Christoph Ohlmeier

Incidence, prevalence, and antithrombotic management of atrial fibrillation in elderly Germans.

AIMS Data on the epidemiology of atrial fibrillation (AF) and its antithrombotic management in elderly populations are scarce. The aims of this study were to estimate the incidence and prevalence of AF in the elderly in Germany and to describe antithrombotic management of AF cases. METHODS AND RESULTS Estimation of prevalence and incidence was based on data of three German statutory health insurances, which insured more than 800 000 people aged 65 years and older in the study period. The 1-year period prevalence of AF was estimated for each of the years 2004-2007. The incidence rate of AF in 2007 was assessed in patients with a preceding continuous 3-year insurance period without diagnoses of AF. Antithrombotic management of AF was described among incident AF cases in 2008 and predictors for lack of prescriptions of oral anticoagulants were identified. Age-standardized period prevalence of AF among those 65 years or older was 7.7% in 2004, 9.4% in 2005, 9.8% in 2006, and 10.3% in 2007. The age-standardized incidence of AF was 27.4 of 1000 person-years in 2007. Prevalence and incidence increased with age and were higher in men than in women. In 2008, 58.2% of new AF cases received antithrombotic drugs. Treatment was less common among women and older people. CONCLUSION Incidence and prevalence of AF are relatively high in the elderly in Germany. A considerable fraction of new AF cases did not receive antithrombotic drugs in routine care.

The contribution of comorbidities to mortality in hospitalized patients with heart failure

BackgroundHeart failure (HF) with reduced ejection fraction (HFrEF) has a worse prognosis than HF with preserved EF (HFpEF). The study aimed to evaluate whether different comorbidity profiles of HFrEF- and HFpEF-patients or HF-specific mechanisms contribute to a greater extent to this difference.MethodsWe linked data from two health insurances to data from a cardiology clinic hospital information system. Patients with a hospitalization with HF in 2005–2011, categorized as HFrEF (EF < 45%) or HFpEF (EF ≥ 45%), were propensity score (PS) matched to controls without HF on comorbidites and medication to assure similar comorbidity profiles of patients and their respective controls. The balance of the covariates in patients and controls was compared via the standardized difference (SDiff). Age-standardized 1-year mortality rates (MR) with 95% confidence intervals (CI) were calculated.Results777 HFrEF-patients (1135 HFpEF-patients) were PS-matched to 3446 (4832) controls. Balance between patients and controls was largely achieved with a SDiff < 0.1 on most variables considered. The age-standardized 1-year MRs per 1000 persons in HFrEF-patients and controls were 267.8 (95% CI 175.9–359.8) and 86.1 (95% CI 70.0–102.3). MRs in HFpEF-patients and controls were 166.2 (95% CI 101.5–230.9) and 61.5 (95% CI 52.9–70.1). Thus, differences in MRs between patients and their controls were higher for HFrEF (181.7) than for HFpEF (104.7).ConclusionsGiven the similar comorbidity profiles between HF-patients and controls, the higher difference in mortality rates between HFrEF-patients and controls points more to HF-specific mechanisms for these patients, whereas for HFpEF-patients a higher contribution of comorbidity is suggested by our results.

Nutzungsmöglichkeiten von Routinedaten der Gesetzlichen Krankenversicherung in der Gesundheitsberichterstattung des Bundes

ZusammenfassungDie Gesundheitsberichterstattung (GBE) des Bundes übernimmt zentrale Aufgaben in der Politikberatung sowie bei der Information der Öffentlichkeit über den Gesundheitszustand und das Gesundheitsverhalten der Bevölkerung. Routinedaten der Gesetzlichen Krankenversicherungen (GKV) wurden hierzu bisher wenig genutzt. GKV-Routinedaten ermöglichen Analysen zur Häufigkeit von Krankheiten und Risikofaktoren sowie von Krankheitsverläufen, des Inanspruchnahmeverhaltens von Gesundheitsleistungen und der Mortalität. Vorteile der Nutzung von GKV-Daten für die GBE des Bundes ergeben sich aus der sektorübergreifenden Perspektive und der weitgehenden Abwesenheit von Selektions- und Recall-Bias in der jeweiligen Versicherungspopulation. Zudem ermöglichen es die großen Stichprobenumfänge und die kontinuierliche Erhebung der Daten, selbst bei tiefgliedriger Stratifizierung belastbare Aussagen über den Gesundheitszustand der Versicherten zu treffen. Dem stehen Nachteile, die sich aus dem Abrechnungscharakter der Daten ergeben, sowie die hohen administrativen Hürden im Genehmigungsprozess zur Datennutzung entgegen. Vor dem Hintergrund einer zukünftig vereinfachten Verfügbarkeit von Daten aller GKV-Versicherten für forschende Einrichtungen im Rahmen des Versorgungsstrukturgesetzes stellen GKV-Routinedaten eine interessante Datenbasis für die GBE des Bundes dar.AbstractFederal health monitoring deals with the state of health and the health-related behavior of populations and is used to inform politics. To date, the routine data from statutory health insurances (SHI) have rarely been used for federal health monitoring purposes. SHI routine data enable analyses of disease frequency, risk factors, the course of the disease, the utilization of medical services, and mortality rates. The advantages offered by SHI routine data regarding federal health monitoring are the intersectoral perspective and the nearly complete absence of recall and selection bias in the respective population. Further, the large sample sizes and the continuous collection of the data allow reliable descriptions of the state of health of the insurants, even in cases of multiple stratification. These advantages have to be weighed against disadvantages linked to the claims nature of the data and the high administrative hurdles when requesting the use of SHI routine data. Particularly in view of the improved availability of data from all SHI insurants for research institutions in the context of the “health-care structure law”, SHI routine data are an interesting data source for federal health monitoring purposes.

Validating mortality in the German Pharmacoepidemiological Research Database (GePaRD) against a mortality registry

The study aimed at validating the status and date of death of a large electronic health insurance database against data of a mortality registry, using a probabilistic record linkage.

Evaluating methods for intersectoral comparison of quality of care. A routine data analysis of elective percutaneous coronary interventions.

OBJECTIVES To compare the quality of care regarding the use of elective percutaneous coronary interventions (PCIs) in the inpatient and outpatient setting and to evaluate different methods of confounder control in this context. METHODS Based on data of three statutory health insurances including more than nine million insurance members, a retrospective cohort study between 2005 and 2009 was conducted. The occurrence of myocardial infarction, stroke, further coronary intervention and death was ascertained following the first PCI in the study period, which was preceded by a one-year period without a PCI. A Cox proportional hazard model was used to assess the influence of the setting of the elective PCI on the risk for complications after the PCI for each outcome separately. Age, sex, the number of diseases of the Elixhauser comorbidity measure, past acute coronary syndrome, coronary artery disease, dyslipidemia, past stroke, past coronary artery bypass surgery and the year of the PCI were included as covariables. The analyses were repeated in a propensity score matched cohort as well as in inverse probability of treatment weighted analyses. RESULTS The cohort comprised 4,269 patients with an outpatient PCI and 26,044 patients with an inpatient PCI. The majority of the analyses revealed no statistically significant effect of the setting of the PCI on the risk of myocardial infarction, stroke and further coronary interventions, whereas a reduced mortality risk was observed for outpatient PCIs. Similar results were obtained in the propensity score analyses. CONCLUSIONS The analysis revealed that the adjusted risk for complications following an elective PCI is similar between the inpatient and the outpatient setting. For mortality the risk differed but this might be explained by residual or unmeasured confounding. The different methods applied in this study revealed mostly similar results. Since our study only covered one aspect of quality of care in the field of PCI and did not consider drug treatment in hospital or in the outpatient setting, further studies are needed which include these aspects.

Use of routine data from statutory health insurances for federal health monitoring purposes

ZusammenfassungDie Gesundheitsberichterstattung (GBE) des Bundes übernimmt zentrale Aufgaben in der Politikberatung sowie bei der Information der Öffentlichkeit über den Gesundheitszustand und das Gesundheitsverhalten der Bevölkerung. Routinedaten der Gesetzlichen Krankenversicherungen (GKV) wurden hierzu bisher wenig genutzt. GKV-Routinedaten ermöglichen Analysen zur Häufigkeit von Krankheiten und Risikofaktoren sowie von Krankheitsverläufen, des Inanspruchnahmeverhaltens von Gesundheitsleistungen und der Mortalität. Vorteile der Nutzung von GKV-Daten für die GBE des Bundes ergeben sich aus der sektorübergreifenden Perspektive und der weitgehenden Abwesenheit von Selektions- und Recall-Bias in der jeweiligen Versicherungspopulation. Zudem ermöglichen es die großen Stichprobenumfänge und die kontinuierliche Erhebung der Daten, selbst bei tiefgliedriger Stratifizierung belastbare Aussagen über den Gesundheitszustand der Versicherten zu treffen. Dem stehen Nachteile, die sich aus dem Abrechnungscharakter der Daten ergeben, sowie die hohen administrativen Hürden im Genehmigungsprozess zur Datennutzung entgegen. Vor dem Hintergrund einer zukünftig vereinfachten Verfügbarkeit von Daten aller GKV-Versicherten für forschende Einrichtungen im Rahmen des Versorgungsstrukturgesetzes stellen GKV-Routinedaten eine interessante Datenbasis für die GBE des Bundes dar.AbstractFederal health monitoring deals with the state of health and the health-related behavior of populations and is used to inform politics. To date, the routine data from statutory health insurances (SHI) have rarely been used for federal health monitoring purposes. SHI routine data enable analyses of disease frequency, risk factors, the course of the disease, the utilization of medical services, and mortality rates. The advantages offered by SHI routine data regarding federal health monitoring are the intersectoral perspective and the nearly complete absence of recall and selection bias in the respective population. Further, the large sample sizes and the continuous collection of the data allow reliable descriptions of the state of health of the insurants, even in cases of multiple stratification. These advantages have to be weighed against disadvantages linked to the claims nature of the data and the high administrative hurdles when requesting the use of SHI routine data. Particularly in view of the improved availability of data from all SHI insurants for research institutions in the context of the “health-care structure law”, SHI routine data are an interesting data source for federal health monitoring purposes.

The Potential of High‐Dimensional Propensity Scores in Health Services Research: An Exemplary Study on the Quality of Care for Elective Percutaneous Coronary Interventions

OBJECTIVE Evaluating the potential of the high-dimensional propensity score (HDPS) to control for residual confounding in studies analyzing quality of care based on administrative health insurance data. DATA SOURCE Secondary data from 2004 to 2009 from three German statutory health insurance providers. STUDY DESIGN We conducted a retrospective cohort study in patients with elective percutaneous coronary interventions (PCIs) and compared the mortality risk between the in- and outpatient setting using Cox regression. Adjustment for predefined confounders was performed using conventional propensity score (PS) techniques. Further, an HDPS was calculated based on predefined and empirically selected confounders from the database. PRINCIPAL FINDINGS Conventional PS methods showed a decreased mortality risk for outpatient compared to inpatient PCIs, while trimming of patients with nonoverlap in the HDPS distribution and weighting resulted in a comparable risk. Most comorbidities were less prevalent in the HDPS-trimmed population compared to the original one. CONCLUSION The HDPS methodology may reduce residual confounding by rendering the studied cohort more comparable through restriction. However, results cannot be generalized for the entire study population. To provide unbiased results, full assessment of all unmeasured confounders from proxy information in the database would be necessary.

Nutzungsmöglichkeiten von Routinedaten der Gesetzlichen Krankenversicherung in der Gesundheitsberichterstattung des Bundes@@@Use of routine data from statutory health insurances for federal health monitoring purposes

ZusammenfassungDie Gesundheitsberichterstattung (GBE) des Bundes übernimmt zentrale Aufgaben in der Politikberatung sowie bei der Information der Öffentlichkeit über den Gesundheitszustand und das Gesundheitsverhalten der Bevölkerung. Routinedaten der Gesetzlichen Krankenversicherungen (GKV) wurden hierzu bisher wenig genutzt. GKV-Routinedaten ermöglichen Analysen zur Häufigkeit von Krankheiten und Risikofaktoren sowie von Krankheitsverläufen, des Inanspruchnahmeverhaltens von Gesundheitsleistungen und der Mortalität. Vorteile der Nutzung von GKV-Daten für die GBE des Bundes ergeben sich aus der sektorübergreifenden Perspektive und der weitgehenden Abwesenheit von Selektions- und Recall-Bias in der jeweiligen Versicherungspopulation. Zudem ermöglichen es die großen Stichprobenumfänge und die kontinuierliche Erhebung der Daten, selbst bei tiefgliedriger Stratifizierung belastbare Aussagen über den Gesundheitszustand der Versicherten zu treffen. Dem stehen Nachteile, die sich aus dem Abrechnungscharakter der Daten ergeben, sowie die hohen administrativen Hürden im Genehmigungsprozess zur Datennutzung entgegen. Vor dem Hintergrund einer zukünftig vereinfachten Verfügbarkeit von Daten aller GKV-Versicherten für forschende Einrichtungen im Rahmen des Versorgungsstrukturgesetzes stellen GKV-Routinedaten eine interessante Datenbasis für die GBE des Bundes dar.AbstractFederal health monitoring deals with the state of health and the health-related behavior of populations and is used to inform politics. To date, the routine data from statutory health insurances (SHI) have rarely been used for federal health monitoring purposes. SHI routine data enable analyses of disease frequency, risk factors, the course of the disease, the utilization of medical services, and mortality rates. The advantages offered by SHI routine data regarding federal health monitoring are the intersectoral perspective and the nearly complete absence of recall and selection bias in the respective population. Further, the large sample sizes and the continuous collection of the data allow reliable descriptions of the state of health of the insurants, even in cases of multiple stratification. These advantages have to be weighed against disadvantages linked to the claims nature of the data and the high administrative hurdles when requesting the use of SHI routine data. Particularly in view of the improved availability of data from all SHI insurants for research institutions in the context of the “health-care structure law”, SHI routine data are an interesting data source for federal health monitoring purposes.