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Christian Madelaire,1,2 Thomas Gerds,3,4 Lars Køber,5 Finn Gustafsson,5 Charlotte Andersson,1,6 Søren Lund Kristensen,5 Jawad Haider Butt,1 Deewa Zahir Anjum,1 Ann Banke,2 Emil Loldrup Fosbøl,5 Gunnar Gislason,1,4 Christian Torp-Pedersen,7 Morten Schou1 1Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark; 2Department of Cardiology, Odense University Hospital, Odense, Denmark; 3Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; 4The Danish Heart Foundation, Copenhagen, Denmark; 5Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; 6Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University, Boston, MA, USA; 7Department of Clinical Research and Cardiology, Nordsjællands Hospital, Hillerød, DenmarkCorrespondence: Christian Madelaire, Email Christian.madelaire@rsyd.dkBackground: Heart failure (HF) is associated with increased risk of death and a hospitalization, but for patients initiating guideline directed medical therapy, it is unknown how high these risks are compared to the general population – and how this may vary depending on age and comorbidity.Methods: In this retrospective cohort study, we identified patients diagnosed with HF in the period 2011– 2017, surviving the initial 120 days after diagnosis. Patients who were on angiotensin converting enzyme inhibitor (ACEi)/ angiotensin receptor blocker (ARB) and beta-blocker were included and matched to 5 non-HF individuals from the background population each based on age and sex. We assessed the 5-year risk of all-cause death, HF and non-HF hospitalization according to sex and age and baseline comorbidity.Results: We included 35,367 patients with HF and 176,835 matched non-HF individuals. Patients with HF had a five-year excess risk (absolute risk difference) of death of 13% (31% [for HF] – 18% [for non-HF]), of HF hospitalization of 17% and of non-HF hospitalization of 24%. Excess risk of death increased with increasing age, whereas the relative risk decreased - for women in their twenties, the excess risk was 7%, risk ratio 7.2, while the excess risk was 18%, risk ratio 1.5 for women in their eighties. Having HF as a 60-year old man was associated with a five-year risk of death similar to a 75-year old man without HF. Further, HF was associated with an excess risk of non-HF hospitalization, ranging from 8% for patients > 85 years to 30% for patients < 30 years.Conclusion: Regardless of age, sex and comorbidity, HF was associated with excess risk of mortality and non-HF hospitalizations, but the relative risk ratio diminishes sharply with advancing age, which may influence allocation of resources for medical care across populations.Keywords: heart failure, excess risk, mortality, hospitalization

Mikkel Porsborg Andersen,1,2 Rikke Wiingreen,3 Talip E Eroglu,4,5 Helle Collatz Christensen,6 Laura Bech Polcwiartek,7,8 Stig Nikolaj Fasmer Blomberg,6,9 Kristian Kragholm,10,11 Christian Torp-Pedersen,1,12 Kathrine Kold Sørensen1 1Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark; 2The Prehospital Center, Region Zealand, Denmark; 3Department of Pediatrics, Nordsjællands Hospital, Hillerød, Denmark; 4Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark; 5Department of Experimental and Clinical Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; 6Copenhagen Emergency Medical Services, Copenhagen, Denmark; 7Department of Pediatrics, Randers Regional Hospital, Randers, Denmark; 8Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark; 9Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; 10Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; 11Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark; 12Department of Public Health, University of Copenhagen, Copenhagen, DenmarkCorrespondence: Mikkel Porsborg Andersen, Department of Cardiology, Nordsjællands Hospital, Dyrehavevej 29, Hillerød, 3400, Denmark, Tel +45 92 43 22 99, Email mikkel.porsborg.andersen@regionh.dkAim of the Database: The aim of the National Child Health Registry is to provide comprehensive insight into children’s health and growth on a national scale by continuously monitoring the health status of Danish children. Through this effort, the registry assists the health authorities in prioritizing preventive efforts to promote better child health outcomes.Study Population: The registry includes all Danish children, however, incomplete coverage persists.Main Variables: The National Child Health Registry contains information on exposure to secondhand smoking, breastfeeding duration, and anthropometric measurements through childhood. The information in the registry is divided into three datasets: Smoking, Breastfeeding, and Measurements. Beside specific information on the three topics, all datasets include information on CPR-number, date of birth, sex, municipality, and region of residence.Database Status: The National Child Health Registry was established in 2009 and contains health information on children from all Danish municipalities, collected through routinely performed health examinations conducted by general practitioners and health nurses.Conclusion: The National Child Health Register is an asset to epidemiological and health research with nationwide information on children’s health and growth in Denmark. Due to the unique Danish Civil Registration System, it is possible to link data from the National Child Health Register to information from several other national health and social registers which enables longitudinal unambiguous follow-up.Keywords: child health, children‘s database, register-based research, Danish register, epidemiology

Theo Walther Jensen,1– 3 Annette Kjær Ersbøll,3,4 Fredrik Folke,2,3,5 Mikkel Porsborg Andersen,6 Stig Nikolaj Blomberg,1– 3 Mathias Geldermann Holgersen,2,7 Lars Bredevang Andersen,1 Freddy Lippert,2,3 Christian Torp-Pedersen,6,8 Helle Collatz Christensen1,2,9 1Emergency Medical Services Region Zealand, Naestved, Denmark; 2Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; 3Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark; 4National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; 5Department of Cardiology, Herlev Gentofte University Hospital, Gentofte, Denmark; 6Department of Cardiology, Nordsjaellands Hospital, Hilleroed, Denmark; 7Paediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark; 8Aalborg University Hospital, Aalborg & Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; 9Danish Clinical Quality Program (RKKP), National Clinical Registries & Department of Clinical Medicine, Copenhagen, DenmarkCorrespondence: Theo Walther Jensen, Emergency Medical Services, Region Zealand and University of Copenhagen, Ringstedgade 61, 13. etage, Naestved, 4700, Denmark, Tel +45 51 21 10 06, Email theje@regionsjaelland.dkIntroduction: Annually, approximately 4% of the entire adult population of Denmark participate in certified basic life support (BLS) courses. It is still unknown whether increases in BLS course participation in a geographical area increase bystander cardiopulmonary resuscitation (CPR) or survival from out-of-hospital cardiac arrest (OHCA). The aim of the study was to examine the geographical association between BLS course participation, bystander CPR, and 30-day survival from OHCA.Methods: This nationwide register-based cohort study includes all OHCAs from the Danish Cardiac Arrest Register. Data concerning BLS course participation were supplied by the major Danish BLS course providers. A total of 704,234 individuals with BLS course certificates and 15,097 OHCA were included from the period 2016– 2019. Associations were examined using logistic regression and Bayesian conditional autoregressive analyses conducted at municipality level.Results: A 5% increase in BLS course certificates at municipality level was significantly associated with an increased likelihood of bystander CPR prior to ambulance arrival with an adjusted odds ratio (OR) of 1.34 (credible intervals: 1.02;1.76). The same trends were observed for OHCAs in out-of-office hours (4pm-08am) with a significant OR of 1.43 (credible intervals: 1.09;1.89). Local clusters with low rate of BLS course participation and bystander CPR were identified.Conclusion: This study found a positive effect of mass education in BLS on bystander CPR rates. Even a 5% increase in BLS course participation at municipal level significantly increased the likelihood of bystander CPR. The effect was even more profound in out-of-office hours with an increase in bystander CPR rate at OHCA.Keywords: basic life support, survival, geography, epidemiology, conditional autoregressive regression

Peter Ascanius Jacobsen,1,2 Kristian Kragholm,2,3 Christian Torp-Pedersen,4 Ulla Møller Weinreich1,2 1Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark; 2The Clinical Institute, Aalborg University, Aalborg, Denmark; 3Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; 4Department of Clinical Research, Hillerød Hospital, Hillerød, DenmarkCorrespondence: Peter Ascanius Jacobsen, Department of Respiratory Diseases, Aalborg University Hospital, Mølleparkvej 4, Aalborg, DK-9100, Denmark, Tel +4597664800, Email Mail:peter.jacobsen@rn.dkIntroduction: Many chronic obstructive pulmonary disease (COPD) patients below retirement age are outside the workforce. The existing knowledge about association between acute exacerbation of COPD (AECOPD) and disability retirement is limited.Aim: The aim of this study is to explore disability retirement in COPD patients 3 years following first-ever AECOPD.Methods: This retrospective registry-based follow-up cohort study design is based on nationwide Danish registry data. Patients admitted to the hospital for the first time between 1999 and 2017 with AECOPD and age between 35 and 59 years, active in the workforce, were included in the study. Socio-demographics, comorbidities and inhaled medication use were explored. COPD patients’ hazard ratio of disability retirement during 3-year follow-up was calculated. Cox regression was used to examine the effects of covariates on disability retirement.Results: A total of 4032 patients were included in the study. During follow-up, 17.2% (692/4032) experienced disability retirement from the workforce. Factors associated with disability retirement were expressed as hazard ratio (95% confidence intervals): Higher age (ref. age 46– 50: Age 51– 55, 1.42, (1.12– 1.81); age 56– 59, 1.37 (1.08– 1.74)); living alone (1.34 (1.14– 1.56)); number of comorbidities for 1, 2, and 3 comorbidities (1.36 (1.14– 1.62), 1.57 (1.19– 2.07), 1.77 (1.20– 2.60)); emphysema (2.01 (1.44– 2.79)); depression (1.60 (1.12– 2.28)); cardiac comorbidity (1.38 (1.07– 1.78)); triple inhalation therapy (2.76 (2.20– 3.47)); ICS + LAMA or ICS + LABA treatment (1.82 (1.48– 2.23)); and ICS treatment (1.49 (1.17– 1.90)). Higher educational level was associated with a significantly reduced risk of disability retirement, medium, short higher and long higher educational level, relative to low education level (0.78 (0.67– 0.91), 0.63 (0.48– 0.83) and 0.27 (0.12– 0.60)).Conclusion: Patients vulnerable to disability retirement are patients with markers of severe COPD, comorbidities, and social vulnerability.Keywords: chronic obstructive pulmonary disease, return to work, early retirement, comorbidities

Theo Walter Jensen,1,2 Stig Nikolaj Blomberg,1,2 Fredrik Folke,1– 3 Søren Mikkelsen,4,5 Martin Rostgaard-Knudsen,6 Palle Juelsgaard,7 Erika Frishknecht Christensen,6,8 Christian Torp-Pedersen,9,10 Freddy Lippert,1,2 Helle Collatz Christensen1,2,11,12 1Research, Copenhagen Emergency Medical Services, Copenhagen, Denmark; 2Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; 3Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark; 4Emergency Medical Services, The Region of Southern Denmark, Odense, Denmark; 5Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; 6Emergency Medical Services, North Region of Denmark, Aalborg, Denmark; 7Emergency Medical Services, Central Denmark Region, Viborg, Denmark; 8Center for Prehospital and Emergency Research, Aalborg University Hospital and Aalborg University, Aalborg, Denmark; 9Department of Cardiology and Clinical Investigation, Nordsjaellands Hospital, Hillerød, Denmark; 10Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; 11Emergency Medical Services, Naestved, Region Zealand, Denmark; 12Danish Clinical Quality Program (RKKP) &squf; National Clinical Registries, Copenhagen, DenmarkCorrespondence: Helle Collatz Christensen, Email helle.collatz.christensen.02@regionh.dkAim of the Database: The aim of the Danish Cardiac Arrest Registry is to monitor the quality of prehospital cardiac arrest treatment, evaluate initiatives regarding prehospital treatment of cardiac arrest, and facilitate research.Study Population: All patients with prehospital cardiac arrest in Denmark treated by the emergency medical services in whom resuscitation or defibrillation has been attempted.Main Variables: The Danish Cardiac Arrest Register records descriptive and qualitative variables as outlined in the “Utstein” template for reporting out-of-hospital-cardiac arrest. Main variables include whether the case was witnessed, whether the cardiac arrest was electrocardiographically monitored, the timing of cardiopulmonary resuscitation, and the timing of the first analysis of the cardiac rhythm. The outcome measures are the status of the patient at handover to the hospital, return of spontaneous circulation, and 30-day survival after event.Database Status: The Danish Cardiac Arrest Registry was established in June 2001, and all Danish emergency medical services are reporting to the database.Conclusion: The Danish Cardiac Arrest Registry is among the oldest Danish national clinical registries, with a high quality of clinical data and coverage. This registry provides the prerequisite for all research on out-of-hospital cardiac arrest research in Denmark and is essential for monitoring and improving the quality of care for patients suffering from out-of-hospital cardiac arrest.Keywords: cardiac arrest, OHCA, cardiopulmonary resuscitation, Denmark, quality, survival

Oda Jensen,1 Andreas Kiesbye Øvlisen,1,2 Lasse Hjort Jakobsen,1,2 Anne Stidsholt Roug,1,2 René Ernst Nielsen,2,3 Claus Werenberg Marcher,4 Lene Hyldahl Ebbesen,5 Kim Theilgaard-Mönch,6 Peter Møller,7 Claudia Schöllkopf,8 Christian Torp-Pedersen,9,10 Tarec Christoffer El-Galaly,1,2 Marianne Tang Severinsen1,2 1Department of Haematology, Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark; 2Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; 3Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark; 4Department of Haematology, Odense University Hospital, Odense, Denmark; 5Department of Haematology, Aarhus University Hospital, Aarhus, Denmark; 6Department of Haematology, Rigshospitalet, Copenhagen, Denmark; 7Department of Haematology, Roskilde Sygehus, Roskilde, Denmark; 8Department of Haematology, Herlev Hospital, Herlev, Denmark; 9Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark; 10Department of Cardiology, Nordsjællands Hospital, Hillerød, DenmarkCorrespondence: Marianne Tang Severinsen, Department of Haematology, Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark, Email m.severinsen@rn.dkIntroduction: The diagnosis of a life-threatening disease can lead to depression and anxiety resulting in pharmacological treatment. However, use of psychotropic drugs (antidepressants, anxiolytics, and antipsychotics) in acute myeloid leukaemia (AML) and myelodysplastic syndrome (MDS) is undetermined.Methods: Prescription of psychotropic drugs in Danish AML and MDS patients was compared to a cohort matched on age, sex, and country of origin from the Danish background population using national population-based registries.Results: In total, 2404 AML patients (median age 69 years) and 1307 MDS patients (median age 75 years) were included and each matched to five comparators from the background population. Two-year cumulative incidences showed that AML (20.6%) and MDS (21.2%) patients had a high risk of redemption of a psychotropic drug prescription compared to the background population (7.0% and 7.9%). High age, low educational level, and Charlson Comorbidity Index score ≥ 1 was associated with a higher risk in AML and MDS patients. Furthermore, non-curative treatment intent and performance status in AML patients, and high risk MDS were associated with elevated risk of psychotropic drug prescription.Conclusion: In conclusion, diagnoses of AML and MDS were associated with a higher rate of psychotropic drugs prescription compared to the background population.Keywords: acute myeloid leukaemia, myelodysplastic syndrome, depression, anxiety, psychotropic drugs

Peter Ascanius Jacobsen,1,2 Kristian Hay Kragholm,2,3 Christian Torp-Pedersen,4 Daisy JA Janssen,5,6 Martijn A Spruit,5,7,8 Ulla Møller Weinreich1,2 1Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark; 2The Clinical Institute, Aalborg University, Aalborg, Denmark; 3Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; 4Department of Clinical Research, Hillerød Hospital, Hillerød, Denmark; 5Department of Research and Development, Ciro, Horn, the Netherland; 6Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; 7Nutrim School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; 8Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the NetherlandsCorrespondence: Peter Ascanius JacobsenDepartment of Respiratory Diseases, Aalborg University Hospital, Aalborg, DenmarkTel +45 97 66 48 00Email peter.jacobsen@rn.dkIntroduction: The understanding of whether and to what extent employment status affects readmission and mortality is limited in patients with COPD.Aim: To explore how employment status affects readmission and mortality after first admission to the hospital with acute exacerbation of COPD (AECOPD).Methods: This study used Danish national registry-based data. All patients admitted for the first time to the hospital between 1999 and 2014 with a diagnosis of AECOPD, age 35– 59, without a previous asthma diagnosis were included in the study. Employment status effect on 30-, 90-, and 365-day readmission and mortality was examined using logistic regression, adjusting for relevant confounders.Results: A total of 11,850 COPD patients were included in the study of which 3563 (30%) were working, 1368 (12%) unemployed, 840 (7%) on sick leave, and 6079 (51%) receiving early retirement. Patients receiving early retirement had, compared to patients working, an adjusted increased likelihood of readmission at 30, 90, and 365 days (odds ratio (OR) 1.26 (CI95% (1.06– 1.49)), 1.33 (CI95% (1.16– 1.53)), and 1.48 (CI95% (1.33– 1.66)), respectively). An increased likelihood was also seen in unemployed at 365 days follow-up (OR 1.44 (CI95% (1.22– 1.68))). Early retirement was associated with an increased mortality at 30, 90, and 365 days (OR 1.39 (CI95% (1.07– 1.80)) 1.37 (CI95% (1.09– 1.79)) and 1.48 (CI95% (1.25– 1.75)), respectively). An increased likelihood was also seen in patients receiving sick leave (OR 1.57 (CI95% (1.21– 2.04))).Conclusion: Patients with COPD who are not working at the time of first admission have a higher likelihood of readmission and mortality.Keywords: chronic obstructive pulmonary disease, employment, mortality, readmission

Christian Madelaire,1 Finn Gustafsson,2,3 Lars Køber,2 Christian Torp-Pedersen,4,5 Charlotte Andersson,1,6 Søren Lund Kristensen,2 Gunnar Gislason,1,7 Morten Schou1 1Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark; 2Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; 3Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; 4Department of Cardiology and Clinical Research, Nordsjaellands Hospital, Hilleroed, Denmark; 5Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; 6Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston, MA, USA; 7Danish Heart Foundation, Copenhagen, DenmarkCorrespondence: Christian MadelaireDepartment of Cardiology, Copenhagen University Hospital Gentofte, Kildegårdsvej 28, Opgang 6, 3rd floor, Copenhagen, DenmarkTel +45 20 92 86 45Email cras0185@regionh.dkBackground: 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.Keywords: heart failure, reduced ejection fraction, register data, validation

Inger Lise Gade,1,2 Marianne Tang Severinsen,2,3 Kristian Hay Kragholm,4,5 Søren Risom Kristensen,1,3 Christian Torp-Pedersen,3,5,6 Signe Juul Riddersholm7 1Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark; 2Department of Hematology and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark; 3Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; 4Department of Cardiology, North Denmark Regional Hospital, Hjørring, Denmark; 5Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark; 6Department of Cardiology and Clinical Investigation, North Zealand Hospital, Hillerød, Denmark; 7Department of Medicine, Randers Regional Hospital, Randers, DenmarkCorrespondence: Inger Lise GadeDepartment of Hematology, Aalborg University Hospital, Mølleparkvej 4, Aalborg 9000, DenmarkTel +45 61656584Email inlg@rn.dkBackground: Venous thromboembolism (VTE) is a serious, yet preventable, complication in cancer. Some patients are diagnosed with a second cancer; however, little is known about the epidemiology of VTE in this population.Methods: From Danish national healthcare registries, we studied all patients diagnosed with a first breast, prostate, lung, or colorectal cancer from 1995 to 2015. We estimated incidence rates (IRs) of VTE according to the timing of the diagnosis of a second cancer. We controlled for confounder variables in Poisson regression models.Results: In total, 309,077 patients with a first breast, prostate, lung, or colorectal cancer were included in the study. A second cancer was diagnosed in 20,090 (6.5%) of these patients. In total, 11,908 VTEs were observed in the study period, 786 of these occurred after a diagnosis of second cancer. Second cancer types such as pancreas and stomach cancer were associated with fivefold higher IRs of VTE compared with second cancer types such as breast and prostate cancer. The IR of VTE was highest within the first 6 months after the second cancer was diagnosed (IR 40.5 per 1000 person-years, 95% CI 36.3– 42.2) with no differences based on how long since the first cancer it was diagnosed.Conclusion: The epidemiology of VTE after a second cancer is similar to the epidemiology of VTE after a first cancer with higher rates within the first months after aggressive second cancer types.Keywords: venous thromboembolism, second cancer, epidemiology, incidence, cancer

Rasmus Rørth,1 Emil L Fosbøl,1 Kristian Kragholm,2 Ulrik M Mogensen,1,3 Pardeep S Jhund,3 Mark C Petrie,3 Christian Torp-Pedersen,4 Gunnar H Gislason,5 John JV McMurray,3 Lars Køber,1 Søren L Kristensen1,3 1Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; 2Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Aalborg, Denmark; 3BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK; 4Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark; 5Department of Cardiology, Gentofte/Herlev University Hospital, Copenhagen, Denmark Background: Heart failure (HF) has a major impact on a patient’s quality of life and functional status. This impact may be sufficiently profound to prevent independent living although how often this is the case is unknown. We examined the need for domiciliary assistance and admission to a nursing home following first HF hospitalization. Methods: In nationwide Danish registries, we identified a cohort of patients discharged alive after a first-time HF hospitalization in the period 2008–2014 who were matched 1:5 with comparison subjects based on age and sex and followed for 5 years. Results: We included 37,547 patients (69% men) discharged after a first-time HF-hospitalization and 187,735 comparison subjects. The 5-year incidence of initiation of domiciliary care was 24.1% [23.7%–24.6%] among HF patients and 9.2% [9.1%–9.4%] among the comparison cohort and yielded a corresponding adjusted HR of 2.02 [1.96–2.09]. Covariates associated with initiation of domiciliary support included older age (HR 1.08 [1.07–1.08] per 1 year increase in age), living alone (HR 2.09 [2.04–2.15]) and comorbidities. The 5-year incidence of nursing home admission was 3.9% [3.7%–4.0%] among HF patients and 1.7% [1.7%–1.8%] among the comparison cohort and this resulted in an adjusted HR of 1.91 [1.77–2.06]. Covariates associated with nursing home admission included older age (HR 1.10 [1.10–1.11]), living alone (HR 2.15 [2.02–2.28]) and history of stroke (HR 2.71 [2.53–2.90]). Conclusion: Hospitalization for HF is associated with increased need for domiciliary support and nursing home admissions. Older age, living alone, and comorbidities were associated with higher risk of both outcomes. Keywords: domiciliary care, nursing home admission, heart failure, epidemiology

Anne Pernille Toft-Petersen,1,2 Christian Torp-Pedersen,1,3 Ulla Møller Weinreich,1,4 Bodil Steen Rasmussen1,2 1Department of Clinical Medicine, Aalborg University, 2Department of Anaesthesia and Intensive Care, 3Department of Clinical Epidemiology, 4Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark Abstract: Low concentrations of hemoglobin have previously been demonstrated in many patients with COPD. There is evidence of anemia as a prognostic factor in acute exacerbations, but the detailed relationship between concentrations of hemoglobin and mortality is not known. A register-based cohort of patients admitted for the first time to Danish hospitals for acute exacerbations of COPD from 2007 through 2012 was established. Age, sex, comorbidities, medication, renal function, and concentrations of hemoglobin were retrieved. Sex-specific survival analyses were fitted for different rounded concentrations of hemoglobin. The cohort encompassed 6,969 patients. Hemoglobin below 130 g/L was present in 39% of males and below 120 g/L in 24% of females. The in-hospital mortality rates for patients with hemoglobin below or above these limits were 11.6% and 5.4%, respectively. After discharge, compared to hemoglobin 130 g/L, the hazard ratio (HR) for males with hemoglobin 120 g/L was 1.45 (95% confidence interval [CI] 1.22–1.73), adjusted HR 1.37 (95% CI 1.15–1.64). Compared to hemoglobin 120 g/L, the HR for females with hemoglobin 110 g/L was 1.4 (95% CI 1.17–1.68), adjusted HR 1.28 (95% CI 1.06–1.53). In conclusion, low concentrations of hemoglobin are frequent in COPD patients with acute exacerbations, and predict long-term mortality. Keywords: pulmonary disease, chronic obstructive, anemia, mortality, polycythemia, epidemiology

Anne Pernille Toft-Petersen,1,2 Christian Torp-Pedersen,1,3 Ulla Møller Weinreich,1,4 Bodil Steen Rasmussen1,2 1Department of Clinical Medicine, Aalborg University, 2Department of Anaesthesia and Intensive Care, Aalborg University Hospital, 3Department of Health, Science and Technology, Aalborg University, Aalborg, 4Department of Respiratory Medicine, Aalborg University Hospital, Denmark Background: In general, previous studies have shown an association between prior exacerbations and mortality in COPD, but this association has not been demonstrated in the subpopulation of patients in need of assisted ventilation. We examined whether previous hospitalizations were independently associated with mortality among patients with COPD ventilated for the first time. Patients and methods: In the Danish National Patient Registry, we established a cohort of patients with COPD ventilated for the first time from 2003 to 2011 and previously medicated for obstructive airway diseases. We assessed the number of hospitalizations for COPD in the preceding year, age, sex, comorbidity, mode of ventilation, survival to discharge, and days to death beyond discharge. Results: The cohort consisted of 6,656 patients of whom 66% had not been hospitalized for COPD in the previous year, 18% once, 8% twice, and 9% thrice or more. In-hospital mortality was 45%, and of the patients alive at discharge, 11% died within a month and 39% within a year. In multivariate models, adjusted for age, sex, mode of ventilation, and comorbidity, odds ratios for in-hospital death were 1.26 (95% confidence interval [CI]: 1.11–1.44), 1.43 (95% CI: 1.19–1.72), and 1.56 (95% CI: 1.30–1.87) with one, two, and three or more hospitalizations, respectively. Hazard ratios for death after discharge from hospital were 1.32 (95% CI: 1.19–1.46), 1.76 (95% CI: 1.52–2.02), and 2.07 (95% CI: 1.80–2.38) with one, two, and three or more hospitalizations, respectively. Conclusion: Preceding hospitalizations for COPD are associated with in-hospital mortality and after discharge in the subpopulation of patients with COPD with acute exacerbation treated with assisted ventilation for the first time. Keywords: pulmonary disease, chronic obstructive, respiration, artificial, patient readmission, hospital mortality, critical care

It remains disputed how much the risk of Staphylococcus aureus bacteraemia (SAB) is increased in patients with rheumatoid arthritis (RA), and the extent to which orthopaedic implants explain the risk. We assessed SAB incidence rates (IRs) and incidence rate ratios (IRRs), comparing RA patients with a general population cohort (GPC) and individuals with versus without orthopaedic implants. Danish residents aged ≥ 18 years without prior RA or SAB (=GPC) were followed up for RA and microbiologically verified SAB events (1996–2017). IRRs were calculated by age- and sex-stratified Poisson regression adjusted for age, comorbidities, calendar year, and socioeconomic status. The GPC comprised 5 398 690 individuals. We identified 33 567 incident RA patients (=RA cohort) (median follow-up 7.3 years, IQR 3.6–12.3). We observed 25 023 SAB events (n = 224 in the RA cohort). IRs per 100 000 person-years were 81.0 (RA cohort) and 29.9 (GPC). IRs increased with age. Adjusted IRRs in 18–59-year-old RA patients were 2.6 (95% confidence interval 1.8–3.7) for women and 1.8 (1.1–3.1) for men, compared with same sex and age group GPC. IRRs declined with age. Compared with the GPC without implants, IRRs for RA patients with implants ranged from 1.9 (1.3–2.8) (women ≥ 70 years) to 5.3 (2.2–12.8) (18–59-year-old men). In this nationwide registry-based cohort study RA was a risk factor for SAB, and orthopaedic implants further increased the risk. Clinicians should be aware of potential SAB in patients with RA and orthopaedic implants. [ABSTRACT FROM AUTHOR]

Britt Falskov1, Thomas Steffen Hermann1, Christian Rask-Madsen2, Atheline Major-Pedersen1, Buris Christiansen1, Jakob Raunsø1, Lars Køber3, Christian Torp-Pedersen1, Helena Dominguez41Department of Cardiology, Gentofte Hospital, Denmark; 2Joslin Diabetes Center, Boston (MA), USA; 3Department of Cardiology, Rigshospitalet, Copenhagen, Denmark; 4Department of Cardiology, Herlev Hospital, Herlev, DenmarkAim: Chronic heart failure is associated with endothelial dysfunction and insulin resistance. The aim of this investigation was to study insulin-stimulated endothelial function and glucose uptake in skeletal muscles in patients with heart failure in comparison to patients with type 2 diabetes.Methods: Twenty-three patients with systolic heart failure and no history of diabetes, seven patients with both systolic heart failure and type 2 diabetes, 19 patients with type 2 diabetes, and ten healthy controls were included in the study. Endothelial function was studied by venous occlusion plethysmography. Insulin-stimulated endothelial function was assessed after intra-arterial infusion of insulin followed by co-infusion with serotonin in three different dosages. Forearm glucose uptake was measured during the insulin infusion.Results: Patients with systolic heart failure had impaired insulin-stimulated endothelial function. The percentage increase in blood flow during co-infusion with insulin and serotonin dose response study was 24.74% ± 6.16%, 23.50% ± 8.32%, and 22.29% ± 10.77% at the three doses respectively, compared to the healthy control group 45.96% ± 11.56%, 67.40% ± 18.11% and 84.57% ± 25.73% (P = 0.01). Insulin-stimulated endothelial function was similar in heart failure patients and patients with type 2 diabetes, while it was further deteriorated in patients suffering from both heart failure and diabetes with a percentage increase in blood flow of 19.15% ± 7.81%, -2.35% ± 11.76%, and 5.82% ± 17.70% at the three doses of serotonin, respectively. Forearm glucose uptake was impaired in patients with heart failure compared to healthy controls (P = 0.03) and tended to be further impaired by co-existence of diabetes (P = 0.08).Conclusion: Systolic heart failure and type 2 diabetes result in similar vascular insulin resistance and reduced muscular insulin-stimulated glucose uptake. The effects of systolic heart failure and type 2 diabetes appear to be additive.Keywords: insulin resistance, diabetes, heart failure, endothelial function

To investigate the incidence and prevalence of rheumatoid arthritis (RA) in the adult Danish population. In this nationwide register-based cohort study, patients with incident RA between 1998 and the end of 2018 were identified using Danish administrative registries. The age- and sex-standardized incidence rate (IR), incidence proportion (IP), lifetime risk (LR), and point prevalence (PP) of RA were calculated. RA was defined as a first-time RA diagnosis registered in the Danish National Patient Registry combined with a redeemed prescription of a conventional synthetic disease-modifying anti-rheumatic drug in the following year. In addition, three different case definitions of RA were explored. The overall age- and sex-standardized IR of RA from 1998 to 2018 was 35.5 [95% confidence interval (CI) 35.1–35.9] per 100 000 person-years while the IP was 35.2 (95% CI 34.8–35.5) per 100 000 individuals. The IR was two-fold higher for women than for men. The LR of RA ranged from 2.3% to 3.4% for women and from 1.1% to 1.5% for men, depending on the RA case definition used. The overall PP of RA was 0.6% (95% CI 0.5–0.6%) in 2018: 0.8% (95% CI 0.7–0.8%) for women and 0.3% (95% CI 0.3–0.4%) for men. The prevalence increased about 1.5-fold from 2000 to 2018. The IR and PP were approximately two-fold higher for women than for men. The prevalence of RA in Denmark increased significantly from 2000 to 2018. The RA case definition had more impact on the results than the choice of denominator. [ABSTRACT FROM AUTHOR]