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Introduction: The aim was to evaluate the practices of routine management of dyslipidemia performed by general practitioners in a large geographic area., Methodology: Patients were identified by three or more plasma cholesterol measurements registered in the electronic laboratory information system (LIS) covering the total geographic area, and the study population was characterised by information from general practitioners' records, and from a questionnaire sent to the patients. Further information on ischaemic heart disease (IHD) was obtained from the National Hospital register, and information on prescriptions on lipid lowering medications from the National Health Service., Participants: A sample of 1163 subjects, monitored by 134 different general practices., Results: One third of the patients monitored for dyslipidemia had IHD, and two thirds were monitored as part of primary intervention. Dietary counselling was reported by 76%, and 54% were treated with lipid-lowering medications. The treatment frequency was related to cardiovascular risk, increasing from 25% of those with the lowest risk to 72% of the patients with IHD. The treatment goal was not reached in 74% of the cases, but overall a 20% reduction in plasma cholesterol was achieved., Conclusion: Subjects monitored for dyslipidemia were relevantly monitored because of IHD or high risk of IHD, and initiated treatment of dyslipidemia was clearly related to the individual assessed risk of IHD. Only a minority reached the treatment goals (< 5 mmol/l), and the statin doses used were generally lower than the doses used in clinical trials.

Objective: To evaluate the safety of heparin neutralisation by protamine immediately after PCI., Design: Retrospective analysis of prospectively registered data., Setting: A Danish mono-centre study., Patients: All angina pectoris patients treated with PCI between January 1999 and December 2002. The cohort was divided into two groups. Group I (n=1.129 procedures) were patients admitted January 1999 to December 1999, and group II n=4.193 procedures) were admitted January 1, 2000 to December 31, 2002., Interventions: In group I, the femoral sheath was removed 4 hours after the PCI procedure. In group II, circulating heparin was neutralised by protamine sulphate, and the femoral sheath removed immediately after the procedure., Main Outcome Measures: Rates of puncture site complications, stent thrombosis, non-fatal myocardial infarction and death during admission., Results: The rates of stent thrombosis, non-fatal myocardial infarction and in-hospital mortality were similar in the two groups. The rate of puncture site complications were 4,7% in group 1 and 2,6% in group 2 (p<0,001)., Conclusions: Circulating heparin can be safely neutralised by protamine sulphate immediately after PCI.

Background: Electrical cardioversion of atrial fibrillation (AF) is associated with a thromboembolic risk, and this risk can be reduced by the use of antithrombotic therapy. International guidelines recommend an effective oral anticoagulant therapy (OAT) for at least 3 weeks before, and 4 weeks after cardioversion. We studied whether electrical cardioversion in it self causes changes in the level of activity in the haemostatic system during treatment with either low-molecular-weight heparin (LMWH)., Methods: Thirty-eight patients with AF were randomised consecutively to either LMWH administered subcutaneous in a fixed daily dose, or conventional OAT. Changes in the biochemical markers prothrombin fragment 1+2 (F1+2), D-Dimer, and soluble fibrin, all reflecting the activity in the haemostatic system, were assessed at baseline, before and after electrical cardioversion in patients treated with LMWH for 3 weeks prior to cardioversion. A follow up compared the time spent on anticoagulation prior to cardioversion, and eventual complications in the two group (LMWH vs. OAT)., Results and Conclusions: No significant differences between the levels of the biochemical markers measured before, and after cardioversion were seen, indicating that during anticoagulant therapy with LMWH, electrical cardioversion in itself, does not cause an increased activity in the haemostatic system. Also the level of F1+2 had declined significantly after cardioversion, when compared to baseline level in patients, whom had a normal sinus rhythm (NSR) re-established. This indicates that even in patients on a stable anticoagulant treatment, restoration of a NSR can cause a further decrease in thrombin generation. The median time spent on antithrombotic treatment prior to cardioversion, was significantly different between the LMWH (27 days) and the OAT group (138 days). Our study indicates that cardioversion in patients on LMWH does not cause a hypercoagulable state and that LMWH significantly shortens the time spent on anticoagulant therapy prior to cardioversion.

Objectives: This study aims to describe the use of routine screening for diabetic eye complications in a large population based cohort of type 2 diabetic patients in the County of Vejle, Denmark. Furthermore, it aims to identify characteristics of patients and general practitioners related to the frequency of eye examinations., Methods: The type 2 diabetic population alive and resident in the County of Vejle on 1st January 1997. Data concerning eye examinations were collected from public data files for the period of January 1993 to December 1997., Results: In a population of 4438 type 2 diabetic patients, 46% had had one annual eye examination in 1997 and 26% had not had a single eye examination within the last five years. Patient characteristics related to an eye examination included: treatment with insulin or oral hypoglycaemic agents, females and long duration of diabetes. The number of diabetic patients who had had an eye examination varied substantially between the general practices. The characteristics of general practitioners were not related to this variation., Conclusions: The results of this study indicate a great need for quality improvement of ophthalmologic service in diabetes care. To achieve this improvement, more focus should be given to cooperation between the general practitioners and the ophthalmologists.

Introduction: The aim was to develop a method for continuous monitoring of routine practice of screening and monitoring of dyslipidaemia, and to present the present status of cholesterol screening and monitoring in a large well-defined geographic area in Denmark., Methodology: Population based register survey, based on the electronic laboratory information system (LIS) as primary data source. All lipid measurements from both hospitals and primary health care, were included for a five-year period (1995.8.1.-2000.7.31.), and civil registration number was used to separate measurements from subjects living in an area comprising 248,475 adult inhabitants., Results: An increasing number of subjects was screened every year, and during the five-year period approximately 25% of the total population older than 16 years were screened for dyslipidaemia (61,102), and half the subjects between 60 and 69 years were screened. The proportion of measurements prescribed from general practice increased significantly from 62.2% to 66.8%. The fraction of laboratory request forms including LDL-cholesterol increased from 39.8% to 58.5%. The number of subjects monitored for dyslipidaemia, by three plasma cholesterol measurements during 1 1/2 years increased by 71%., Conclusions: The method adequately identified subjects monitored for dyslipidaemia, and provided important information on routine practice for screening and monitoring of dyslipidaemia.

Introduction: The aim of this study was to estimate the extension of oral anticoagulant therapy (OAT) in Denmark between 1997 and 1999., Material and Methods: 1) Data from persons who were registered at the Danish Medicines Agency with at least one prescription of a vitamin K-antagonist, and 2) persons registered in the Laboratory Information System, Aarhus County Hospital, Denmark, with three or more consecutive INR tests, with no more than four months between each test, and with at least one INR test > 1.9 were examined., Results: The prevalence of OAT increased from 663 patients per 100,000 inhabitants in 1997 to 784 patients in 1999 (method 1). The prevalence increased significantly from 1997 to 1998 and from 1998 to 1999 and had a mean increase of 73.1 patients per 100,000 inhabitants (95% CI: 61.3-84.8) and a mean increase of 52.8 patients per 100,000 inhabitants (95% CI: 44.3-61.2), respectively. The prevalence of OAT was highest within the Country of Copenhagen and lowest within the County of Ringkobing. The difference between these two counties in 1997 was 0.0024 (p < 0.0001; 95% CI: 0.0017-0.0031). Within the admission area of Aarhus County Hospital (method 2), the prevalence increased from 518 patients per 100,000 inhabitants in 1997 to 630 patients in 1999. There was no statistical difference in the prevalence identified by the two methods., Discussion: The study shows: 1) a significant increase in the prevalence throughout the study period, 2) a significant variation between the counties. A precise estimate of prevalence is identified by method 1. A more detailed survey is, however, provided by method 2. We recommend further investigations on the identified regional variation.

Objectives: To evaluate changes in plasma cholesterol following health screening and health discussions in general practice., Design: Randomised prospective population-based study conducted over a period of 5 years., Setting: Primary care, all general practitioners (GPs) in a well-defined area., Subjects: A random sample of inhabitants aged 30-49 years in January 1991, registered with a local GP was invited to participate. The participants (1507 persons, or 75.4% of the 2000 invited) were randomly allocated to two intervention groups and a control group., Main Outcome Measures: Plasma cholesterol, percentage of subjects with plasma cholesterol higher than 7 mmol/l., Results: After 5 years of intervention, plasma cholesterol in the whole population was significantly lower in the intervention groups compared to the control group. The decrease was most pronounced (0.5 mmol/l) in subjects at high cardiovascular risk. The percentage of high-risk individuals with a cholesterol level higher than 7 mmol/l was significantly lower in the intervention groups compared to the control group (9.8% vs 6.2%, p = 0.04), corresponding to a 37% reduction., Conclusions: The study shows that the health checks had a measurable impact on plasma cholesterol levels, the most pronounced effect is seen among individuals at high cardiovascular risk.