Symptoms of anxiety and depression and risk of heart failure: the HUNT Study.
Bottom Line: For depression, the multi-adjusted hazard ratios for HF were 1.07 (0.87-1.30) for moderate symptoms and 1.41 (1.07-1.87) for severe symptoms (P for trend 0.026).Established cardiovascular risk factors, acute myocardial infarction (AMI) prior to baseline, and adjustment for incident AMI as a time-dependent covariate during follow-up had little influence on the estimates.The increased risk could not be fully explained by cardiovascular or socio-economic risk factors, or by co-morbid AMI.
Affiliation: Department of Internal Medicine, Nord-Trøndelag Hospital Trust, Levanger Hospital, Levanger, Norway; Department of Neuroscience, Norwegian University of Technology and Science (NTNU), Trondheim, Norway.Show MeSH
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Mentions: After baseline, the participants were followed up for a first incident of HF until 31 December 2008, identified either by linkage with medical records at the two hospitals in Nord-Trøndelag county or by the National Cause of Death Registry.25 A total of 126 participants were excluded because their medical records indicated HF before they participated at baseline. Therefore, 62 567 people were included in the analyses, as displayed in Figure1. Heart failure was defined and diagnosed according to the current European Society of Cardiology (ESC) Guidelines.26 The overall quality of the hospital discharge diagnosis of HF is generally high in Nordic countries.27,28 In order to increase specificity, we only extracted primary diagnoses as recommended.27 Deaths due to HF were extracted from the National Death Registry. We used International Classification of Diseases (ICD) 9 code 428 and ICD codes I50.0, I50.1, and I50.9 to identify HF.25 Having 100% specificity and low—but non-differential—sensitivity leads to no bias of the risk ratio. Even a slight decrease in specificity, even if non-differential, might lead to a severe bias. Therefore, in brief, our decision to include only primary diagnosis decreases our power, but preserved our validity.29
Affiliation: Department of Internal Medicine, Nord-Trøndelag Hospital Trust, Levanger Hospital, Levanger, Norway; Department of Neuroscience, Norwegian University of Technology and Science (NTNU), Trondheim, Norway.