Nordsjællands Hospital

The chronic obstructive pulmonary disease (COPD)-specific comorbidity test (COTE) aims to predict long-term mortality in patients with COPD, whereas the Charlson comorbidity index (CCI) score is used as a validated tool for predicting long-term mortality across medical conditions. Comparison of the two comorbidity scores' ability to predict mortality has only been studied scarcely. This study aimed to compare the predictive ability of the COTE and CCI scores including the updated CCI score with updated weights (CCI (Quan)) in patients with COPD following acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Using nationwide registry data, all Danish patients at first admission due to AECOPD during 2005-2018 were included in this retrospective cohort study. 1-year mortality was explored including age, sex and CCI or COTE comorbidity scores. Logistic regression was performed with fivefold cross-validation comparing area under the curve (AUC) and optimal threshold using Youden index. The logistic regression models were furthermore examined using 10 000 bootstrap analyses and comparing the distribution of accuracy using a T-test. Cox regression analysis was used to compare Brier scores over time for models including combinations of age, sex, COTE, CCI and CCI (Quan). A total of 87 271 individuals were identified with a first-time AECOPD during the study period. The median age was 74 IQR (66, 81) and 48.4% were males.The logistic regression revealed an AUC of the CCI and CCI (Quan) models of 0.714 and for the COTE model 0.707 (p<0.001).Comparison using T-test on 10 000 bootstrap samples revealed small differences with an accuracy of 0.7281 (95% CI 0.7241 to 0.7320) for the COTE model and 0.7275 (95% CI 0.7235 to 7314) for the CCI model (p<0.001).Brier scores were 0.1793 for CCI, 0.1789 for CCI (Quan) and 0.1802 for COTE, only slightly favouring the CCI model. In a cohort of patients with first-time AECOPD, we found similar predictive abilities of 1-year mortality comparing the CCI, CCI (Quan) and COTE score.

Tuberculosis (TB) among refugee minors in low-incidence countries remains underexplored. We estimated the incidence of TB disease among refugee minors compared to Danish-born minors. This nationwide prospective historical cohort study included 31 172 refugee minors (< 18 years) granted residency in Denmark from 1993 to 2015. Each was matched 1:6 with a Danish-born control on age and sex. Follow-up extended from the date of residency until the earliest of: TB diagnosis, the age of 21 years, or study-end (31.12.2015). Data were obtained from Statistics Denmark and the International Reference Laboratory of Mycobacteriology. We conducted descriptive analyses and estimated incidence rates (IRs) using Poisson regression. Refugee minors had a 48 times higher TB IR compared to their Danish-born peers. Notably, refugee minors from sub-Saharan Africa had an IR of 203 per 100 000 person-years. For both refugee minors and their Danish-born peers, pulmonary TB was the most common form, but still more than a third had extrapulmonary manifestations. Among refugee minors, most TB cases were diagnosed more than 2 years after arrival. Our findings underscore the need for national policies and clinical guidelines for TB screening of all refugee minors upon arrival to reduce morbidity and advance TB elimination efforts.

Hybrid hospital-at-home (HaH) models, combining remote patient monitoring (RPM) with home visits, offer an alternative to inpatient care. Yet, evidence on how RPM is delivered is limited. This paper reports a substudy embedded within a feasibility study, examining RPM quality in a hybrid HaH programme for patients with lower respiratory tract infections before a large trial. We analysed 19 patient trajectories in a multimethod feasibility study (April 2022-May 2023). We hypothesised that effective RPM implementation enables the timely detection of deterioration, prompting patients' return to the hospital and preventing harm. Quality was assessed via implementation fidelity and patient safety. Fidelity referred to adherence to RPM protocols for virtual ward rounds and alert management. Data sources include telemedicine logs, electronic health records, clinical observations and clinician feedback. No severe adverse events occurred. Four patients (21%) returned to the hospital. A total of 48 virtual ward rounds were scheduled, and 46 (96%) were provided, 37 of which (77%) were conducted via video. Most RPM alerts were logged outside protocol-defined timeframes, as clinicians prioritised clinical action over documentation. We demonstrate a gap between protocol assumptions and real-world clinical workflows. Ultimately, rigid performance metrics may overlook essential adaptive practices, underestimating true quality. Despite protocol deviations, our findings suggest that RPM practices may have supported timely detection of deterioration during early-phase testing. This study underscores the need to balance protocol adherence with clinical flexibility, emphasising core functions over administrative compliance in complex interventions like hybrid HaH. NCT05087082.

Kidney function influences the concentration of cardiac troponin T (cTnT) and I (cTnI). We investigate how this impacts their prognostic ability. This Danish nationwide study included patients from 2013 to 2023 with at least two measurements of Roche hs-cTnT, Abbott hs-cTnI, or Siemens hs-cTnI Vista or Atellica during the index admission. Patients were stratified by estimated glomerular filtration rate (eGFR). We assessed prognostic ability by Cox models and area under the receiver operating characteristics curve (AUC). The primary endpoint was 30-day all-cause mortality. We included 277,723 patients (median age 69years, 38.4% female) of whom 19,565 (7.0%) died within 30days. Almost all patients with eGFR <30ml/min/1.73m2 had myocardial injury using hs-cTnT (99.4%) compared to hs-cTnI (85.4%). Hazard ratios (HRs) for overall myocardial injury were higher than for acute myocardial injury and declined with worsening eGFR, particularly for hs-cTnT: HR 15.58 (95% CI 12.77-19.00) for eGFR ≥90ml/min/1.73m2, while estimation was impossible at eGFR 15-30ml/min/1.73m2 due to few normal values. The highest HR for acute myocardial injury at eGFR ≥90ml/min/1.73m2 was for hs-cTnI Abbott, HR 3.50 (95% CI 2.79-4.38). AUC decreased with worsening eGFR across assays, 0.68-0.76 for eGFR ≥90ml/min/1.73m2 to 0.59-0.63 for eGFR <15ml/min/1.73m2. At eGFR ≥90ml/min/1.73m2 the optimal cutoff was 16.5ng/l for hs-cTnT and below the sex-specific 99th percentile for all hs-cTnI assays, increasing 5-20-fold with lower eGFR for all assays. Kidney function affects cTn prognostic performance, with reduced predictive ability and higher optimal cutoff concentrations for lower eGFR.

Abstract Background Societal treatment guidelines recommend unprotected left main (LM) disease revascularized by either percutaneous intervention (PCI) or coronary artery bypass grafting (CABG). Revascularization vs. deferring is unlikely to be assessed in a randomized trial. Purpose To compare patients with isolated LM lesions who underwent PCI, CABG or deferred treatment, in a real-world setting. Methods We included patients with isolated LM lesion by invasive coronary angiography on the indication chronic coronary syndrome between January 2002 and January 2021, registered in the Western Denmark Heart Registry. Patients were divided into four groups: Defer with diameter stenosis (DS)&amp;lt;=50%, defer with DS&amp;gt;50%, PCI or CABG. Patients were included after 90-days event free survival. Outcomes were: Acute coronary syndrome (ACS), revascularization, stroke and all-cause mortality within 5 years. Adjusted absolute 5-year risks were derived using multivariate cox models and g-formula methods. Models were adjusted for cardiovascular risk factors including diabetes and year of angiography. Results A total of 16,565 patients were identified. Of these, 6,703 patients underwent PCI, 6,460 CABG, 1,834 were in the defer group with &amp;lt;=50% stenosis, and 1,568 in the &amp;gt;50% group. Median LM diameter stenosis; PCI: 80%(Interquartile Range [IQR] 60-90%), CABG: 70%(IQR 60-90%), defer&amp;lt;=50%: 40%(IQR 30-50%) and defer&amp;gt;50%: 80%(IQR 66-99%) (p&amp;lt;0.0005). For diabetes; PCI: 17.5%, CABG: 21.4%, defer&amp;lt;=50%: 17.4% and defer&amp;gt;50% 22.7%(p&amp;lt;0.0005). Survival probability was 84.8 % for patients receiving PCI, 89.0% for CABG, 85.0% for defer&amp;lt;=50% and 75.9% for defer&amp;gt;50%(p&amp;lt; 0.0005%)(Figure 1). Cumulative incidence of ACS was 10.8% for patients receiving PCI, 4.7% for CABG, 7.6% for defer&amp;lt;=50% and 12.4% for defer&amp;gt;50%(p&amp;lt; 0.0005%)(Figure 1). For revascularization, the numbers were 17.5%, 9.2%, 13.8% and 19.2%(p&amp;lt;0.0005) and for stroke 3.9%, 3.8%, 3.9% and 5.4%,(p&amp;lt;0.005). Adjusted absolute risks of all-cause mortality were; PCI: 12.7%(95% confidence interval [CI] 12.0-13.4%), CABG: 11.6%(95%CI 11.0-12.2%), defer&amp;lt;=50%: 13.2%(95%CI 12.2-14.3%) and defer&amp;gt;50%: 15.4%(95%CI 14.2-16.5%)(Figure 2). For ACS; 10.7%(95%CI 9.9-11.5%) for PCI, 5.2%(95%CI 4.8-5.8%) for CABG, 8.3%(95%CI 7.2-9.5%) for defer&amp;lt;=50% and 12.2%(95%CI 10.7-13.6%) for defer&amp;gt;50%. For revascularization; PCI: 18.6%(95%CI 17.6-19.6%), CABG: 9.4%(95%CI 8.7-10.1%), defer&amp;lt;=50%: 14.9%(95%CI 13.3-16.4%) and defer&amp;gt;50%: 19.5%(95%CI 17.5-21.4%). For stroke; PCI: 4.1%(95%CI 3.6-4.6%), CABG: 4.4%(95%CI 3.9-4.8%), defer&amp;lt;=50%: 4.1%(95%CI 3.4-4.9%) and defer&amp;gt;50%: 4.8%(95%CI 3.9-5.7%). Conclusions Real-world data on revascularization of isolated significant LM stenosis with CABG or PCI showed superior survival versus deferred treatment. PCI was associated with a higher rate of non-fatal ACS and revascularization than CABG but comparable to the deferred group. Deferred revascularization of LM (DS&amp;gt; 50%) stenosis was associated with worst outcomes.Cumulative incidence and survival curves Adjusted absolute risks of outcomes

Abstract Background Patients with atrial fibrillation (AF) may face an elevated risk of influenza-related complications, including cardiovascular and respiratory adverse outcomes. However, limited knowledge exists regarding the excess burden of hospitalizations and mortality due to influenza activity among patients with AF at a population level. Purpose We sought to estimate the excess number of deaths and hospitalizations associated with influenza activity among individuals with AF in Denmark. Methods Data on weekly number of deaths and hospitalizations among patients with AF in Denmark were collected from the nationwide registries. Weekly estimates of influenza circulation were based on the proportion of positive influenza samples analyzed at all hospitals in Denmark during the study period. We used a time-series linear regression model to correlate the weekly estimates of influenza circulation with the weekly number of deaths and hospitalizations to estimate the annual excess number of deaths and hospitalizations associated with influenza circulation among patients with AF in Denmark. The model also incorporated data on weekly mean temperature in Denmark and restricted cubic spline terms to account for seasonal changes and trends over time. Confidence intervals were derived using block bootstrapping. Results During the study period encompassing 8 influenza seasons from 2010-2018, an annual mean of 141,746 patients were living with AF. An annual mean of 25,181 samples were tested for influenza at all Danish hospitals with a mean proportion of positive samples of 7.9% (Figure 1). Based on our model, influenza activity was associated with an annual excess of 298 all-cause deaths (95% CI 126-564 deaths) and 86 cardiovascular deaths (95% CI 45-204 deaths) corresponding to 2.3% of all all-cause deaths (95% CI 1.0-4.3% deaths) and 1.8% of all cardiovascular deaths (95% CI 1.0-4.3% deaths) in patients with AF in Denmark (Figure 1). Influenza activity was also associated with an annual excess of 387 hospitalizations for pneumonia or influenza (95% CI 148-667 hospitalizations for pneumonia or influenza) corresponding to 5.5% of all hospitalizations for pneumonia or influenza (95% CI 2.3-8.8%) among patients with AF. Conclusions Based on the results of our model, approximately 2.3% of all deaths and 5.5% of all hospitalizations for pneumonia or influenza may be attributed to influenza activity among patients with AF in Denmark, suggesting substantial morbidity and mortality associated with influenza in patients with AF.Figure 1.

Abstract Purpose To investigate the association between hormonal contraceptive use and the risk of retinal vascular occlusions in women of reproductive age. Design Register-based, nationwide cohort study. Participants A total of 2208172 women aged 15 – 49 years were followed from January 1, 1996, to June 30, 2021, excluding those with prior venous or arterial thrombosis, thrombophilia, cancer (except non-melanoma skin cancer), liver disease, chronic kidney disease, hysterectomy, bilateral oophorectomy, hormone therapy, infertility treatment, endometriosis, or polycystic ovary syndrome. Methods Women were followed until study end, age 50, emigration, death, or occurrence of exclusion criteria. Individual-level, time-updated hormonal contraception use was identified through prescription records; retinal vascular occlusion events were detected through hospital diagnoses. Poisson regression models estimated incidence rate ratios of retinal vascular occlusion by duration, dosage, and type of hormonal contraceptives, adjusting for age, educational level, hypertension, diabetes, hypercholesterolemia, atrial fibrillation/flutter during observation. Main Outcome Measures Adjusted incidence rate ratios (AIRR) and standardized incidence rate differences (SIRD) of retinal vein occlusion and retinal artery occlusion with hormonal contraceptive use compared to non-use. Results The cohort contributed 23882016 person-years with a median follow-up time of 10 years (1st to 3rd quartile: 4 to 17). Compared to non-use, current hormonal contraception use was associated with a 40% increased rate of retinal vein occlusion (AIRR 1.4, 95% Confidence Interval (95% CI): 1.1 to 1.8), corresponding to SIRD of 4.6 (95% CI: 0.9 to 8.4) additional cases per 1000000 person-years. AIRR of retinal artery occlusion was 1.2 (95% CI: 0.8 to 1.7) with current hormonal contraception use compared to non-use. The increased rate of retinal vein occlusion persisted with use of combined oral contraceptives containing 30 – 40 μg of estrogen (AIRR 1.6, 95% CI: 1.2 to 2.3), while no increased rate was observed with the low-dose 20 μg combined contraceptives (AIRR 0.7, 95% CI: 0.3 to 1.5). No increase observed with use of hormonal intrauterine devices. Conclusion Combined oral contraceptives containing 30 – 40 μg estrogen were associated with an increased rate of retinal vein occlusion compared to non-use, although the absolute increase was low. No increased rate was observed for retinal artery occlusions.Figure 1 Figure 2

Abstract Background The effectiveness of aspirin (ASA) for primary prevention of major adverse cardiovascular events (MACE) in persons who smoke tobacco remains unclear, particularly among patients who underwent cardiac computed tomography angiography (CCTA) and coronary artery calcium scoring (CACS) due to suspected chronic coronary syndrome. Purpose To evaluate the risk of MACE and bleeding events across predefined CACS categories in relation to ASA use and smoking status. Methods A registry-based study of adult individuals (≥18 years of age) who underwent CCTA and CACS measurement from 2008-2022. Individuals were stratified by baseline ASA use (yes/no), CACS category (0, 1–99, 100–399, 400–999, ≥1000) and smoking status (current or prior versus no). Main exclusion criteria: history of acute coronary syndrome, coronary interventions, stroke, or treatment with ASA, anticoagulants, or P2Y12 inhibitors. The effectiveness endpoint was MACE, a composite of: death from any cause, non-fatal acute coronary syndrome, or non-fatal stroke, or revascularization. The safety endpoint was major bleeding requiring hospitalization. Follow-up began at 180 days after CCTA and ended upon event, emigration, death (for bleeding endpoint), or 2 years of follow-up, whichever came first. Absolute risks and risk differences (ASA vs no ASA) of the effectiveness and safety endpoints were computed using average treatment effect modelling with multivariable Cox regression analysis standardised to the distributions of age, sex and selected comorbidities. Results Of 65,519 included patients, 44.8% were non-smokers (25.7% used ASA), 55.2% were smokers (32.6% used ASA). Among non-smokers in lower CACS categories, no significant difference in the standardized absolute risk of MACE was observed between ASA users and non-users (all P for risk difference ≥0.05, Figure 1). ASA use was associated with a numerically lower absolute risk of MACE in patients with CACS 400-999 and ≥1000 (for 400-999: 3.5% [2.2% ; 4.7%] vs 4.6% [2.9% ; 6.3%] and for ≥1000: 4.8% [95% CI 2.8%; 6.7%] vs. 5.8% [95% CI 3.3%; 8.3%]), P=0.48. Bleeding risk did not differ significantly between ASA vs. no ASA (Figure 1). Among smokers, ASA use was not associated with a significant reduction in MACE risk across all CACS categories (all P for risk difference &amp;gt;0.05) In the CACS group ≥1000, event rates were similar between ASA users and non-users (8.8% [95% CI 6.8% ; 10.8%] vs. 8.0% [95% CI 5.8% ; 10.3%], P=0.58). Bleeding risks in the smoking group were generally higher with ASA use across all CACS levels, except for those with CACS ≥1000. In general, smokers had numerically higher MACE and bleeding risks than non-smokers (Figure 1). Conclusion ASA use for primary prevention was not associated with reduced risk of MACE across CACS categories or with a significant impact on bleeding risk in smokers and non-smokers undergoing CCTA. These findings suggest that ASA may have limited preventive effects in this population.Figure 1

IntroductionThe combination of a reduction in the Danish hospital bed count, the shortage of hospital staff and demographic changes challenges the Danish hospital capacity. This was further highlighted during the COVID-19 pandemic when hospitals worldwide were overwhelmed by infected patients requiring acute hospital care. To address these challenges, a hospital-at-home (HaH) programme offers an alternative to conventional in-hospital admission. Furthermore, HaH has the potential to improve patient outcomes, reduce costs and increase patient satisfaction. However, few studies have evaluated HaH in a Scandinavian setting, and this article describes the protocol for a randomised controlled trial (RCT) comparing an HaH model with continued conventional in-hospital admission. The main aim of the trial is to evaluate physical activity level and mental wellbeing in patients admitted at home compared with conventionally admitted patients.Methods and analysis110 clinically stable patients from two internal medical wards at Nordsjaellands Hospital in Denmark will be included and randomised in a ratio of 1:1 to either continued conventional in-hospital admission (control group) or virtual HaH model (intervention group). The control group will receive standard hospital treatment, and the intervention group will be transferred home for continued treatment (eg, intravenous antibiotics or oxygen treatment). The primary outcome measures are physical activity assessed using daily step count (during the first 24 hours after inclusion, as an intermediary indicator of the risk of adverse events) and treatment satisfaction (assessed using a patient satisfaction survey). Secondary outcome measures are adverse events of special interest, escalation of care, readmission rate postdischarge (30 days and 90 days), mortality (associated and 7 days, 30 days and 90 days postdischarge), process data (eg, the number of teleconsultations) and a health economic evaluation.Ethics and disseminationThe study was approved by the Danish Research Ethics Committees (no. 2303051) and the Danish Medicines Agency (CIV-23-03-042542) and will be monitored by the Copenhagen University Hospital Good Clinical Practice unit. Results will be published in peer-reviewed journals and presented at relevant national and international conferences. We also plan to communicate the results to relevant stakeholders in the Danish healthcare system.Trial registration numberNCT05920304.