Validity of diagnoses of major coronary events in national registers of hospital diagnoses and deaths in Finland Article DOI:
Cite this article as: Rapola, J.M., Virtamo, J., Korhonen, P. et al. Eur J Epidemiol (1997) 13: 133. doi:10.1023/A:1007380408729 Abstract
We validated diagnoses of acute myocardial infarction (AMI) and death from coronary heart disease (CHD) found in the Finnish National Hospital Discharge Register and the Register of Causes of Death from a sample of the 29,133 men participating in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. The cases were traced to hospitals and institutes performing medico-legal death cause examinations and all relevant information was collected. The cardiac events were re-evaluated according to the diagnostic criteria of the Finnish contribution to the WHO MONICA project, i.e. the FINMONICA criteria. Altogether 408 cases of non-fatal AMI (n = 217) and death from CHD (n = 191) were reviewed. In the re-evaluation 94% of them (95% confidence interval 92--96%) were diagnosed as either definite (57%) or possible (37%) AMI. Non-fatal cases were more often classified definite AMI in the review, whereas fatal cases were more often classified possible AMI. Age or trial supplementation group did not affect classification, and no secular trend was observed. In conclusion, the diagnoses of AMI and death from CHD in the registers were highly predictive of a true major coronary event defined by strict criteria, thus their use in endpoint assessment in epidemiological studies and clinical trials is justified.
Coronary heart disease Diagnoses Hospital discharge register Myocardial infarction Register of causes of death Validity References
Martin CA, Hobbs MST, Armstrong BK. Identification of non-fatal myocardial infarction through hospital discharge data in western Australia. J Chron Dis 1987; 40: 1111–1120.
The West of Scotland Coronary Prevention Study Group. Computerized record linkage: Compared with traditional patient follow-up methods in clinical trials and illustrated in a prospective epidemiological study. J Clin Epidemiol 1995; 48: 1441–1452.
Penttilä A, Ahonen A. Arteriosclerotic and other degenerative heart diseases in Finland, II: A death certificate study of the examination of the cause of death from degenerative heart diseases. Scand J Soc Med 1975; 3: 69–74.
Salmela R, Koistinen V. Is the discharge register of general hospitals complete and reliable. Sairaala 1987; 50: 480–482.
Aro S, Koskinen R, Keskimäki I. Sairaalastapoistorekisterin diagnoosi-, toimenpide-ja tapaturmatietojen luotettavuus. Duodecim 1990; 106: 1443–1450.
Näyhä S. Improved survival after acute myocardial infarction in Finland. Int J Epidemiol 1992; 21: 30–35.
Martini CJM, Hughes AO, Patton VA. A study of the validity of the hospital activity analysis information. Br J Prev Soc Med 1976; 30: 180–186.
Romano PS, Mark DH. Bias in the coding of hospital discharge data and its implications for quality assessment. Med Care 1994; 32: 81–90.
Stenbäck F. Accuracy of antemortem diagnosis in the north. An autopsy study. Arct Med Res 1986; 41: 9–15.
Martin CA, Hobbs MST, Armstrong BK. Estimation of myocardial infarction mortality from routinely collected data in western Australia. J Chron Dis 1987; 40: 661–669.
Beaglehole R, Stewart AW, Walker P. Validation of coronary heart disease hospital discharge data. Aust NZ J Med 1987; 17: 43–46.
Palomäki P. Sydäninfarki ja sepelvaltimotautikuolema Kuopion läänissä vuonna 1983. Diagnoosikäytäntö ja epidemiologia (Acute myocardial infarction and coronary heart disease death in Kuopio province in 1983. Diagnostic practice and epidemiology) [Dissertation]. Publications of the University of Kuopio, Kuopio. Original reports 12/1989, 184 pp.
Joensuu T, Näyhä S. Reliability of hospital discharge diagnoses of acute myocardial infarction [Letter]. Scand J Soc Med 1992; 20: 85–86.
Tuomilehto J, Arstila M, Kaarsalo E, et al. Acute myocardial infarction (AMI) in Finland: Baseline data from the FINMONICA AMI register in 1983–1985. Eur Heart J 1992; 13: 577–587.
Mähönen M. Poistoilmoitusrekisteri sepelvaltimotaudin epidemiologisen tutkimuksen tietolähteenä. Sairaaloiden poistoilmoitusrekisterin ja FINMONICA-sydäninfarktirekisterin vertailu (The reliability of hospital discharge data as a tool for epidemiologic research on ischemic heart disease. Comparison of the hospital discharge register and the FINMONICA AMI register) [Dissertation]. Department of Public Health, University of Helsinki, 1993, 157 pp.
Palomäki P, Miettinen H, Mustaniemi H, et al. Diagnosis of acute myocardial infarction by MONICA and FINMONICA diagnostic criteria in comparison with hospital discharge diagnosis. J Clin Epidemiol 1994; 47: 659–666.
The ATBC Cancer Prevention Study Group. The alpha-tocopherol, beta-carotene lung cancer prevention study: Design, methods, participant characteristics, and compliance. Ann Epidemiol 1994; 4: 1–10.
The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group. The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Eng J Med 1994; 330: 1029–1035.
WHO MONICA Project. MONICA Manual. Geneva: Cardiovascular Unit, World Health Organization, 1990.
Kannel WB, Abbott RD. Incidence and prognosis of unrecognized myocardial infarction. An update on the Framingham Study. N Eng J Med 1984; 311: 1144–1147.
Sigurdsson E, Thorgeirsson G, Sigvaldason H, et al. Unrecognized myocardial infarction: Epidemiology, clinical characteristics, and the prognostic role of angina pectoris. Ann Intern Med 1995; 122: 96–102.
Reunanen A, Suhonen O, Aromaa A, et al. Incidence of different manifestations of coronary heart disease in middle-aged Finnish men and women. Acta Med Scand 1985; 218: 19–26.
Mänttäri M, Romo M, Manninen V, et al. Reduction in Q wave myocardial infarctions with gemfibrozil in the Helsinki Heart Study. Am Heart J 1990; 119: 991–995.
Mähönen M, Miettinen H, Pyörälä K, et al. Hospital discharge register data in the assessment of trends in acute myocardial infarction. Ann Med 1995; 27: 547–554.
Fleiss JL. Statistical methods for rates and proportions. New York: John Wiley & Sons, 1973.
Google Scholar Copyright information
© Kluwer Academic Publishers 1997