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Published on: February 26, 2013
Validation of self-reported and hospital-diagnosed atrial fibrillation: the HUNT study
Vegard Malmo1, Arnulf Langhammer2, Kaare H Bønaa3
1Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Department of Cardiology, St Olav's Hospital, Trondheim, Norway.
Insights
Self-reported atrial fibrillation (AF) diagnoses have low sensitivity. Combining questionnaires with health care register data significantly improves AF case identification in population studies.
Area of Science:
- Epidemiology
- Cardiovascular Research
- Health Informatics
Background:
- Atrial fibrillation (AF) identification often relies on self-reports or hospital records.
- Validation of these methods is crucial for accurate population-based studies.
Purpose of the Study:
- To validate self-reported AF diagnoses against hospital discharge diagnoses.
- To assess the accuracy of AF identification methods in a population-based cohort.
Main Methods:
- Included 16,247 participants from the HUNT Study (HUNT3).
- Utilized self-reported AF from questionnaires and AF diagnoses from hospital/primary care registers.
- Verified all diagnoses through medical record review.
Main Results:
- Self-reported AF had 49.6% sensitivity and 99.2% specificity.
- Hospital discharge diagnoses showed 73.7% sensitivity and 99.7% specificity.
- Register data substantially enhanced AF case ascertainment compared to self-reports alone.
Conclusions:
- Questionnaire-based AF identification alone has limited sensitivity.
- Integrating health care register data significantly improves AF prevalence and incidence estimates.
- Health care registers are essential for accurate AF epidemiology.
Background:
Self-reported atrial fibrillation (AF) and diagnoses from hospital registers are often used to identify persons with AF. The objective of this study was to validate self-reported AF and hospital discharge diagnoses of AF among participants in a population-based study.
Materials And Methods:
Among 50,805 persons who participated in the third survey of the HUNT Study (HUNT3), 16,247 participants from three municipalities were included. Individuals who reported cardiovascular disease, renal disease, or hypertension in the main questionnaire received a cardiovascular-specific questionnaire. An affirmative answer to a question on physician-diagnosed AF in this second questionnaire defined self-reported AF diagnoses in the study. In addition, AF diagnoses were retrieved from hospital and primary care (PC) registers. All AF diagnoses were verified by review of hospital and PC medical records.
Results:
A total of 502 HUNT3 participants had a diagnosis of AF verified in hospital or PC records. Of these, 249 reported their AF diagnosis in the HUNT3 questionnaires and 370 had an AF diagnosis in hospital discharge registers before participation in HUNT3. The sensitivity of self-reported AF in HUNT3 was 49.6%, specificity 99.2%, positive predictive value (PPV) 66.2%, and negative predictive value (NPV) 98.4%. The sensitivity of a hospital discharge diagnosis of AF was 73.7%, specificity 99.7%, PPV 88.5%, and NPV 99.2%.
Conclusion:
Use of questionnaires alone to identify cases of AF has low sensitivity. Extraction of diagnoses from health care registers enhances the sensitivity substantially and should be applied when estimates of incidence and prevalence of AF are studied.
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