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ImportanceBreast cancer–specific mortality is increased among women with intellectual disability (ID), and knowledge about participation in breast cancer screening in this group is needed.ObjectiveTo examine participation in the Danish national breast cancer screening program among women with ID compared with women without ID.Design, Setting, and ParticipantsThis dynamic population-based cohort study assessed participation in the Danish national breast cancer screening program initiated in 2007, targeting women aged 50 to 69 years with a screening interval of 2 years. In all, 6357 women with ID born between 1941 and 1967 and eligible for the screening program were identified in national registers. Women entered the study between January 1, 2007, and December 31, 2017. Subsequently, 273 women were excluded due to a history of carcinoma in situ or breast cancer, and 489 due to registration errors in registers. Each woman was individually age-matched with 10 women without ID (reference group). All women were followed up until March 31, 2021, or censoring (due to death, carcinoma in situ, or breast cancer). Data were analyzed from December 1, 2021, to June 31, 2022.ExposuresIntellectual disability was defined as being registered with an ID diagnosis or a diagnosis most likely leading to ID or residing at an institution for persons with ID.Main Outcomes and MeasuresParticipation in breast cancer screening (fully, partly, and never).ResultsA total of 5595 women with ID and 49 423 age-matched women in the reference group were included in the analysis. Of these, 2747 women with ID (49%) and 24 723 in the reference group (50%) were 50 years of age at study entry; for those older than 50 years, the median age was 51 years (IQR, 50-58 years) in both groups. In all, 1425 women with ID (25%) were fully screened according to guidelines for the Danish breast cancer screening program compared with 30 480 women in the reference group (62%). Women with ID had nearly 5 times higher odds of never being screened compared with the reference group (odds ratio, 4.90 [95% CI, 4.60-5.22]). In all, 2498 women with ID (45%) and 6573 in the reference group (13%) were never screened. The proportion of never-screened women increased with severity of ID, from 834 of 2287 (36%) among women with mild ID to 173 of 212 (82%) among women with profound ID.Conclusions and RelevanceThe findings of this cohort study suggest that women with ID are markedly less likely to participate in breast cancer screening compared with women without ID. These findings further suggest a need for tailored guidelines and approaches for breast cancer screening in this group of women.

BackgroundA paucity of resuscitation studies have examined sex differences in patient-reported outcomes upon hospital discharge. It remains unclear whether male and female patients differ in health outcomes in their immediate responses to trauma and treatment after resuscitation.ObjectivesThe aim of this study was to examine sex differences in patient-reported outcomes in the immediate recovery period after resuscitation.MethodsIn a national cross-sectional survey, patient-reported outcomes were measured by 5 instruments: symptoms of anxiety and depression (Hospital Anxiety and Depression Scale), illness perception (Brief Illness Perception Questionnaire [B-IPQ]), symptom burden (Edmonton Symptom Assessment Scale [ESAS]), quality of life (Heart Quality of Life Questionnaire), and perceived health status (12-Item Short Form Survey).ResultsOf 491 eligible survivors of cardiac arrest, 176 (80% male) participated. Compared with male, resuscitated female reported worse symptoms of anxiety (Hospital Anxiety and Depression Scale–Anxiety score ≥8) (43% vs 23%; P = .04), emotional responses (B-IPQ) (mean [SD], 4.9 [3.12] vs 3.7 [2.99]; P = .05), identity (B-IPQ) (mean [SD], 4.3 [3.10] vs 4.0 [2.85]; P = .04), fatigue (ESAS) (mean [SD], 5.26 [2.48] vs 3.92 [2.93]; P = .01), and depressive symptoms (ESAS) (mean [SD], 2.60 [2.68] vs 1.67 [2.19]; P = .05).ConclusionsBetween sexes, female survivors of cardiac arrest reported worse psychological distress and illness perception and higher symptom burden in the immediate recovery period after resuscitation. Attention should focus on early symptom screening at hospital discharge to identify those in need of targeted psychological support and rehabilitation. BackgroundA paucity of resuscitation studies have examined sex differences in patient-reported outcomes upon hospital discharge. It remains unclear whether male and female patients differ in health outcomes in their immediate responses to trauma and treatment after resuscitation.ObjectivesThe aim of this study was to examine sex differences in patient-reported outcomes in the immediate recovery period after resuscitation.MethodsIn a national cross-sectional survey, patient-reported outcomes were measured by 5 instruments: symptoms of anxiety and depression (Hospital Anxiety and Depression Scale), illness perception (Brief Illness Perception Questionnaire [B-IPQ]), symptom burden (Edmonton Symptom Assessment Scale [ESAS]), quality of life (Heart Quality of Life Questionnaire), and perceived health status (12-Item Short Form Survey).ResultsOf 491 eligible survivors of cardiac arrest, 176 (80% male) participated. Compared with male, resuscitated female reported worse symptoms of anxiety (Hospital Anxiety and Depression Scale–Anxiety score ≥8) (43% vs 23%; P = .04), emotional responses (B-IPQ) (mean [SD], 4.9 [3.12] vs 3.7 [2.99]; P = .05), identity (B-IPQ) (mean [SD], 4.3 [3.10] vs 4.0 [2.85]; P = .04), fatigue (ESAS) (mean [SD], 5.26 [2.48] vs 3.92 [2.93]; P = .01), and depressive symptoms (ESAS) (mean [SD], 2.60 [2.68] vs 1.67 [2.19]; P = .05).ConclusionsBetween sexes, female survivors of cardiac arrest reported worse psychological distress and illness perception and higher symptom burden in the immediate recovery period after resuscitation. Attention should focus on early symptom screening at hospital discharge to identify those in need of targeted psychological support and rehabilitation.

BACKGROUND: The healthy donor effect (HDE) is a selection bias caused by the health criteria blood donors must meet. It obscures investigations of beneficial/adverse health effects of blood donation and complicates the generalizability of findings from blood donor cohorts. To further characterize the HDE we investigated how self-reported health and lifestyle are associated with becoming a blood donor, lapsing, and donation intensity. Furthermore, we examined differences in mortality based on donor status.STUDY DESIGN AND METHODS: The Danish National Health Survey was linked to the Scandinavian Donations and Transfusions (SCANDAT) database and Danish register data. Logistic- and normal regression was used to compare baseline characteristics and participation. Poisson regression was used to investigate future donation choices. Donation intensity was explored by the Anderson-Gill model and Poisson regression. Mortality was investigated using Poisson regression.RESULTS: Blood donors were more likely to participate in the surveys, OR = 2.45 95% confidence interval (2.40-2.49) than non-donors. Among survey participants, better self-reported health and healthier lifestyle were associated with being or becoming a blood donor, donor retention, and to some extent donation intensity, for example, current smoking conveyed lower likelihood of becoming a donor, OR = 0.70 (0.66-0.75). We observed lower mortality for donors and survey participants, respectively, compared with non-participating non-donors.CONCLUSION: We provide evidence that blood donation is associated with increased likelihood to participate in health surveys, possibly a manifestation of the HDE. Furthermore, becoming a blood donor, donor retention, and donation intensity was associated with better self-reported health and healthier lifestyles.

BACKGROUND: Because of high readmission rates for patients treated with ablation for atrial fibrillation (AF), there is great value in nurses knowing which risk factors make the largest contribution to readmission.OBJECTIVE: The aims of this study were to (1) describe potential risk factors at discharge and (2) describe the associations of risk factors with readmission from 60 days to 1 year after discharge.METHODS: Data from a national cross-sectional survey exploring patient-reported outcomes were used in conjunction with data from national health registers. This study included patients who had an ablation for AF during a single calendar year. The Hospital Anxiety and Depression Scale and questions on risk factors were included. Sociodemographic and clinical data were collected through registers, and readmissions were examined at 1 year.RESULTS: In total, 929 of 1320 (response rate, 70%) eligible patients treated with ablation for AF completed the survey. One year after ablation, there were 333 (36%) acute readmissions for AF and 401 (43%) planned readmissions for AF. Readmissions were associated with ischemic heart disease, anxiety, and depression.CONCLUSION: High observed readmission rates were associated with risk factors that included anxiety and depression. Postablation care should address these risk factors.

BACKGROUND: Mental distress is reported internationally among patients with cardiac disease. A Danish survey found that 25% of patients with cardiac disease experienced symptoms indicating anxiety and that anxiety was associated with an increased risk of death.AIM: The aims of this study were to (1) compare cause of death patterns among deceased cardiac patients with anxiety to those without anxiety and (2) examine the association between anxiety symptoms and specific causes of death.METHODS: We used data from the DenHeart survey to evaluate symptoms of anxiety at discharge by using the Hospital Anxiety and Depression Scale. Data on mortality in the 3 years after discharge and cause of death according to International Classification of Diseases-10 classification came from national registers. Cause of death was compared between patients with and without anxiety using χ2 tests. The association between symptoms of anxiety and cause of death was investigated using logistic regression.RESULTS: Of 12 913 patients included, a total of 1030 (8%) died within 3 years. After 1 year, 4% of patients with anxiety symptoms had died versus 2% of patients without; after 3 years, the proportions were 9% versus 8%, respectively. Almost all died of natural causes irrespective of anxiety symptoms. No statistically significant differences were found regarding the cause of death between patients with and without anxiety.CONCLUSION: Despite higher mortality rates in patients with cardiac disease with anxiety symptoms, the pattern of cause of death was identical for patients with cardiac disease with and without anxiety symptoms. It seems that an acceleration of morbid processes leading to mortality is more likely than a difference in cause of death. However, further research is needed to better understand the behavioral and pathophysiological processes that cause the higher mortality seen among patients reporting symptoms of anxiety.

PURPOSE: In patients with ischemic heart disease, the objectives were (1) to explore associations between patient-reported outcomes, sociodemographic, and clinical factors at discharge and 1-year all-cause mortality and (2) to investigate the discriminant predictive performance of the applied patient-reported outcome instruments on 1-year all-cause mortality.METHODS: Data from the Danish national DenHeart cohort study were used. Eligible patients (n = 13,476) were invited to complete a questionnaire-package, of which 7167 (53%) responded. Questionnaires included the 12-item Short form health survey (SF-12), Hospital anxiety and depression scale (HADS), EQ-5D, HeartQoL, Edmonton symptom assessment scale (ESAS), and ancillary questions on, e.g., social support. Clinical and demographic characteristics were obtained from registers, as were data on mortality. Comparative analyses were used to investigate differences in patient-reported outcomes. Mortality associations were explored using multifactorially adjusted Cox regression analyses. Predictive performance was analyzed using receiver operating characteristics (ROC).RESULTS: Patient-reported outcomes at discharge differed among those alive versus those deceased at one year, e.g., depression (HADS-Depression ≥ 8) 19% vs. 44% (p CONCLUSION: Patient-reported health, sociodemographic, and clinical factors are associated with 1-year mortality. We propose systematic screening with robust predictive tools to identify patients at risk and healthcare initiatives to explore and offer effective treatment to modify patient-reported health indicators.

Aims Comorbid psychiatric disorders and the use of psychotropic medication are common among cardiac patients and have been found to increase the risk of mortality. The aims of this study were: (i) to describe the use of psychotropic medication among cardiac patients with and without symptoms of anxiety, (ii) to estimate the association between use of psychotropic medication prior to hospital admission and all-cause, 1-year mortality following discharge, and (iii) to estimate the risk of mortality among users and non-users of psychotropic medication with or without self-reported symptoms of anxiety. Methods and results Cardiac patients from the DenHeart survey were included, providing information on self-reported symptoms of anxiety. From national registers, information on the use of psychotropic medication 6 months prior to hospitalization and mortality was obtained. By logistic regression analyses, the association between the use of psychotropic medication, anxiety, and all-cause, 1-year mortality was estimated. The risk of subsequent incident use of psychotropic medication among patients with and without anxiety was furthermore explored. All analyses were fully adjusted. A total of 12 913 patients were included, of whom 18% used psychotropic medication, and 3% died within 1 year. The use of psychotropic medication was found to be associated with increased 1-year all-cause mortality [odds ratio 1.90 (95% confidence interval, 1.46–2.46)]. Patients with symptoms of anxiety were significantly more likely to use psychotropic medication following hospital discharge [2.47 (2.25–2.72)]. Conclusion The use of psychotropic medication was associated with 1-year mortality. Thus, the use of psychotropic medication might explain some of the association between anxiety and mortality; however, the association is probably mainly a reflection of the underlying mental illness, rather than the use of psychotropic medication.

A growing number of older men are living alone. They are often referred to as an at-risk group in health-care systems. The purpose of this article is to establish an overview of these men's health and health-care utilisation. We do so by drawing on three sources: an online survey with health-care professionals, data from a national self-report health study and register-based data on health-care utilisation. The results show that older men living alone generally have lower health scores than older men co-habiting and that, among older men living alone, lower educational level is associated with lower health scores but also a greater use of free-of-charge health-care services. Health-care professionals conducting preventive home visits consider older men's social needs the most pronounced problem for the men's wellbeing and call for new services to be custom made for them. In this article, we discuss differences between older men living in rural and urban areas and between those who are single, divorced or widowed. We conclude that health and social care systems must differentiate between sub-groups of older men living alone when developing new services and that free-of-charge services, such as general practitioners and home care, should be considered as vehicles for addressing health inequities.

Background: The consequences of poor mental health on morbidity and mortality are well established. However, studies prospectively examining the consequences on social life events are lacking. This study prospectively examines the risk of various social life events (educational attainment, employment status, marital status and parenthood) defined in administrative registers by mental health status at baseline defined by the MCS-12 in the Danish adult population. Methods: The analysis is based on data from the Danish National Health Survey 2010. A total of 177,639 individuals completed the questionnaire (59.5% of the sample). MCS-12 was used to categorise participants according to mental health status (poor, moderate and good). Survey data were linked to administrative registers at the individual level and followed for a minimum of 4 years. Cox proportional hazards models were used to prospectively examine the risk of various social life events according to mental health status at baseline. Results: Individuals with poor mental health and, to a certain degree, individuals with moderate mental health were less likely to experience positive life events such as progression in educational level, getting married, being employed and becoming a parent and were more likely to experience negative life events such as becoming unemployed and divorced/widowed. Conclusions: Mental health status is associated with educational attainment, employment status, marital status and parenthood. These results add to a growing body of evidence indicating that poor mental health is associated with substantial societal-level impairments that should be taken into consideration when making decisions regarding allocation of treatment and research resources.

Mortality disparities among persons with intellectual disability are important to guide health-care practices. The objective was to evaluate mortality patterns of persons with intellectual disability in a nationwide study from 1976 to 2020. This study establishes a Danish nationwide cohort of persons with intellectual disability and age- and sex-matched reference cohort through linkage between several registers. We established a cohort of 79,114 persons with intellectual disability. Standardized mortality ratios were increased for persons with intellectual disability, most pronounced among younger persons and among females. Life expectancies were markedly lower; among persons with intellectual disability 63.6 years among females and 59.8 years among males in 2016-2020 compared to 82.4 and 78.7 years among females and males in the reference cohort. Life expectancies decreased with severity of intellectual disability. This study reports the establishment of a nationwide Danish cohort of persons with intellectual disability.

Aims Due to an ageing population and increasing survival from concurrent diseases, the burden of left-sided degenerative valvular heart disease is expected to increase over time. This study aims at determining the temporal trends in incidence rates at the population level and examines whether there are socioeconomic differences. Methods and results A total of 133 209 patients were identified with a first-time diagnosis of aortic stenosis (AS), mitral regurgitation (MR), or aortic regurgitation (AR) in the Danish National Patient Registry in the 2000–17 period. Incidence rates (per 100 000 person-years) doubled over the period for AS (57 in 2000–02; 114 in 2015–17) and for AR (22 in 2000–02; 41 in 2015–17) and remained the same for MR (38 in both 2000–02 and 2015–17). Incidence rates increased rapidly with increasing age, most markedly for AS. Men had a higher risk of being affected [relative risk (RR) 1.69 for AS, 1.19 for MR, 1.35 for AR]. Compared to high-level education, patients with medium- and low-level education had a higher risk of being affected (RR 1.18 for AS medium level and 1.47 for AS low level; 1.03 for MR medium level and 1.14 for MR low level; 1.03 for AR medium level and 1.18 for AR low level). Conclusions For AS and AR, the incidence rates doubled, while the incidence rates remained at the same level for MR. The risk of being affected increased with advanced age and male gender. Patients with low-level education had a higher risk of being affected compared to patients with high-level education, especially among patients with AS.

Aims Readiness for hospital discharge describes a patient’s perception of feeling prepared to leave the hospital. In mixed patient populations, readiness for hospital discharge has shown to predict readmission and mortality in the short term. The objectives of a population of men and women with cardiac diseases, were to investigate: (i) whether readiness for hospital discharge predicts readmission and mortality within 1-year post-discharge, as well as (ii) the association between ‘physical stability’, ‘adequate support’, ‘psychological ability’, and ‘adequate information and knowledge’ and readiness for hospital discharge. Methods and results Data from the national cross-sectional survey DenHeart were used and included patients with cardiac diseases at hospital discharge. Readiness for hospital discharge was evaluated by one self-reported question, and attributes were illuminated by Short-Form-12, the Edmonton Symptom Assessment Scale and ancillary questions. Data were combined with national registries at baseline and at 1-year follow-up. Cox proportional-hazards model were used to regress readmission and mortality. The analysis included 13 114 patients (response rate: 52%). The majority responded that they felt ready for hospital discharge (95%). Feeling unready (n = 618) was a predictor of 1 year, all-cause readmission among women and men [hazard ratio (HR) = 1.43, 95% confidence interval (CI) 1.18–1.74; HR = 1.59, 95% CI 1.34–1.90]. No significant results were found on all-cause mortality. The four attributes were associated with unreadiness at hospital discharge. Conclusion Not feeling ready for hospital discharge was a predictor of increased readmission risk in women and men with cardiac disease during 1 year after hospital discharge. Four attributes were significantly impaired in patients feeling unready for hospital discharge.

AIMS: This study aims at determining the temporal trends and the socioeconomic differences in treatment and mortality following a diagnosis of aortic stenosis.METHODS AND RESULTS: A total of 45,026 patients with a first-time diagnosis of aortic stenosis were identified in the Danish National Patient Registry in the period 2000-17. The risk of AVR within the first year after diagnosis decreased (OR = 1.84 in 2000-02 compared to 2015-16) and the risk was lower in the low-level educational group (OR = 0.85) and in the medium-level group (OR = 0.94) compared to high-level education. The risk of death after AVR within the first year decreased (OR = 2.25 in 2000-02 compared to 2015-16) and the risk was higher in the low-level educational group (OR = 1.32) and in the medium-level group (OR = 1.28) compared to high-level education. The risk of death within the first year after diagnosis, for those patients who did not get an AVR during the follow-up, decreased (OR = 3.08 in 2000-02 compared to 2015-16) and the risk was higher in the low-level educational group (OR = 1.21) and in the medium-level group (OR = 1.10) compared to high-level education.CONCLUSION: Since 2000 there has been a decrease in both AVR treatment rate, mortality rate after AVR and mortality rate in patients not receiving AVR. For patients with lower-level education there is lower AVR treatment rate, higher mortality rate after AVR and higher mortality rate in patients not receiving AVR.

In patients with ischemic heart disease, the objectives were (1) to explore associations between patient-reported outcomes, sociodemographic, and clinical factors at discharge and 1-year all-cause mortality and (2) to investigate the discriminant predictive performance of the applied patient-reported outcome instruments on 1-year all-cause mortality.Data from the Danish national DenHeart cohort study were used. Eligible patients (n = 13,476) were invited to complete a questionnaire-package, of which 7167 (53%) responded. Questionnaires included the 12-item Short form health survey (SF-12), Hospital anxiety and depression scale (HADS), EQ-5D, HeartQoL, Edmonton symptom assessment scale (ESAS), and ancillary questions on, e.g., social support. Clinical and demographic characteristics were obtained from registers, as were data on mortality. Comparative analyses were used to investigate differences in patient-reported outcomes. Mortality associations were explored using multifactorially adjusted Cox regression analyses. Predictive performance was analyzed using receiver operating characteristics (ROC).Patient-reported outcomes at discharge differed among those alive versus those deceased at one year, e.g., depression (HADS-Depression ≥ 8) 19% vs. 44% (p 0.001). Associations with 1-year mortality included feeling unsafe about returning home from the hospital; hazard ratio (HR) 2.07 (95% CI 1.2-3.61); high comorbidity level, HR 3.6 (95% CI 2.7-4.8); and being unmarried, HR 1.60 (95% CI 1.33-1.93). Best predictive performance was observed for SF-12 physical component summary (Area under the curve (AUC) 0.706).Patient-reported health, sociodemographic, and clinical factors are associated with 1-year mortality. We propose systematic screening with robust predictive tools to identify patients at risk and healthcare initiatives to explore and offer effective treatment to modify patient-reported health indicators.

Mental distress is reported internationally among patients with cardiac disease. A Danish survey found that 25% of patients with cardiac disease experienced symptoms indicating anxiety and that anxiety was associated with an increased risk of death.The aims of this study were to (1) compare cause of death patterns among deceased cardiac patients with anxiety to those without anxiety and (2) examine the association between anxiety symptoms and specific causes of death.We used data from the DenHeart survey to evaluate symptoms of anxiety at discharge by using the Hospital Anxiety and Depression Scale. Data on mortality in the 3 years after discharge and cause of death according to International Classification of Diseases-10 classification came from national registers. Cause of death was compared between patients with and without anxiety using χ2 tests. The association between symptoms of anxiety and cause of death was investigated using logistic regression.Of 12 913 patients included, a total of 1030 (8%) died within 3 years. After 1 year, 4% of patients with anxiety symptoms had died versus 2% of patients without; after 3 years, the proportions were 9% versus 8%, respectively. Almost all died of natural causes irrespective of anxiety symptoms. No statistically significant differences were found regarding the cause of death between patients with and without anxiety.Despite higher mortality rates in patients with cardiac disease with anxiety symptoms, the pattern of cause of death was identical for patients with cardiac disease with and without anxiety symptoms. It seems that an acceleration of morbid processes leading to mortality is more likely than a difference in cause of death. However, further research is needed to better understand the behavioral and pathophysiological processes that cause the higher mortality seen among patients reporting symptoms of anxiety.

BACKGROUND: A growing population is living with ischemic heart disease (IHD). Patient-reported outcomes (PROs) are reliable prognostic tools. Studies exploring PROs are needed to identify vulnerable patients and guide targeted healthcare strategies.OBJECTIVES: The aims of this study were to (i) describe PROs at hospital discharge across 3 diagnostic subgroups: (1) chronic IHD/stable angina, (2) non-ST-elevation myocardial infarction (non-STEMI)/unstable angina, and (3) ST-elevation myocardial infarction (STEMI), and (ii) examine determinants for PROs at hospital discharge in patients with IHD.METHODS: This study included a national cohort with register-data linkage including 14 115 adults with IHD discharged from Danish heart centers. Eligible patients (n = 13 476) were invited to complete a questionnaire, and 7 167 (53%) responded. Questionnaires included the Medical Outcome Study Short-Form 12, the Hospital Anxiety and Depression Scale, EuroQoL, HeartQoL, the Edmonton Symptom Assessment Scale, and ancillary questions. Sociodemographic and clinical characteristics were obtained from national registers. Student t test, χ test, and adjusted linear and logistic regression analyses were conducted to investigate subgroup differences, and adjusted linear and logistic regression analyses were conducted to explore determinants for PROs.RESULTS: Statistically significant subgroup differences were found, with groups reporting worst to best scores for most of PROs being as follows: chronic IHD/stable angina, non-STEMI/unstable angina, and STEMI. Symptoms of anxiety were highly prevalent in the non-STEMI/unstable angina group, with 33.8% exceeding a Hospital Anxiety and Depression Scale-Anxiety cutoff score indicating a possible anxiety disorder. Determinants for worse PROs included female sex, lower educational level, obesity, and poor physical fitness.CONCLUSIONS: Significant differences in PROs across IHD subgroups were observed and determinants for poor outcomes suggested. Results may guide differentiated care initiatives and resource allocation for preventative strategies.

Aims Increased prevalence and survival among patients with heart failure draws attention to their everyday life, including their ability to work. Many patients with heart failure withdraw from the workforce, which can affect their quality of life. The aim was to investigate patient-reported outcomes (PROs) and clinical and demographic variables as predictors of withdrawal from the workforce after admission with a diagnose of heart failure. Methods and results Patients with heart failure, who were part of the workforce at admission were included from the national cross-sectional survey, DenHeart. Data were collected from five national heart centres in Denmark, from April 2013 to April 2014. Patient-reported outcomes measured at discharge included SF-12, HeartQoL, HADS, and ESAS. Clinical and demographic variables were obtained from registers, medical records, and index hospitalization. Patient-reported outcomes, clinical, and demographic variables were combined with labour market affiliation 3, 6, 9, and 12 months after admission. The response rate was 49.1% (n = 1517) and of those 364 patients were part of the workforce at index admission. Patients with lower QoL odds ratio (OR) 2.58 [95% confidence interval (CI) 1.24–5.37], symptoms of depression OR 2.57 (95% CI 1.47–4.50) and ejection fraction (EF) ≤35% OR 2.48 (95% CI 1.35–4.56) were more likely to withdraw from the workforce in the first year after admission. Patients with lower symptom burden OR 0.36 (95% CI 0.19–0.68) and a hospital stay of 0–2 days OR 0.18(95% CI 0.08–0.37) were less likely to withdraw. Conclusion Low QoL, high symptom burden, symptoms of depression, a longer length of hospital stay, and low EF can predict withdrawal from the workforce in the first year after admission with heart failure.

Background Anxiety among cardiac patients is highly prevalent and is associated to poor outcomes. Certain types of psychotropic medication are suspected of causing adverse events in cardiac patients. However, an association between symptoms of anxiety and use of psychotropic medication among cardiac patients has not yet been established. Purpose The objective was to explore the association between anxiety (measured by HADS-A) and use of psychotropic medication among cardiac patients. Methods All study participant were identified from the DenHeart study and data were a combination of patient-reported survey data and baseline and follow-up data from Danish national registers. Information on redeemed prescriptions of psychotropic medication was obtained from The Danish National Prescription Registry. Anxiety symptoms were defined by a HADS-A score≥8. Patients were defined as users of psychotropic medication if they had redeemed at least one prescription one and three years after discharge. Psychotropic medication was classified by Anatomical Therapeutic Chemical Classification (ATC) codes. Multiple logistic regression analysis within one year and Cox regression analysis within three year from discharge was conducted to determine the association between symptoms of anxiety and use of psychotropic medication. Results Among the 12,913 cardiac patients included, a total of 3231 (28%) redeemed at least one prescription of psychotropic medication within one year and 4726 (37%) within three years after discharge. The most commonly used drugs were benzodiazepines and antidepressants. Among patients using psychotropic medication 1481 (46%) had a HADS-A score ≥8. Cardiac patients with symptoms of anxiety had significantly higher odds of using psychotropic medication within one year from discharge OR 2.47 (95% CI 2.25; 2.72). The increased risk of use of psychotropic medication was confirmed with a almost two-fold risk after three years, HR 1.92 (95% CI 1.80; 2.04), Table 1. Conclusion Cardiac patients with symptoms of anxiety measured by HADS were significantly more likely to use psychotropic medication within one and three years after discharge than cardiac patients without symptoms of anxiety. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Novo Nordisk Foundation

Aims: This study aimed to explore whether educational level is associated with mental and physical health status, anxiety and depression symptoms and quality of life at hospital discharge and predicts cardiac events and all-cause mortality 1 year after hospital discharge in patients with ischaemic heart disease, arrhythmias, heart failure or heart valve disease. Methods: The DenHeart survey is cross-sectional and combined with data from national registers. Information on educational level and co-morbidity at hospital discharge and cardiac events and mortality 1-year post-discharge was obtained from registers. Patient-reported outcomes included SF-12, Hospital Anxiety and Depression Scale and HeartQoL. Multivariate linear and logistic regression and Cox proportional hazards regression models were used. Results: A total of 13,145 patients were included. A significant educational gradient was found in patient-reported mental and physical health status, anxiety and depression symptoms and quality of life, with lower educational groups reporting worse outcomes in adjusted analyses. No association was found between educational level and risk of cardiac events or all-cause mortality within 1 year after hospital discharge in adjusted analyses. Conclusions: In a large population of patients with cardiac disease a significant educational gradient was found in mental and physical health and quality of life at hospital discharge. There was, however, no association between educational level and risk of cardiac events or mortality 1 year after hospital discharge.

Previous studies have clarified that many patients with Philadelphia-negative myeloproliferative neoplasms (MPNs) have burdensome symptom profiles and accordingly impaired functioning and quality of life (QoL). In Denmark, all MPN patients are affiliated with public hospitals and because of a healthcare system financed by taxpayers these patients do not have any financial costs related to the hematological disease. Diagnoses are recorded for all patients in hospitals, and diagnosis codes are communicated to the National Patient Register (NPR). Owing to this, it was possible to contribute to the elucidation of Philadelphia-negative MPN patients&rsquo, health-related quality of life (HRQoL), by conducting a nationwide, population-based, cross-sectional HRQoL survey of these patients with cost-free access to the best available, suitable medical treatment. The survey contained validated questionnaires covering functioning, symptom burden, symptom profile, QoL, and additional questions on lifestyle. Information on comorbid diagnoses was obtained from the NPR. The participants&rsquo, HRQoL was compared to the general population. Moreover, differences in HRQoL across essential thrombocythemia, polycythemia vera, myelofibrosis, and unclassifiable MPN participants were investigated, adjusted for age, sex, comorbidity, and lifestyle. To the best of our knowledge this is the first survey of HRQoL in patients with unclassifiable MPN. A total of 2228 Philadelphia-negative MPN patients participated. The participants reported their HRQoL to be inferior to the general population, but the difference was minor. The differences in HRQoL across groups of participants with different MPN subtypes were subtle. Fatigue and sexual problems were prevalent and burdensome. Overall, participants reported a slightly healthier lifestyle compared to the general population.

Background: Patient participation in treatment and care is often encouraged and is desirable because of its proven positive impact on treatment, quality of care and patient safety. Aims: To develop an instrument to measure patient participation in health care and to investigate the measurement properties of the Patient Participation Questionnaire (PPQ). Methods: A literature review was conducted to develop a model of patient participation. The PPQ was constructed consisting of 17 items organized into four subscales. Psychometric evaluation of factor structure, convergent construct validity by hypothesis testing and analyses of internal consistency using Cronbach’s alpha were performed on data from a hospitalised mixed group of patients with cardiac disease, pulmonary disease and cancer ( N=378 patients). Results: Confirmatory factor analysis did not show a clear model fit, which is why an exploratory factor analysis was performed, suggesting a different four subscale structure consisting of a total of 16 items. The four subscales were labelled Shared decision power, Adapted and individualized knowledge, Collaboration and Human approach. There were strong ceiling effects on all items. Analysis of convergent construct validity showed a moderate correlation (0.59) between the PPQ and another instrument measuring patient participation. Internal consistency for the total PPQ score was high: 0.89. Conclusion: In a mixed group of patients with cardiac disease, pulmonary disease and cancer, the PPQ showed promising psychometric properties in terms of factor structure, convergent construct validity and internal consistency. The PPQ may be used to shed light on the experience of patient participation and guide quality improvements.

Background Though survival has improved markedly in ischemic heart disease (IHD), it remains a leading cause of death worldwide. Screening tools to identify patients at risk are ever in demand. Large-scale studies exploring the association between patients' self-reported mental and physical health and mortality are lacking. Purpose (i) to describe patient-reported outcomes (PROs) at discharge in IHD patients deceased and alive at one year, (ii) to investigate the discriminant predictive performance of PRO instruments on mortality, (iii) to investigate differences in time to death among survey responders/non-responders and among three diagnostic sub-groups (chronic ischemic heart disease/stable angina, non-STEMI/unstable angina and STEMI), and (iv) to investigate predictors of one-year mortality among sociodemographic, clinical and self-reported factors. Methods Data from the national DenHeart survey with register-data linkage was used. A total of 14,115 adults with IHD were discharged during one year. Eligible (n=13,476) were invited to complete a questionnaire and 7,167 (53%) responded. Questionnaires included the Health survey short form 12-items (SF-12), Hospital Anxiety and Depression Scale (HADS), EuroQoL-5-dimensions (EQ-5D), HeartQoL, Edmonton Symptom Assessment Scale (ESAS) and ancillary questions. Clinical and demographic characteristics were obtained from registries as were data on one-year mortality. Comparative analyses investigated differences in PROs, and discriminant PRO-performance was explored by Receiver Operating Characteristics (ROC) curves. Kaplan-Meier survival analysis explored differences in time to death across sub-groups. Predictors of mortality were explored using multifactorially adjusted cox regression analyses with time to death as underlying timescale. Results Highly significant and clinically important differences in PROs were found between those alive and those deceased at one year. The best discriminant performance was observed for the physical component scale of the SF-12 (Area Under the Curve (AUC) 0.706) (Figure 1). One-year mortality among responders and non-responders was 2% and 7%, respectively. Significant differences in time to death was observed between responders and non-responders (p Conclusions One-year post-discharge mortality was expectedly low, however notably higher in certain subgroups. Though clinical predictors may be difficult to modify, factors such as feeling unsafe about returning home should be addressed at discharge. PRO-performance estimates may guide clinicians and researchers in choosing appropriate predictive patient-reported outcome tools. Figure 1. PRO instruments ROC curves Funding Acknowledgement Type of funding source: None

Background: The SF-12v2 health survey (SF-12) is widely used as a generic measure of health-related quality of life. However, interpretation of score differences can be difficult. Aim: To estimate benchmarks for interpretation of score differences on the SF-12 for readmission and all-cause mortality in cardiac patients. Methods: Data from the DenHeart study, a national cross-sectional survey including one year follow-up register data, were used. Patients with ischaemic heart disease, arrhythmia, heart failure and heart valve disease answered the survey at hospital discharge. Cox proportional hazards models were used to regress readmission and all-cause mortality. Results: A total of 10,813 cardiac patients completed the SF-12. For patients with ischaemic heart disease and arrhythmia, a one point lower physical component summary score was associated with a 2% increase in risk in readmission (hazard ratio (HR) 1.022 (95% confidence interval 1.017;1.027) and HR 1.024 (1.018; 1.029), respectively) and a 3% increase in risk for patients with heart failure (HR 1.027 (1.015; 1.038)). A one point lower mental component summary score was associated with a 2% increase in the risk of readmission (HR 1.017 (1.013; 1.022)) across diagnoses. For both the physical and mental component summary score, a one point lower score meant a 5% increase in the risk of all-cause mortality (HR 1.046 (1.031; 1.060) and HR 1.046 (1.029; 1.065), respectively) across diagnoses. Conclusion: In a large group of cardiac patients, a one point lower physical or mental component summary score was associated with an up to 3% increased risk of readmission and a 5% increased risk of mortality in the first year after discharge.

Background: Patient-reported outcomes are important predictors of mortality, cardiovascular events and hospitalisation in patients with cardiac diseases, but differences in patient-reported outcomes between groups of patients with arrhythmia have not yet been investigated. Aims: To describe and compare patient-reported outcomes at discharge among patients with different types of cardiac arrhythmia and to examine the associations between demographic characteristics, inhospital factors and patient-reported outcomes. Methods: Data were derived from the national DenHeart study including patient-reported outcomes from the following questionnaires: the hospital anxiety and depression scale (HADS), HeartQoL, short form 12 (SF-12), current health status (EQ-5D), brief illness perception questionnaire (B-IPQ) and the Edmonton symptom assessment scale (ESAS). Clinical and demographic data were obtained from national registers. Multiple linear and logistic regression models were used to investigate the associations between the potential risk factors and the patient-reported outcomes. Results: A total of 4251 patients diagnosed with arrhythmia completed the questionnaire. Across the arrhythmia subgroups, some differences were observed. In general, patient-reported outcome scores were worst among patients with ‘ventricular arrhythmia’ (e.g. highest depression scores and highest prevalence of feeling unsafe at discharge). Regression analysis revealed that longer hospital stay, female gender, being unmarried and having a short education were significantly associated with poor health for almost all arrhythmia subgroups. Conclusion: Differences exist in self-reported health, quality of life and symptom burden across arrhythmia groups with patients with ventricular arrhythmia reporting poorer patient-reported outcomes. Longer hospital stay, female gender, being unmarried and having a low level of education were significantly associated with worse outcomes among the total population.

The data presented in this paper describe a supplementary figure and supplementary tables to the research article; Patient-reported outcomes predict high readmission rates among patients with cardiac diagnoses - Findings from the DenHeart study [1]. The data reports on findings from the DenHeart study, investigating the association between patient-reported outcomes (PROs) and the risk of readmission after a cardiac diagnosis. Data from a national survey with register-based follow-up of a cohort of 34,564 patients were analysed. PROs included the following instruments; The Short Form-12 (SF-12), the Hospital Anxiety and Depression Scale (HADS), the EuroQol 5 Dimensions 5 Levels (EQ-5D 5L), the HeartQol and the Edmonton Symptom Assessment Scale (ESAS). The included tables show the association between PROs and the risk of readmission and the figure illustrates the cumulative incidence function of readmission.

BACKGROUND: High rates of readmission after myocardial infarction and cardiac surgery have been reported, indicating a heavy burden for both patients and society. Patient-reported outcomes are predictors of adverse outcomes such as morbidity and mortality and may also be useful in preventive risk assessment as predictors of readmission.AIM: To describe (i) the prevalence of cardiac readmissions one year after hospital discharge among cardiac patients, (ii) patient-reported outcomes at hospital discharge as predictors of readmission.METHODS: The following patient-reported outcomes were measured across cardiac diagnoses at hospital discharge from the five heart centres, cardiology and thoracic surgery units, as a part of the national, cross-sectional DenHeart Study: Short-Form 12 (SF-12), Hospital Anxiety and Depression Scale (HADS), EuroQoL (EQ-5D-5L), HeartQoL and the Edmonton Symptom Assessment Scale (ESAS). One year readmissions were obtained from national registers.RESULTS: A total of 34,564 cardiac patients were discharged of whom 16,712 patients completed the questionnaire. A total of 11,693 (36%) patients were readmitted for cardiac reasons at least once during the first year after index admission. The risk of readmission was predicted by anxiety (HR = 1.36 (CI:1.26-1.46)) and depression (HR = 1.42 (CI:1.31-1.55)). Higher scores reflected lower readmission risk on the physical (HR = 0.98 (CI:0.98-0.98)) health component of the SF-12.CONCLUSION: A total of 36% of cardiac patients admitted to a national heart center were readmitted during the first year. Readmission was predicted by patient-reported anxiety, depression, perceived health, quality of life and symptom distress, which may be used in risk assessment in clinical practice.

ObjectiveTo explore whether living alone and loneliness 1) are associated with poor patient-reported outcomes at hospital discharge and 2) predict cardiac events and mortality 1 year after hospital discharge in women and men with ischaemic heart disease, arrhythmia, heart failure or heart valve disease.MethodsA national cross-sectional survey including patients with known cardiac disease at hospital discharge combined with national register data at baseline and 1-year follow-up. Loneliness was evaluated using one self-reported question, and information on cohabitation was available from national registers. Patient-reported outcomes were Short Form-12, Hospital Anxiety and Depression Scale and HeartQoL. Clinical outcomes were 1-year cardiac events (myocardial infarction, stroke, cardiac arrest, ventricular tachycardia/fibrillation) and all-cause mortality from national registers.ResultsA total of 13 443 patients (53%) with ischaemic heart disease, arrhythmia, heart failure or heart valve disease completed the survey. Of these, 70% were male, and mean age was 66.1 among women and 64.9 among men. Across cardiac diagnoses, loneliness was associated with significantly poorer patient-reported outcomes in men and women. Loneliness predicted all-cause mortality among women and men (HR 2.92 (95% CI 1.55 to 5.49) and HR 2.14 (95% CI 1.43 to 3.22), respectively). Living alone predicted cardiac events in men only (HR 1.39 (95% CI 1.05 to 1.85)).ConclusionsA strong association between loneliness and poor patient-reported outcomes and 1-year mortality was found in both men and women across cardiac diagnoses. The results suggest that loneliness should be a priority for public health initiatives, and should also be included in clinical risk assessment in cardiac patients.

Introduction and Aims The gender difference in alcohol use seems to have narrowed in the Nordic countries, but it is not clear to what extent this may have affected differences in levels of harm. We compared gender differences in all‐cause and cause‐specific alcohol‐attributed disease burden, as measured by disability‐adjusted life‐years (DALY), in four Nordic countries in 2000–2017, to find out if gender gaps in DALYs had narrowed. Design and Methods Alcohol‐attributed disease burden by DALYs per 100 000 population with 95% uncertainty intervals were extracted from the Global Burden of Disease database. Results In 2017, all‐cause DALYs in males varied between 2531 in Finland and 976 in Norway, and in females between 620 in Denmark and 270 in Norway. Finland had the largest gender differences and Norway the smallest, closely followed by Sweden. During 2000–2017, absolute gender differences in all‐cause DALYs declined by 31% in Denmark, 26% in Finland, 19% in Sweden and 18% in Norway. In Finland, this was driven by a larger relative decline in males than females; in Norway, it was due to increased burden in females. In Denmark, the burden in females declined slightly more than in males, in relative terms, while in Sweden the relative decline was similar in males and females. Discussion and Conclusions The gender gaps in harm narrowed to a different extent in the Nordic countries, with the differences driven by different conditions. Findings are informative about how inequality, policy and sociocultural differences affect levels of harm by gender. © 2020 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Background Anxiety and depression symptoms are common among cardiac patients. The Hospital Anxiety and Depression Scale (HADS) is frequently used to measure symptoms of anxiety and depression; however, no study on the validity and reliability of the scale in Danish cardiac patients has been done. The aim, therefore, was to evaluate the psychometric properties of HADS in a large sample of Danish patients with the four most common cardiac diagnoses: ischemic heart disease, arrhythmias, heart failure and heart valve disease. Methods The DenHeart study was designed as a national cross-sectional survey including the HADS, SF-12 and HeartQoL and combined with data from national registers. Psychometric evaluation included analyses of floor and ceiling effects, structural validity using both exploratory and confirmatory factor analysis and hypotheses testing of convergent and divergent validity by relating the HADS scores to the SF-12 and HeartQoL. Internal consistency reliability was evaluated by Cronbach’s alpha, and differential item functioning by gender was examined using ordinal logistic regression. Results A total of 12,806 patients (response rate 51%) answered the HADS. Exploratory factor analysis supported the original two-factor structure of the HADS, while confirmatory factor analysis supported a three-factor structure consisting of the original depression subscale and two anxiety subscales as suggested in a previous study. There were floor effects on all items and ceiling effect on item 8. The hypotheses regarding convergent validity were confirmed but those regarding divergent validity for HADS-D were not. Internal consistency was good with a Cronbach’s alpha of 0.87 for HADS-A and 0.82 for HADS-D. There were no indications of noticeable differential item functioning by gender for any items. Conclusions The present study supported the evidence of convergent validity and high internal consistency for both HADS outcomes in a large sample of Danish patients with cardiac disease. There are, however, conflicting results regarding the factor structure of the scale consistent with previous research. Trial registration ClinicalTrials.gov: NCT01926145.

BACKGROUND: Although highly effective in preventing arrhythmic death, there is a high prevalence of anxiety, depression and reduced quality of life among patients who have received an implantable cardioverter defibrillator (ICD). Whether mortality, ICD shock and readmission are predicted by patient-reported outcomes is unknown.AIM: The aim of this study was to describe patient-reported outcomes among patients with ICDs compared by: ICD indication and generator type (ICD or cardiac resynchronisation therapy ICD), and to determine whether patient-reported outcomes at discharge predict mortality, ICD therapy and readmission.METHODS: A national cross-sectional survey at hospital discharge ( n=998) with register follow-up. Patient-reported outcomes included the Hospital Anxiety and Depression Scale, Short Form-12, HeartQoL, EQ-5D and Edmonton Symptom Assessment Scale. Register data: ICD therapy, readmissions and mortality within one year following discharge.RESULTS: Patients with primary prevention ICDs had significantly worse patient-reported outcomes at discharge than patients with secondary prevention ICDs. Likewise, patients with cardiac resynchronisation therapy ICDs had significantly worse patient-reported outcomes at discharge than patients without cardiac resynchronisation therapy. One-year mortality was predicted by patient-reported outcomes, with the highest hazard ratio (HR) being anxiety (HR 2.02; 1.06-3.86), but was not predicted by indication or cardiac resynchronisation therapy. ICD therapy and ventricular tachycardia/ventricular fibrillation were not predicted by patient-reported outcomes, indication or cardiac resynchronisation therapy. Overall, patient-reported outcomes predicted readmissions, e.g. symptoms of anxiety and depression predicted all readmissions within 3 months (HR 1.50; 1.13-1.98) and 1.47 (1.07-2.03), respectively).CONCLUSION: Patients with primary indication ICDs and cardiac resynchronisation therapy ICDs report worse patient-reported outcomes than patients with secondary indication and no cardiac resynchronisation therapy. Patient-reported outcomes such as mental health, quality of life and symptom burden predict one-year mortality and acute and planned hospital readmissions.

Objective: Surveys are considered the best source of data available on the prevalence of illicit drug use in the general adult population. The objective of the present study was to examine the consistency in self-reported lifetime use of illicit drugs. Method: Data were obtained from the Danish Health and Morbidity Surveys. A nationally representative subsample of the individuals invited in 2000 was also invited to the subsequent three survey waves (2005, 2010, and 2013). The baseline sample size included 4,803 individuals between ages 16 and 64 years, of whom 3,053 completed a self-administered questionnaire. Recanting was defined as reporting lifetime use at baseline but denying such use in at least one of the subsequent survey waves. Results: In all, 926 individuals reported lifetime use of cannabis in 2000 and 234 individuals reported lifetime use of hard drugs. After 5, 10, and 13 years, 10.2%, 15.6%, and 16.3% recanted their earlier reported use of cannabis, respectively. The prevalence increased with higher age. After 5 years, 20.4% recanted their earlier use of hard drugs. After 10 and 13 years, approximately 30% recanted their earlier use of hard drugs. This prevalence, too, increased with higher age. Conclusions: The validity of data on the lifetime use of illicit drugs derived from population surveys is questionable among adults in Denmark and perhaps in other countries. Future studies should take these findings into account when interpreting results, as such reporting patterns have considerable implications on the validity of the study results.

Purpose of Review: Smoking habits early in life are known to have important implications for lifetime smoking behaviors and efforts that discourage smoking among young people are essential for national tobacco control. In Denmark, various approaches have been taken to prevent or stop smoking in youth. This paper provides an overview of approaches to tobacco control policies and smoking cessation programs targeting adolescents and young adults in Denmark and presents current evidence of their effectiveness. Recent Findings: Extensive research documents the effect of tobacco control policies on youth smoking behavior, especially that of increasing prices on tobacco. Further, it has been suggested that strategies addressing the social aspect of smoking should be emphasized. Summary: This paper highlights that Denmark has an untapped potential within national tobacco control. Denmark should prioritize a comprehensive approach including enactment of tobacco control policies and implementation of interventions shown to be effective to prevent smoking initiation and encourage quitting among Danish youth.

Objective: To describe: (i) differences in patient reported physical and mental health outcomes at hospital discharge between a) cardiac diagnostic groups and b) cardiac patients and a national representative reference population and to describe (ii) in-hospital predicting factors for patient reported outcomes.Methods: A national cross-sectional survey combined with national register data. From April 2013 to April 2014 all patients (n = 34,564) discharged or transferred from one of five Danish Heart Centres were invited to participate. 16,712 patients (51%) responded; 67% male and mean age 64 years. All diagnostic groups were represented similar to real life proportions. Patient reported outcome measures included: SF-12, Hospital Anxiety and Depression Scale, EQ-5D, Brief Illness Perception Questionnaire, HeartQoL and Edmonton Symptom Assessment Scale.Results: Statistically significant differences were found in all patient reported outcomes across diagnostic groups. Listed from worst to best outcomes were heart failure, heart valve disease, ischemic heart disease, infectious heart disease, arrhythmia, congenital heart disease and heart transplant Also "observation for cardiac disease" scored poorly on some aspects such as anxiety and treatment control. Compared to the reference population, cardiac patients had lower physical and mental health scores. Predicting factors for worse outcomes across diagnoses were female sex, older age, being unmarried, planned admission, longer hospital stay, and higher co-morbidity score.Conclusions: This large nationwide study finds significant differences in patient reported outcomes across cardiac diagnostic groups, however the differences were small and did not reach minimal important difference. The total population of cardiac patients had significant and clinically relevant poorer scores on mental and physical health than the reference population. Predicting factors for poor outcomes were identified. It is the first study comparing all diagnostic groups within cardiology and it provides important benchmarks between diagnostic groups and future comparisons. This knowledge may help clinicians make better decisions about post-hospital care and prevention.(C) 2017 Elsevier Inc. All rights reserved.

Aims Patient-reported quality of life and anxiety/depression scores provide important prognostic information independently of traditional clinical data. The aims of this study were to describe: (a) mortality and cardiac events one year after hospital discharge across cardiac diagnoses; (b) patient-reported outcomes at hospital discharge as a predictor of mortality and cardiac events. Design A cross-sectional survey with register follow-up. Methods Participants: All patients discharged from April 2013 to April 2014 from five national heart centres in Denmark. Main outcomes Patient-reported outcomes: anxiety and depression (Hospital Anxiety and Depression Scale); perceived health (Short Form-12); quality of life (HeartQoL and EQ-5D); symptom burden (Edmonton Symptom Assessment Scale). Register data: mortality and cardiac events within one year following discharge. Results There were 471 deaths among the 16,689 respondents in the first year after discharge. Across diagnostic groups, patients reporting symptoms of anxiety had a two-fold greater mortality risk when adjusted for age, sex, marital status, educational level, comorbidity, smoking, body mass index and alcohol intake (hazard ratio (HR) 1.92, 95% confidence interval (CI) 1.52–2.42). Similar increased mortality risks were found for patients reporting symptoms of depression (HR 2.29, 95% CI 1.81–2.90), poor quality of life (HR 0.46, 95% CI 0.39–0.54) and severe symptom distress (HR 2.47, 95% CI 1.92–3.19). Cardiac events were predicted by poor quality of life (HR 0.71, 95% CI 0.65–0.77) and severe symptom distress (HR 1.58, 95% CI 1.35–1.85). Conclusions Patient-reported mental and physical health outcomes are independent predictors of one-year mortality and cardiac events across cardiac diagnoses.

Publisher's version (útgefin grein), Background The Nordic countries have commonalities in gender equality, economy, welfare, and health care, but differ in culture and lifestyle, which might create country-wise health differences. This study compared life expectancy, disease burden, and risk factors in the Nordic region.Methods Life expectancy in years and age-standardised rates of overall, cause-specific, and risk factor-specific estimates of disability-adjusted life-years (DALYs) were analysed in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. Data were extracted for Denmark, Finland, Iceland, Norway, and Sweden (ie, the Nordic countries), and Greenland, an autonomous area of Denmark. Estimates were compared with global, high-income region, and Nordic regional estimates, including Greenland.Findings All Nordic countries exceeded the global life expectancy; in 2017, the highest life expectancy was in Iceland among females (85·9 years [95% uncertainty interval [UI] 85·5–86·4] vs 75·6 years [75·3–75·9] globally) and Sweden among males (80·8 years [80·2–81·4] vs 70·5 years [70·1–70·8] globally). Females (82·7 years [81·9–83·4]) and males (78·8 years [78·1–79·5]) in Denmark and males in Finland (78·6 years [77·8–79·2]) had lower life expectancy than in the other Nordic countries. The lowest life expectancy in the Nordic region was in Greenland (females 77·2 years [76·2–78·0], males 70·8 years [70·3–71·4]). Overall disease burden was lower in the Nordic countries than globally, with the lowest age-standardised DALY rates among Swedish males (18 555·7 DALYs [95% UI 15 968·6–21 426·8] per 100 000 population vs 35 834·3 DALYs [33 218·2–38 740·7] globally) and Icelandic females (16 074·1 DALYs [13 216·4–19 240·8] vs 29 934·6 DALYs [26 981·9–33 211·2] globally). Greenland had substantially higher DALY rates (26 666·6 DALYs [23 478·4–30 218·8] among females, 33 101·3 DALYs [30 182·3–36 218·6] among males) than the Nordic countries. Country variation was primarily due to differences in causes that largely contributed to DALYs through mortality, such as ischaemic heart disease. These causes dominated male disease burden, whereas non-fatal causes such as low back pain were important for female disease burden. Smoking and metabolic risk factors were high-ranking risk factors across all countries. DALYs attributable to alcohol use and smoking were particularly high among the Danes, as was alcohol use among Finnish males.Interpretation Risk factor differences might drive differences in life expectancy and disease burden that merit attention also in high-income settings such as the Nordic countries. Special attention should be given to the high disease burden in Greenland., This study was funded by the Bill & Melinda Gates Foundation. The authors wish to thank Jonas Minet Kinge (Norwegian Institute of Public Health, Oslo, Norway) for valuable input regarding socioeconomic differences in life expectancy in the Nordic countries. CRC has received research funding from Svenska Läkaresällskapet (SLS-779681), Tysta Skolan, Hörselforskningsfonden (#503), the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 72204655 and the GENDERNET Co-Plus Fund (GNP-182). JJC acknowledges grant support from the Swedish Research Council (grant number 2019-01059). JMcG is supported by the Danish National Research Foundation (Niels Bohr Professorship), and is employed by The Queensland Centre for Mental Health Research which receives core funding from the Queensland Health. STS is currently funded by a grant from Region Zealand and a grant from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation program (grant agreement No 801790). OP-R has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement No 837180. TL is supported by the Academy of Finland (Grant #319200). Where authors are identified as personnel of the International Agency for Research on Cancer/WHO, the authors alone are responsible for the views expressed in this Article and they do not necessarily represent the decisions, policy, or views of the International Agency for Research on Cancer/WHO., "Peer Reviewed"

Nana Brochmann,1 Esben Meulengracht Flachs,2 Anne Illemann Christensen,3 Marie Bak,1 Christen Lykkegaard Andersen,1 Knud Juel,3 Hans Carl Hasselbalch,1 Ann-Dorthe Zwisler,4 Nina Rottmann4–6 1Department of Hematology, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark; 2Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark; 3National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; 4Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, University of Southern Denmark, Nyborg, Denmark; 5Department of Psychology, University of Southern Denmark, Odense, Denmark; 6Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark Objective: We sought to determine the prevalence and severity of anxiety and depression among patients with Philadelphia-negative myeloproliferative neoplasms (MPNs) and respective associations of anxiety and depression with demographic and lifestyle factors, comorbidity burden, duration of MPN disease, financial difficulties, and health-related quality of life (QoL). Methods: This study used data from a nationwide, population-based, cross-sectional survey of health-related QoL in MPN patients in Denmark called the MPNhealthSurvey. Individuals with a diagnosis of MPN in the National Patient Register were invited. The Hospital Anxiety and Depression Scale was used to assess the prevalence and severity of anxiety and depression. The associations of anxiety and depression with age, sex, education, body mass index (BMI), smoking, alcohol intake, physical activity, comorbidity burden, duration of MPN disease, financial difficulties, symptom burden, sexual problems, fatigue, functioning, and global health/QoL were examined. Results: In total, 2,029 patients completed the Hospital Anxiety and Depression Scale. The prevalence of anxiety, depression, and both was 21%, 12%, and 8%, respectively. Many participants who reported anxiety or depression exhibited mild symptoms. Middle-aged and elderly participants had lower odds of experiencing anxiety and depression when compared to younger participants, and females had higher odds of anxiety compared to males. Participants with higher education had lower odds of anxiety compared to those with lower education. Current smokers and ex-smokers had higher odds of anxiety and depression compared to those who had never smoked, and sedentary participants and participants with a lower level of physical activity had higher odds of anxiety and depression compared to participants who performed hard training several times a week. Higher comorbidity burden increased the odds of depression, and greater financial difficulties increased the odds of anxiety and depression. Higher total symptom burden and fatigue burden and higher level of sexual problems increased the odds of anxiety and depression. Finally, lower functional level and global health/quality of life increased the odds of anxiety and depression. BMI, alcohol intake, comorbidity burden, and duration of disease were not substantially associated with anxiety, whereas sex, educational level, and duration of MPN disease were not substantially associated with depression. Conclusion: There may be an unmet need in handling psychological distress in MPN patients. Future research might explore the utility of screening for psychological distress and the effectiveness of lifestyle interventions, rehabilitation, and MPN-symptom reduction in preventing and treating psychological distress. Keywords: myeloproliferative neoplasm, anxiety, depression, health-related quality of life, patient-reported outcomes

AIM: The Danish Heart Registry (DHR) seeks to monitor nationwide activity and quality of invasive diagnostic and treatment strategies in patients with ischemic heart disease as well as valvular heart disease and to provide data for research.STUDY POPULATION: All adult (≥15 years) patients undergoing coronary angiography (CAG), percutaneous coronary intervention (PCI), coronary artery bypass grafting, and heart valve surgery performed across all Danish hospitals were included.MAIN VARIABLES: The DHR contains a subset of the data stored in the Eastern and Western Denmark Heart Registries (EDHR and WDHR). For each type of procedure, up to 70 variables are registered in the DHR. Since 2010, the data quality protocol encompasses fulfillment of web-based validation rules of daily-submitted records and yearly approval of the data by the EDHR and WDHR.DESCRIPTIVE DATA: The data collection on procedure has been complete for PCI and surgery since 2000, and for CAG as of 2006. From 2000 to 2014, the number of CAG, PCI, and surgical procedures changed by 231%, 193%, and 99%, respectively. Until the end of 2014, a total of 357,476 CAG, 131,309 PCI, and 60,831 surgical procedures had been performed, corresponding to 249,445, 100,609, and 55,539 first-time patients, respectively. The DHR generally has a high level of completeness (1-missing) of each procedure (>90%) when compared to the National Patient Registry. Variables important for assessing the quality of care have a high level of completeness for surgery since 2000, and for CAG and PCI since 2010.CONCLUSION: The DHR contains valuable data on cardiac invasive procedures, which makes it an important national monitoring and quality system and at the same time serves as a platform for research projects in the cardiovascular field.

Aims: (1) To compare alcohol-attributed disease burden in four Nordic countries 1990–2013, by overall disability-adjusted life years (DALYs) and separated by premature mortality [years of life lost (YLL)] and health loss to non-fatal conditions [years lived with disability (YLD)]; (2) to examine whether changes in alcohol consumption informs alcohol-attributed disease burden; and (3) to compare the distribution of disease burden separated by causes. Design: A comparative risk assessment approach. Setting: Sweden, Norway, Denmark and Finland. Participants: Male and female populations of each country. Measurements: Age-standardized DALYs, YLLs and YLDs per 100 000 with 95% uncertainty intervals (UIs). Findings: In Finland, with the highest burden over the study period, overall alcohol-attributed DALYs were 1616 per 100 000 in 2013, while in Norway, with the lowest burden, corresponding estimates were 634. DALYs in Denmark were 1246 and in Sweden 788. In Denmark and Finland, changes in consumption generally corresponded to changes in disease burden, but not to the same extent in Sweden and Norway. All countries had a similar disease pattern and the majority of DALYs were due to YLLs (62–76%), mainly from alcohol use disorder, cirrhosis, transport injuries, self-harm and violence. YLDs from alcohol use disorder accounted for 41% and 49% of DALYs in Denmark and Finland compared to 63 and 64% in Norway and Sweden 2013, respectively. Conclusions: Finland and Denmark has a higher alcohol-attributed disease burden than Sweden and Norway in the period 1990–2013. Changes in consumption levels in general corresponded to changes in harm in Finland and Denmark, but not in Sweden and Norway for some years. All countries followed a similar pattern. The majority of disability-adjusted life years were due to premature mortality. Alcohol use disorder by non-fatal conditions accounted for a higher proportion of disability-adjusted life years in Norway and Sweden, compared with Finland and Denmark. publishedVersion