<p>Identification of Patients with New-Onset Heart Failure and Reduced Ejection Fraction in Danish Administrative Registers</p>

Abstract

Background: 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 (RASi+BB) within 120 days could identify patients with HF and reduced ejection fraction (EF ≤40%) (HFrEF). Methods: 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 RASi+BB at 120 days and calculated sensitivity, specificity and predictive values. Results: 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 RASi+BB compared to 22 (14%) of non-HFrEF patients. At 120 days, 460 (85%) of HFrEF patients received RASi+BB 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%. Conclusion:In Denmark, the ICD-10 HF diagnosis combined with recorded RASi+BB treatment by 120 days after discharge has high positive predictive value and can accurately be used to identify patients with HFrEF.

Temporal trends in initiation of mineralocorticoid receptor antagonists and risk of subsequent withdrawal in patients with heart failure: a nationwide study in Denmark from 2003–2017

“…Our study is based on data from administrative registries and therefore it should be noted that data on LVEF are not available. Our used definition of HFrEF is based on a previous published methodological study that proposed that HFrEF patients could be identified in Danish registries with the definition used in the present study 14 . Though, we cannot further evaluate the association between mildly and severely reduced LVEF and MRA adherence/persistence, which is an important limitation of our study.…”

“…A previous validation study has shown that this HFrEF definition has a high positive predictive value (95%), and that the sensitivity and specificity are 85%. 14 Therefore, some HFrEF patients are overlooked, but only few HFpEF patients included. According to the definition (120 days after the diagnosis HF), the sickest patients might have died before study start.…”

Socioeconomic Disparities in Referral for Invasive Hemodynamic Evaluation for Advanced Heart Failure: A Nationwide Cohort Study

“…However, the definition used for the study population in the sensitivity analysis, which yielded results similar to the primary analysis, has a positive predictive value of 95% in the Danish registries to identify patients with HF and reduced ejection fraction. 27 Compared with the population in the study by Stewart et al 37 of ambulatory patients with advanced HF on oral medical therapy with high risk features, our cohort of patients in the sensitivity analysis were similar regarding age (median 65), sex (72% males) and cohabitant status (65% living together), although ischemic heart disease (38% versus 46%) and number of patients on loop diuretics (64% versus 95%) were less frequent in our cohort. In the group referred to RHC, 82% of the patients had filled prescriptions of loop diuretics.…”

Long‐Term Mortality Associated With Use of Carvedilol Versus Metoprolol in Heart Failure Patients With and Without Type 2 Diabetes: A Danish Nationwide Cohort Study

“…This definition has been shown to capture the majority of new‐onset HFrEF in our registries (defined as a left ventricular ejection fraction ≤40%), with a sensitivity of 85% and a positive predictive value of 95%. 20 We stratified data by T2D status, defined as a diagnosis of diabetes ( ICD E11, E14), excluding type 1 diabetes ( ICD E10), or a claimed prescription of at least one hypoglycemic agent within 120 days of HF diagnosis. Incident T2D was defined by the same criteria.…”