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. 2020 Oct 23;20(1):460.
doi: 10.1186/s12872-020-01737-1.

Validation of myocardial infarction diagnosis in patients with congenital heart disease in Sweden

Maria Fedchenko  1 , Zacharias Mandalenakis  2 , Görel Hultsberg-Olsson  2 , Helena Dellborg  2 , Peter Eriksson  2 , Mikael Dellborg  2
Affiliations

Validation of myocardial infarction diagnosis in patients with congenital heart disease in Sweden

Maria Fedchenko et al. BMC Cardiovasc Disord. .

Abstract

Background: The population of adults with congenital heart disease (CHD) is growing, and increasingly more patients with CHD reach older ages. Patients with CHD are at an increased risk of myocardial infarction (MI) with increased age. Diagnosing MI in patients with CHD can be challenging in clinical practice owing to a high prevalence of aberrant electrocardiograms, ventricular hypertrophy, and heart failure, among other factors. The National Swedish Patient Register (NPR) is widely used in epidemiological studies; however, MI diagnoses specifically in patients with CHD have never been validated in the NPR.

Methods: We contacted hospitals and medical archive services to request medical records for 249 patients, born during 1970-2012, with both CHD and MI diagnoses and who were randomly selected from the NPR by the Swedish National Board of Health and Welfare. Follow-up was until 2015. We performed a medical chart review to validate the MI diagnoses; we also validated CHD diagnoses to ensure that only patients with confirmed CHD diagnoses were included in the MI validation process.

Results: We received medical records for 96.4% (n = 238/249) of patients for validation of CHD diagnoses. In total, 74.8% (n = 178/238) had a confirmed CHD diagnosis; of these, 70.2% (n = 167) had a fully correct CHD diagnosis in the NPR; a further 4.6% (n = 11) had a CHD diagnosis, but it was misclassified. MI diagnoses were validated in 167 (93.8%) patients with confirmed CHD. Of the patients with confirmed CHD, 88.0% (n = 147/167) had correct MI diagnoses. Patients with non-complex CHD diagnoses had more correct MI diagnoses than patients with complex CHD (91.0%, n = 131 compared with 69.6%, n = 16). The main cause for incorrect MI diagnoses was typographical error, contributing to 50.0% of the incorrect diagnoses.

Conclusions: The validity of MI diagnoses in patients with confirmed CHD in the NPR is high, with nearly 9 of 10 MI diagnoses being correct (88.0%). MI in patients with CHD can safely be studied using the NPR.

Keywords: Congenital heart disease; Myocardial infarction; Swedish patient register; Validation.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Results of validation of congenital heart disease diagnoses. CHD congenital heart disease
Fig. 2
Fig. 2
Validation results for myocardial infarction diagnoses in patients with confirmed congenital heart disease
Fig. 3
Fig. 3
Number of patients with STEMI and NSTEMI according to age decades groups in patients with confirmed congenital heart disease and correct myocardial infarction diagnoses. STEMI ST-Elevation Myocardial Infarction; NSTEMI Non-ST-Segment Elevation Myocardial Infarction
See this image and copyright information in PMC

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