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      Undiagnosed cardiovascular disease prior to cardiovascular death in individuals with severe mental illness

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          Abstract

          Objective

          To examine whether individuals with schizophrenia ( SCZ) or bipolar disorder ( BD) had equal likelihood of not being diagnosed with cardiovascular disease ( CVD) prior to cardiovascular death, compared to individuals without SCZ or BD.

          Methods

          Multivariate logistic regression analysis including nationwide data of 72 451 cardiovascular deaths in the years 2011–2016. Of these, 814 had a SCZ diagnosis and 673 a BD diagnosis in primary or specialist health care.

          Results

          Individuals with SCZ were 66% more likely ( OR: 1.66; 95% CI: 1.39–1.98), women with BD were 38% more likely (adjusted OR: 1.38; 95% CI: 1.04–1.82), and men with BD were equally likely ( OR: 0.88, 95% CI: 0.63–1.24) not to be diagnosed with CVD prior to cardiovascular death, compared to individuals without SMI. Almost all (98%) individuals with SMI and undiagnosed CVD had visited primary or specialized somatic health care prior to death, compared to 88% among the other individuals who died of CVD.

          Conclusion

          Individuals with SCZ and women with BD are more likely to die due to undiagnosed CVD, despite increased risk of CVD and many contacts with primary and specialized somatic care. Strengthened efforts to prevent, recognize, and treat CVD in individuals with SMI from young age are needed.

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          Most cited references 65

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          Validity of diagnostic coding within the General Practice Research Database: a systematic review.

          The UK-based General Practice Research Database (GPRD) is a valuable source of longitudinal primary care records and is increasingly used for epidemiological research. To conduct a systematic review of the literature on accuracy and completeness of diagnostic coding in the GPRD. Systematic review. Six electronic databases were searched using search terms relating to the GPRD, in association with terms synonymous with validity, accuracy, concordance, and recording. A positive predictive value was calculated for each diagnosis that considered a comparison with a gold standard. Studies were also considered that compared the GPRD with other databases and national statistics. A total of 49 papers are included in this review. Forty papers conducted validation of a clinical diagnosis in the GPRD. When assessed against a gold standard (validation using GP questionnaire, primary care medical records, or hospital correspondence), most of the diagnoses were accurately recorded in the patient electronic record. Acute conditions were not as well recorded, with positive predictive values lower than 50%. Twelve papers compared prevalence or consultation rates in the GPRD against other primary care databases or national statistics. Generally, there was good agreement between disease prevalence and consultation rates between the GPRD and other datasets; however, rates of diabetes and musculoskeletal conditions were underestimated in the GPRD. Most of the diagnoses coded in the GPRD are well recorded. Researchers using the GPRD may want to consider how well the disease of interest is recorded before planning research, and consider how to optimise the identification of clinical events.
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            Atypical antipsychotic drugs and the risk of sudden cardiac death.

            Users of typical antipsychotic drugs have an increased risk of serious ventricular arrhythmias and sudden cardiac death. However, less is known regarding the cardiac safety of the atypical antipsychotic drugs, which have largely replaced the older agents in clinical practice. We calculated the adjusted incidence of sudden cardiac death among current users of antipsychotic drugs in a retrospective cohort study of Medicaid enrollees in Tennessee. The primary analysis included 44,218 and 46,089 baseline users of single typical and atypical drugs, respectively, and 186,600 matched nonusers of antipsychotic drugs. To assess residual confounding related to factors associated with the use of antipsychotic drugs, we performed a secondary analysis of users of antipsychotic drugs who had no baseline diagnosis of schizophrenia or related psychoses and with whom nonusers were matched according to propensity score (i.e., the predicted probability that they would be users of antipsychotic drugs). Current users of typical and of atypical antipsychotic drugs had higher rates of sudden cardiac death than did nonusers of antipsychotic drugs, with adjusted incidence-rate ratios of 1.99 (95% confidence interval [CI], 1.68 to 2.34) and 2.26 (95% CI, 1.88 to 2.72), respectively. The incidence-rate ratio for users of atypical antipsychotic drugs as compared with users of typical antipsychotic drugs was 1.14 (95% CI, 0.93 to 1.39). Former users of antipsychotic drugs had no significantly increased risk (incidence-rate ratio, 1.13; 95% CI, 0.98 to 1.30). For both classes of drugs, the risk for current users increased significantly with an increasing dose. Among users of typical antipsychotic drugs, the incidence-rate ratios increased from 1.31 (95% CI, 0.97 to 1.77) for those taking low doses to 2.42 (95% CI, 1.91 to 3.06) for those taking high doses (P<0.001). Among users of atypical agents, the incidence-rate ratios increased from 1.59 (95% CI, 1 .03 to 2.46) for those taking low doses to 2.86 (95% CI, 2.25 to 3.65) for those taking high doses (P=0.01). The findings were similar in the cohort that was matched for propensity score. Current users of typical and of atypical antipsychotic drugs had a similar, dose-related increased risk of sudden cardiac death. 2009 Massachusetts Medical Society
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              Positive predictive value of cardiovascular diagnoses in the Danish National Patient Registry: a validation study

              Objective The majority of cardiovascular diagnoses in the Danish National Patient Registry (DNPR) remain to be validated despite extensive use in epidemiological research. We therefore examined the positive predictive value (PPV) of cardiovascular diagnoses in the DNPR. Design Population-based validation study. Setting 1 university hospital and 2 regional hospitals in the Central Denmark Region, 2010–2012. Participants For each cardiovascular diagnosis, up to 100 patients from participating hospitals were randomly sampled during the study period using the DNPR. Main outcome measure Using medical record review as the reference standard, we examined the PPV for cardiovascular diagnoses in the DNPR, coded according to the International Classification of Diseases, 10th Revision. Results A total of 2153 medical records (97% of the total sample) were available for review. The PPVs ranged from 64% to 100%, with a mean PPV of 88%. The PPVs were ≥90% for first-time myocardial infarction, stent thrombosis, stable angina pectoris, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, takotsubo cardiomyopathy, arterial hypertension, atrial fibrillation or flutter, cardiac arrest, mitral valve regurgitation or stenosis, aortic valve regurgitation or stenosis, pericarditis, hypercholesterolaemia, aortic dissection, aortic aneurysm/dilation and arterial claudication. The PPVs were between 80% and 90% for recurrent myocardial infarction, first-time unstable angina pectoris, pulmonary hypertension, bradycardia, ventricular tachycardia/fibrillation, endocarditis, cardiac tumours, first-time venous thromboembolism and between 70% and 80% for first-time and recurrent admission due to heart failure, first-time dilated cardiomyopathy, restrictive cardiomyopathy and recurrent venous thromboembolism. The PPV for first-time myocarditis was 64%. The PPVs were consistent within age, sex, calendar year and hospital categories. Conclusions The validity of cardiovascular diagnoses in the DNPR is overall high and sufficient for use in research since 2010.
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                Author and article information

                Contributors
                ina.heiberg@skde.no
                Journal
                Acta Psychiatr Scand
                Acta Psychiatr Scand
                10.1111/(ISSN)1600-0447
                ACPS
                Acta Psychiatrica Scandinavica
                John Wiley and Sons Inc. (Hoboken )
                0001-690X
                1600-0447
                29 March 2019
                June 2019
                : 139
                : 6 ( doiID: 10.1111/acps.2019.139.issue-6 )
                : 558-571
                Affiliations
                [ 1 ] Center for Clinical Documentation and Evaluation (SKDE) Tromsø Norway
                [ 2 ] Department of Community Medicine UiT – The Arctic University of Norway Tromsø Norway
                [ 3 ] Centre for Sami Health Research Department of Community Medicine UiT – The Arctic University of Norway Tromsø Norway
                [ 4 ] Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders Innlandet Hospital Trust Hamar Norway
                [ 5 ] Department of Clinical Medicine UiT – The Arctic University of Norway Tromsø Norway
                [ 6 ] Institute of Clinical Medicine University of Oslo Oslo Norway
                [ 7 ] Institute of Health and Society University of Oslo Oslo Norway
                [ 8 ] Department of Mental Disorders Norwegian Institute of Public Health Oslo Norway
                [ 9 ] Department of Psychology University of Oslo Oslo Norway
                [ 10 ] PharmacoEpidemiology and Drug Safety Research Group School of Pharmacy University of Oslo Oslo Norway
                [ 11 ] Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden
                [ 12 ] Icahn School of Medicine Mt Sinai Hospital New York NY USA
                [ 13 ] Norwegian Medical Association Oslo Norway
                [ 14 ] Division of Mental Health and Substance Abuse University Hospitalof North Norway Tromsø Norway
                Author notes
                [* ] Ina H. Heiberg, Center for Clinical Documentation and Evaluation (SKDE), postbox 6, 9038 Tromsø, Norway.

                E‐mail: ina.heiberg@ 123456skde.no

                Article
                ACPS13017
                10.1111/acps.13017
                6619029
                30844079
                © 2019 The Authors Acta Psychiatrica Scandinavica Published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 2, Tables: 3, Pages: 14, Words: 10346
                Product
                Funding
                Funded by: Helse Nord RHF
                Award ID: PFP1236‐15
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                acps13017
                June 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.5 mode:remove_FC converted:10.07.2019

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