inequalities in relation to acute myocardial infarction (AMI) incidence among major ethnic groups in The Netherlands. METHODS: A nationwide register-based cohort study was conducted (n=2 591 170) between 1 January 1998 and 31 December 2007 among ethnic Dutch and migrant groups from Suriname, Netherlands Antilles, Indonesia, Morocco and Turkey. Standardised household disposable income was used as a proxy for socioeconomic position. Cox proportional hazard models were used to estimate the socioeconomic inequalities in AMI incidence. RESULTS: Among ethnic Dutch, the AMI incidence was higher in the low-income group than in the high-income group: adjusted HRs were 2.05 (95% CI 2.00 to 2.10) for men and 2.33 (95% CI 2.23 to 2.43) for women. Importantly, similar socioeconomic inequalities in AMI incidence were also observed in all minority groups, with the low socioeconomic group having a higher AMI incidence than the high socioeconomic group: adjusted HR ranging from 2.07 (95% CI 1.26 to 3.40) in Moroccans to 2.73 (95% CI 1.55 to 4.80) in Antilleans in men; and from 2.17 (95% CI 1.74 to 2.71) in Indonesians to 3.88 (95% CI 2.36 to 6.38) in Turks in women. CONCLUSIONS: Our findings demonstrate socioeconomic inequalities in AMI incidence in migrant groups and suggest a convergence towards the Dutch general population. If the AMI incidence rates of the low socioeconomic group could be reduced to the level of the high socioeconomic group, this would represent a major public health improvement for all ethnic groups.

Heart disease in the Netherlands: a quantitative update.

In this review we discuss cardiovascular mortality, incidence and prevalence of heart disease, and cardiac interventions and surgery in the Netherlands. We combined most recently available data from various Dutch cardiovascular registries, Dutch Hospital Data (LMR), Statistics Netherlands (CBS), and population-based cohort studies, to provide a broad quantitative update. The absolute number of people dying from cardiovascular diseases is declining and cardiovascular conditions are no longer the leading cause of death in the Netherlands. However, a substantial burden of morbidity persists with 400,000 hospitalisations for cardiovascular disease involving over 80,000 cardiac interventions annually. In the Netherlands alone, an estimated 730,000 persons are currently diagnosed with coronary heart disease, 120,000 with heart failure, and 260,000 with atrial fibrillation. These numbers emphasise the continuous need for dedicated research on prevention, diagnosis, and treatment of heart disease in our country.

Incidence of acute myocardial infarction in first and second generation minority groups: does the second generation converge towards the majority population?

BACKGROUND: Differences in acute myocardial infarction (AMI) incidence between ethnic minority and migrant groups (henceforth, minority groups) and the majority population have been reported. Health differences may converge towards the majority population over generations. We assessed whether AMI incidence differences between minority groups living in the Netherlands and the Dutch majority population exist, and whether the incidence converges towards the majority population over generations. METHODS: A nationwide register-based cohort study was conducted from 1997 to 2007. Using Cox Proportional Hazard Models AMI incidence differences between minorities and the majority population were estimated. When possible, analyses were stratified by generation. RESULTS: AMI incidence differences between minorities and the majority population depended on the country of origin, and often varied between minorities originating from the same geographical region. For example, among North African and Mediterranean minorities, incidence was higher in Turkish (Hazard Ratio (HR): 1.34; 95% Confidence Interval (95% CI): 1.28-1.41), but lower in Moroccans (HR: 0.46; 95% CI: 0.40-0.52) compared with the majority population. Most minorities had a similar or lower incidence than the majority population, which remained similar or converged towards the incidence of the majority population over generations. In contrast, among minorities from the former Dutch colonies (Suriname, Indonesia, Netherlands Antilles) beneficial intergenerational changes were observed. CONCLUSIONS: Health care professionals and policy makers should be aware of substantial AMI incidence differences between minority groups and the majority population, and the often unbeneficial change over generations. Future research should be cautious when clustering minority groups based on geographical region of the country of origin.

Heart failure admissions in adults with congenital heart disease; risk factors and prognosis.

BACKGROUND: Heart failure (HF) is a serious complication and often the cause of death in adults with congenital heart disease (CHD). Therefore, our aims were to determine the frequency of HF-admissions, and to assess risk factors of first HF-admission and of mortality after first HF-admission in adults with CHD. METHODS: The Dutch CONCOR registry was linked to the Hospital Discharge Registry and National Mortality Registry to obtain data on HF-admissions and mortality. Risk factors for both HF-admission and mortality were assessed using Cox regression models. RESULTS: Of 10,808 adult patients (49% male), 274 (2.5%) were admitted for HF during a median follow-up period of 21 years. The incidence of first HF-admission was 1.2 per 1000 patient-years, but the incidence of HF itself will be higher. Main defect, multiple defects, and surgical interventions in childhood were identified as independent risk factors of HF-admission. Patients admitted for HF had a five-fold higher risk of mortality than patients not admitted (hazard ratio (HR)=5.3; 95% confidence interval 4.2-6.9). One- and three-year mortality after first HF-admission were 24% and 35% respectively. Independent risk factors for three-year mortality after first HF-admission were male gender, pacemaker implantation, admission duration, non-cardiac medication use and high serum creatinine. CONCLUSIONS: The incidence of HF-admission in adults with CHD is 1.2 per 1000 patient-years. Mortality risk is substantially increased after HF-admission, which emphasises the importance to identify patients at high risk of HF-admission. These patients might benefit from closer follow-up and earlier medical interventions. The presented risk factors may facilitate surveillance.

Adult congenital heart disease: new challenges.

Improved surgical care from the last five decades, together with the advances in medical management, led to a remarkable increase of survival of patients with congenital heart disease (CHD). However, aging of the CHD population brings new challenges. Given that many patients with CHD are prone to residua and sequelae, life-long surveillance is essential. Therefore, the first of many challenges is to optimize the transition of patients with CHD from pediatric to adult cardiology to prevent lost to follow-up, and to ensure that there are enough specialized adult cardiologists to take care of this expanding patient population. Another important challenge is the expansion of knowledge on long-term complications and comorbidity in these patients. Increased efforts are needed to gain further understanding on how to prevent and treat these. Furthermore, as patients reach the reproductive age, family planning becomes more important and research on the risks and management of pregnancy should be further extended. Finally, to improve the well-being and social life of adults with CHD efforts should be made to improve employability and insurability.

Surgery in adults with congenital heart disease.

BACKGROUND: A significant proportion of patients with congenital heart disease require surgery in adulthood. We aimed to give an overview of the prevalence, distribution, and outcome of cardiovascular surgery for congenital heart disease. We specifically questioned whether the effects of surgical treatment on subsequent long-term survival depend on sex. METHODS AND RESULTS: From the Dutch Congenital Corvitia (CONCOR) registry for adults with congenital heart disease, we identified 10 300 patients; their median age was 33.1 years. Logistic and Cox regression models were used to assess the association of surgery in adulthood with sex and with long-term survival. In total, 2015 patients (20%) underwent surgery for congenital heart disease in adulthood during a median follow-up period of 15.1 years; in 812 patients (40%), it was a reoperation. Overall, both first operations and reoperations in adulthood were performed significantly more often in men compared with women (adjusted odds ratio=1.4 [95% confidence interval, 1.2-1.6] and 1.2 [95% confidence interval, 1.0-1.4], respectively). Patients with their third and fourth or more surgery in adulthood had a 2- and 3-times-higher risk of death compared with patients never operated on (adjusted hazard ratio=1.9 [95% confidence interval, 1.0-3.6] and 2.7 [95% confidence interval, 1.1-6.3], respectively). Men with a reoperation in adulthood had a 2-times-higher risk of death than women (adjusted hazard ratio=1.9; 95% confidence interval, 1.0-3.5). CONCLUSIONS: Of predominantly young adults with congenital heart disease, one fifth required cardiovascular surgery during a 15-year period; in 40%, the surgery was a reoperation. Men with congenital heart disease have a higher chance of undergoing surgery in adulthood and have a consistently worse long-term survival after reoperations in adulthood compared with women.

Coronary heart disease mortality trends in the Netherlands 1972-2007.

BACKGROUND: Coronary heart disease (CHD) mortality has steadily declined since the early 1970s in the Netherlands. However, in some Western countries the rate of decline in younger groups may be starting to plateau or even rise. OBJECTIVE: To examine trends in age-specific CHD mortality rates among Dutch adults from 1972 to 2007, with a particular focus on recent trends for the younger age groups METHODS: Data for all CHD deaths (1972-2007) in the Netherlands were grouped by year, sex, age. A joinpoint regression was fitted to each age-sex-group to detect points in time at which significant changes in the trends occur. For every time period, the linear slope of the trend, p value, observed number of deaths, CHD mortality rates and change in the CHD mortality rate were calculated. RESULTS: Between 1972 and 2007, the age-adjusted CHD mortality rates decreased overall by 76% in both men and women. In men (35-54 years), the change in CHD mortality rate in the period 1980-1993 was -0.53 but attenuated in period 1993-1999: -0.16. In women (35-54 years) the decline likewise attenuated to -0.44 in period 1979-1989: and -0.05 in period 1989-2000. After 1999-2000, CHD mortality rate further declined in both men (period 1999-2007: -0.46) and women (period 2000-2007: -0.38). CONCLUSIONS: Evidence from several Western countries suggests that among young adults (< 55 years), CHD mortality rates are levelling out. In this study, similar attenuation of the decline in CHD mortality among young adults in the Netherlands has been observed. Furthermore, this is the first study to observe a subsequent increase in the pace of decline after a period of flattening. In order to better explain these encouraging changes in CHD mortality rates, a detailed analysis of recent changes in cardiovascular risk factors and treatments is now urgently required.

Age- and gender-specific risk of death after first hospitalization for heart failure.

BACKGROUND: Hospitalization for heart failure (HF) is associated with high-in-hospital and short- and long-term post discharge mortality. Age and gender are important predictors of mortality in hospitalized HF patients. However, studies assessing short- and long-term risk of death stratified by age and gender are scarce. METHODS: A nationwide cohort was identified (ICD-9 codes 402, 428) and followed through linkage of national registries. The crude 28-day, 1-year and 5-year mortality was computed by age and gender. Cox regression models were used for each period to study sex differences adjusting for potential confounders (age and comorbidities). RESULTS: 14,529 men, mean age 74 ± 11 years and 14,524 women, mean age 78 ± 11 years were identified. Mortality risk after admission for HF increased with age and the risk of death was higher among men than women. Hazard ratio's (men versus women and adjusted for age and co-morbidity) were 1.21 (95%CI 1.14 to 1.28), 1.26 (95% CI 1.21 to 1.31), and 1.28 (95%CI 1.24 to 1.31) for 28 days, 1 year and 5 years mortality, respectively. CONCLUSIONS: This study clearly shows age- and gender differences in short- and long-term risk of death after first hospitalization for HF with men having higher short- and long-term risk of death than women. As our study population includes both men and women from all ages, the estimates we provide maybe a good reflection of 'daily practice' risk of death and therefore be valuable for clinicians and policymakers.

Regional differences in incidence of sudden cardiac death in the young.

BACKGROUND: Observational data on sudden cardiac death (SCD) in the young are scarce, but the SCD incidence of this study is to examine regional differences in SCD incidence within a population among young individuals (<40 years) and to assess whether regional incidences are associated with socio-economic status (SES ). METHODS: SCD cases aged <40 years were identified in 12 provinces of the Netherlands by using death certificates recorded by Statistics Netherlands during 1996-2006. Regional incidence estimates were standardised for age to the Dutch population and assessed for two age categories; 1-29 years and 30-39 years. Regional SCD incidence was related to regional SES with a Spearman correlation coefficient. RESULTS: The nationwide incidence of SCD at ages 1 to 40 years was 1.6 (95% CI 1.5 to 1.7) per 100,000 person-years and the incidence increased substantially after 30 years of age. Significant differences in regional incidences were assessed for both age categories (1-29 and 30-39 years). Although in the population aged 1-29 years significant differences were found in the SCD incidence between regions, no relation could be found with SES . In men aged 30-39 years, the incidence of SCD was inversely related to SES ; a low socio-economic status was associated with a relatively high incidence of SCD. CONCLUSION: Between regions, statistically significant differences in SCD incidence exist in young individuals. The nationwide incidence of SCD increased substantially after 30 years of age and was inversely related to SES in men aged 30-39 years.