A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study.

Background:
The prognostic impact of heart failure relative to that of ‘high-profile’ disease states such as cancer, within the whole population, is unknown.

Methods:
All patients with a first admission to any Scottish hospital in 1991 for heart failure, myocardial infarction or the four most common types of cancer specific to men and women were identified. Five-year survival rates and associated loss of expected life-years were then compared.

Results:
In 1991, 16224 men had an initial hospitalisation for heart failure (n - 3241), myocardial infarction (n - 6932) or cancer of the lung, large bowel, prostate or bladder (n - 6051). Similarly, 14842 women were admitted for heart failure (n - 3606), myocardial infarction (n - 4916), or cancer of the breast, lung, large bowel or ovary (n - 6320). With the exception of lung cancer, heart failure was associated with the poorest 5-year survival rate (approximately 25% for both sexes). On an adjusted basis, heart failure was associated with worse long-term survival than bowel cancer in men (adjusted odds ratio, 0.89; 95% CI, 0.82–0.97; P < 0.01) and breast cancer in women (odds ratio, 0.59; 95% CI, 0.55–0.64; P < 0.001). The overall population rate of expected life-years lost due to heart failure in men was 6.7 years/1000 and for women 5.1 years/1000.

Conclusion:
With the notable exception of lung cancer, heart failure is as ‘malignant’ as many common types of cancer and is associated with a comparable number of expected life-years lost.

More ‘malignant’ than cancer? Five‐year survival following a first admission for heart failure

SUMMARY In the light of an increasing interest in the accountability of public institutions, this paper sets out the statistical issues involved in making quantitative comparisons between institutions in the areas of health and education. We deal in detail with the need to take account of model-based uncertainty in making comparisons. We discuss the need to establish appropriate measures of institutional 'outcomes' and base-line measures and the need to exercise care and sensitivity when interpreting apparent differences. The paper emphasizes that statistical methods exist which can contribute to an understanding of the extent and possible reasons for differences between institutions. It also urges caution by discussing the limitations of such methods.

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League Tables and Their Limitations: Statistical Issues in Comparisons of Institutional Performance

https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1467-842X.1999.tb01297.x

Population-based linkage of health records in Western Australia: development of a health services research linked database.

Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study

Howard Newcombe, pioneer and founder of probability matching techniques, has illustrated the continuing dialectic between the theory and the practical craft of linkage. From the point of view of the development of record linkage in Scotland his most valuable contribution, beyond his initial formulation of the principles of probability matching, has been his emphasis on being guided by the characteristics and structure of the data sets in question and close empirical attention to the emergent qualities of each linkage (Newcombe et al. 1959; Newcombe, 1988). Particularly inspiring has been his insistence that probability matching is at heart a simple and intuitive process and should not be turned into a highly specialised procedure isolated from the day to day concerns of the organisation in which it is carried out (Newcombe et al. 1986).

S Kendrick

Papers

The Scottish Record Linkage System.