GOCARTs Gothenburg CArdiovascular RegisTry studies

Swedish Initiative for Research on Microdata in the Social And Medical

Sciences

www.registerforskning.

se

www.simsam.nu

Rates of Death during Hospitalization for Myocardial Infarction among Women and Men,

According to Age. National Registry of Myocardial Infarction 2 1994-1998

Vaccarino V et al. N Engl J Med 1999;341:217-225.

384,878 patients

(155,565 women

and 229,313 men)

who were 30 to 89

years of age and

who had been

enrolled in the

National Registry of

Myocardial

Infarction 2 between

June 1994 and

January 1998

0

10

20

30

40

50

30-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89

Men

Women

%

Age

28-day AMI mortality by age

in Swedish men and women

hospitalised with AMI 1987-

2000

Rosengren A, et al. Eur Heart J 2001.

0

10

20

30

40

30-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89

Men

Women

%

Age

Out-of-hospital mortality in

Sweden after AMI by age and

sex.

Rosengren A, et al. Eur Heart J 2001.

0

10

20

30

40

50

60

70

30-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89

Women

Men

%

Age

Total 1-year AMI mortality by

age in men and women

Rosengren A, et al. Eur Heart J 2001.

6

AMI and case fatality per 100,000 aged 35-84 1991-2006

0

100

200

300

400

500

600

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Per

100,0

00

Out-of-hospital

In-hospital

Survived to 28 days

Dudas K, et al. Circulation 2011

7

Relevant Swedish registries for CVD research

• Hospital registry (1987-)

• Cause of death (1961-)

• Prescribed Medication (mid-2005 -)

• Swedeheart (coronary heart disease)

• RiksStroke

• RiksSvikt (heart failure)

• SweCon (congenital heart disease

• National Diabetes Registry (NDR)

GOCARTs (Gothenburg CArdiovascular RegisTry studies)

Work-package 1 Work-package 2 Work-package 3 Work-package 4

Heart failure and cardiomyopathy

Grown-up congenital heart disease (GUCH)

Cardiovascular epidemiology (CHD and stroke)

Diabetes and endocrinology

Coordinator Coordinator Coordinator Coordinator

Maria Schaufelberger Mikael Dellborg Annika Rosengren Marcus Lind

Co-coordinator Co-coordinator Co-coordinator Co-coordinator

Annika Rosengren Zacharias Mandalenakis Christina Jern Soffia Gudbjörnsdottir

(Registercentrum)

PhD students PhD students PhD students PhD students

Anders Barasa, MD, PhD 2014

Pär Parén, MD

Carmen Basic, MD

Martin Lindgren, MD

Pigi Dikaiou, MD

Hengameh Ziaei, MD

Eva Furenäs, MD

Naquib Mirzada, MD, PhD 2014

Maria Fedchenko, MD

WK Giang, BSc, PhD 2014,

Susanne Nielsen, RN

Mia Söderberg, BSc, PhD 2014

Petra Redfors MD, PhD 2014

Lukas Holmegaard MD

Annie Pedersén MD

Daniel Vestberg, MD

Araz Rawshani, MD

Christina Hedén Ståhl, MD

Modelling studies and health economics

Lena Björck (Sahlgrenska Academy), Kristian Bolin (School of Business, Economics and Law, GU)

Social sciences, occupational and insurance medicine

Kjell Torén, Gunnel Hensing, Jeong-Ling Kim (Sahlgrenska Academy), Mikael Gilljam (Political Science, GU), David Karlsson (Public

Administration, GU)

Primary care, VEGA database

Staffan Björck (Registercentrum), Cecilia Björkelund, Ingmarie Skoglund, Dominique Hange (Sahlgrenska Academy)

Biostatistics group

Max Petzold, Linus Schiöler, Georg Lappas, Tatiana Zverkova, Martin Adiels

Current projects

I Heart failure and cardiomyopathies

II Adult patients with congenital heart disease

III Cardiovascular disease in adults with Type 1 and Type 2 diabetes

IV The chronic phase in CHD and stroke

V Prior disease trajectories in out-of-hospital deaths from heart

disease

VI Modelling studies – IMPACT model

Cardiovascular death by glycemic control in Type 1 diabetes – case-control study

0

1

2

3

4

5

Controlsn=169249

≤52 n=6142 53-62n=7759

63-72n=8951

73-82n=5442

≥83 n=4000

Deaths per

1000

person

years

Lind M, et al. N Engl J Med 2014;371:1972-82.

HbA1c,

mmol/mol

All-cause and CVD death by age and sex for type 1 diabetic patients and controls. Hazard ratios for all-cause and CVD mortality

Lind M, et al. N Engl J Med 2014;371:1972-82.

CHD death in Sweden 1987-2009. 1987=100%

12

%

Berg J, et al. BMC Cardiovascular

Disorders 2014

0,0

10,0

20,0

30,0

40,0

50,0

60,01

987

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

Men

Women

Age-standardized mortality per 100 000 from ischemic stroke in persons aged 18–84 years in Sweden 1987–2010.

Rosengren at al Stroke 2013;44:2388-93

Relative incidence of ischemic stroke by age in Sweden 1987-2010. 1987=100%

18-44 45-64 65-84 years

Rosengren A, Giang KW, Lappas G, Jern C, Torén K, Björck L

.Stroke 2013;44:2388-93

Prevalence of heart failure by age 1990-2007

% 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

2007

Prevalence, age-adjusted

1.61 1.64 1.72 1.84 1.92 2.01 2.06 2.07 2.11 2.11 2.10 2.12 2.10 2.09 2.08 2.08 2.07 2.03

Men 1.59 1.63 1.70 1.82 1.91 1.99 2.04 2.06 2.10 2.10 2.11 2.13 2.12 2.12 2.12 2.13 2.14 2.11

Women 1.64 1.65 1.73 1.86 1.94 2.03 2.08 2.08 2.12 2.11 2.10 2.11 2.09 2.07 2.05 2.03 2.00 1.96

Age group 19-54 0.09 0.09 0.09 0.10 0.10 0.11 0.11 0.12 0.12 0.12 0.12 0.12 0.12 0.13 0.13 0.13 0.13 0.13

55-64 0.85 0.87 0.91 0.97 1.01 1.06 1.05 1.05 1.07 1.04 1.04 1.03 1.03 1.02 1.02 1.03 1.05 1.06

65-74 2.80 2.89 3.09 3.35 3.52 3.60 3.68 3.65 3.71 3.68 3.64 3.61 3.56 3.48 3.40 3.36 3.29 3.20

75-84 8.11 8.31 8.69 9.37 9.77 10.0 10.1 10.0 10.1 10.0 10.0 10.0 9.92 9.79 9.68 9.53 9.42 9.23

85-99 18.6 18.5 18.5 19.5 19.9 20.6 20.9 20.8 21.3 21.1 20.9 21.2 21.2 21.2 21.2 21.0 20.8 20.4

Period 1 Period 2 Period 3 Period 4 Years EAPC (95% CI) Years EAPC (95% CI) Years EAPC (95% CI) Years EAPC (95% CI) Total population 1990-96 4.9* (4.4 to 5.4) 1996-2001 0.6 (0.0 to 1.2) 2001-7 -0.6* (-0.9 to –0.2)

Gender Men 1990-92 3.0* (0.5 to 0.5) 1992-95 5.9* (4.9 to 6.9) 1995-98 1.9* (1.0 to 2.7) 1998-2007 0.1 (-0.0 to 0.2) Women 1990-92 1.6 (-1.3 to 4.6) 1992-95 6.6* (5.0 to 7.9) 1995-99 1.5* (0.6 to 2.3) 1999-2007 -0.9* (-1.1 to –0.7)

Age 19-54 1990-93 3.6* (2.7 to 4.6) 1993-97 5.7* (5.1 to 6.2) 1997-2007 1.3* (1.2 to 1.4) 55-64 1990-95 4.9* (4.2 to 5.6) 1995-2004 -0.5* (-0.8 to –0.2) 2004-7 1.3* (0.2 to 2.5)

65-74 1990-95 6.2* (5.5 to 6.9) 1995-2000 0.4 (-0.2 to 1.1) 2000-7 -1.9* (-2.2 to –1.5)

75-84 1990-95 5.2* (4.6 to 5.8) 1995-2002 0.0 (-0.3 to 0.3) 2002-7 -1.4* (-1.8 to –1.0)

85-99 1990-96 2.4* (1.7 to 3.1) 1996-2004 0.2 (-0.3 to 0.7) 2004-7 -1.3 (-2.9 to 0.4)

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Total population

All 105449 108785 114345 123471 129924 136118 139692 140606 143841 143728 143862 145417 145110 144964 144919 145547 145872 144925 All men 51212 52845 55432 59726 62815 65800 67522 68240 69927 70055 70501 71496 71649 71990 72308 73230 74064 74063 All women 54238 55941 58913 63745 67109 70318 72171 72366 73914 73674 73361 73921 73461 72974 72611 72317 71808 70861 Age group 19-54

Total 3574 3735 3890 4174 4407 4702 4934 5049 5128 5190 5154 5241 5260 5296 5376 5480 5580 5726

Men 2327 2428 2547 2705 2846 3045 3205 3286 3354 3384 3366 3401 3411 3458 3494 3588 3640 3742 Women 1247 1308 1343 1469 1561 1657 1729 1763 1774 1806 1788 1840 1849 1838 1882 1893 1940 1984

55-64

Total 7091 7276 7609 8165 8582 9074 9205 9489 10056 10298 10744 11119 11514 11732 12016 12399 12732 12930 Men 4758 4896 5136 5466 5698 6064 6193 6462 6863 7062 7357 7653 7985 8160 8352 8634 8903 9068 Women 2333 2380 2473 2699 2884 3010 3013 3027 3193 3236 3386 3466 3529 3571 3665 3765 3828 3862

65-74

Total 23410 24106 25544 27602 28785 28734 28806 28181 28076 27498 26936 26634 26354 25997 25733 25730 25679 25828 Men 13892 14318 15239 16407 17181 17196 17306 17122 17100 16840 16456 16421 16281 16245 16234 16396 16485 16670 Women 9518 9789 10305 11195 11604 11539 11500 11059 10976 10659 10479 10213 10073 9752 9500 9334 9194 9158

75-84

Total 43782 45101 47463 51212 53522 56364 57811 57984 58676 58325 58362 58624 57815 57042 56181 54444 53103 51679 Men 20977 21616 22575 24338 25473 26905 27643 27931 28496 28517 29001 29242 28870 28524 28218 27780 27547 26980 Women 22805 23485 24887 26874 28048 29459 30168 30053 30181 29809 29360 29382 28945 28517 27963 26664 25556 24699

85-99 Total 27592 28567 29839 32318 34629 37244 38936 39902 41904 42417 42667 43799 44167 44898 45612 47494 48778 48761 Men 9257 9587 9935 10811 11617 12591 13175 13438 14115 14253 14320 14780 15102 15602 16010 16834 17489 17603 Women 18335 18980 19904 21507 23012 24653 25761 26464 27789 28164 28347 29019 29065 29295 29602 30660 31289 31158

Figure 2. Relative change in number of men and women with HF from 1990-2007 (Calendar year 1990=0)

Figure 3: Relative change in number of patients with HF by age group from 1990-2007 (Calendar Year 1990=0)

Figure 4: Relative demographic changes in the Swedish population by age group from 1990-2007 (Calendar year 1990=0)

Table 1. Heart failure prevalence in percentage in total population, by gender, age and calendar year.

Table 2. Joinpoint analysis: trends in total population, gender-specific and age-specific heart failure prevalence rates.

EAPC, estimated annual percentage change

*significantly different from 0

E-Table 1: Heart failure in absolute numbers by total population, gender, age and calendar year.

Parén P, et al. European Journal of Heart Failure 2014.

Register-based research in CVD

• National coverage

• Detailed information available

• Excellent potential for the study of unusual or rare diseases

• Potential for subgroup analyses, particularly CVD in the young