Atrial fibrillation: Improvement in identification and stroke preventive therapy —Data from the UK Clinical Practice Research Datalink, 2000–2012

ObjectivesThe ability to efficiently and accurately predict future risk of primary total hip and knee replacement (THR/TKR) in earlier stages of osteoarthritis (OA) has potentially important applications. We aimed to develop and validate two models to estimate an individual’s risk of primary THR and TKR in patients newly presenting to primary care.MethodsWe identified two cohorts of patients aged ≥40 years newly consulting hip pain/OA and knee pain/OA in the Clinical Practice Research Datalink. Candidate predictors were identified by systematic review, novel hypothesis-free ‘Record-Wide Association Study’ with replication, and panel consensus. Cox proportional hazards models accounting for competing risk of death were applied to derive risk algorithms for THR and TKR. Internal–external cross-validation (IECV) was then applied over geographical regions to validate two models.Results45 predictors for THR and 53 for TKR were identified, reviewed and selected by the panel. 301 052 and 416 030 patients newly consulting between 1992 and 2015 were identified in the hip and knee cohorts, respectively (median follow-up 6 years). The resultant model C-statistics is 0.73 (0.72, 0.73) and 0.79 (0.78, 0.79) for THR (with 20 predictors) and TKR model (with 24 predictors), respectively. The IECV C-statistics ranged between 0.70–0.74 (THR model) and 0.76–0.82 (TKR model); the IECV calibration slope ranged between 0.93–1.07 (THR model) and 0.92–1.12 (TKR model).ConclusionsTwo prediction models with good discrimination and calibration that estimate individuals’ risk of THR and TKR have been developed and validated in large-scale, nationally representative data, and are readily automated in electronic patient records.

Download Full-text

Statin use and reduced risk of biliary tract cancers in the UK Clinical Practice Research Datalink

Gut ◽

10.1136/gutjnl-2018-317504 ◽

2018 ◽

Vol 68 (8) ◽

pp. 1458-1464 ◽

Cited By ~ 3

Author(s):

Zhiwei Liu ◽

Rotana Alsaggaf ◽

Katherine A McGlynn ◽

Lesley A Anderson ◽

Huei-Ting Tsai ◽

...

Keyword(s):

Clinical Practice ◽

Biliary Tract ◽

Conditional Logistic Regression ◽

Incidence Density ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Biliary Tract Cancers ◽

The Uk ◽

Reduced Risk ◽

Statin Use

ObjectiveTo evaluate the association between statin use and risk of biliary tract cancers (BTC).DesignThis is a nested case–control study conducted in the UK Clinical Practice Research Datalink. We included cases diagnosed with incident primary BTCs, including cancers of the gall bladder, bile duct (ie, both intrahepatic and extrahepatic cholangiocarcinoma), ampulla of Vater and mixed type, between 1990 and 2017. For each case, we selected five controls who did not develop BTCs at the time of case diagnosis, matched by sex, year of birth, calendar time and years of enrolment in the general practice using incidence density sampling. Exposures were defined as two or more prescription records of statins 1 year prior to BTC diagnosis or control selection. ORs and 95% CIs for associations between statins and BTC overall and by subtypes were estimated using conditional logistic regression, adjusted for relevant confounders.ResultsWe included 3118 BTC cases and 15 519 cancer-free controls. Current statin use versus non-use was associated with a reduced risk of all BTCs combined (adjusted OR=0.88, 95% CI 0.79 to 0.98). The reduced risks were most pronounced among long-term users, as indicated by increasing number of prescriptions (ptrend=0.016) and cumulative dose of statins (ptrend=0.008). The magnitude of association was similar for statin use and risk of individual types of BTCs. The reduced risk of BTCs associated with a record of current statin use versus non-use was more pronounced among persons with diabetes (adjusted OR=0.72, 95% CI 0.57 to 0.91). Among non-diabetics, the adjusted OR for current statin use versus non-use was 0.91 (95% CI 0.81 to 1.03, pheterogeneity=0.007).ConclusionCompared with non-use of statins, current statin use is associated with 12% lower risk of BTCs; no association found with former statin use. If replicated, particularly in countries with a high incidence of BTCs, our findings could pave the way for evaluating the value of statins for BTC chemoprevention.

Download Full-text

Validation of hip osteoarthritis diagnosis recording in the UK Clinical Practice Research Datalink

Pharmacoepidemiology and Drug Safety ◽

10.1002/pds.4673 ◽

2018 ◽

Vol 28 (2) ◽

pp. 187-193 ◽

Cited By ~ 3

Author(s):

Rory J. Ferguson ◽

Daniel Prieto‐Alhambra ◽

Christine Walker ◽

Dahai Yu ◽

Jose M. Valderas ◽

...

Keyword(s):

Clinical Practice ◽

Hip Osteoarthritis ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

The Uk

Download Full-text

Risk factors for nonfatal self‐harm and suicide among adolescents: two nested case–control studies conducted in the UK Clinical Practice Research Datalink

Journal of Child Psychology and Psychiatry ◽

10.1111/jcpp.13552 ◽

2021 ◽

Author(s):

Lukasz Cybulski ◽

Darren M. Ashcroft ◽

Matthew J. Carr ◽

Shruti Garg ◽

Carolyn A. Chew‐Graham ◽

...

Keyword(s):

Risk Factors ◽

Clinical Practice ◽

Case Control ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Case Control Studies ◽

Self Harm ◽

The Uk ◽

Nested Case Control

Download Full-text

The use of 5-aminosalicylates in Crohn’s disease: a retrospective study using the UK Clinical Practice Research Datalink

Annals of Gastroenterology ◽

10.20524/aog.2020.0521 ◽

2020 ◽

Author(s):

Ailsa Hart

Keyword(s):

Crohn’S Disease ◽

Clinical Practice ◽

Retrospective Study ◽

Crohn's Disease ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

The Uk

Download Full-text

The incidence, prevalence, and survival of systemic sclerosis in the UK Clinical Practice Research Datalink

Clinical Rheumatology ◽

10.1007/s10067-018-4182-3 ◽

2018 ◽

Vol 37 (8) ◽

pp. 2103-2111 ◽

Cited By ~ 24

Author(s):

Jeremy G. Royle ◽

Peter C. Lanyon ◽

Matthew J. Grainge ◽

Abhishek Abhishek ◽

Fiona A. Pearce

Keyword(s):

Clinical Practice ◽

Systemic Sclerosis ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

The Uk ◽

Incidence Prevalence

Download Full-text

Risk of ischemic stroke in asymptomatic atrial fibrillation incidentally-detected in primary care compared with other clinical presentations

Thrombosis and Haemostasis ◽

10.1055/a-1541-3885 ◽

2021 ◽

Author(s):

Christopher Wallenhorst ◽

Carlos Martinez ◽

Ben FREEDMAN

Keyword(s):

Atrial Fibrillation ◽

Primary Care ◽

Ischemic Stroke ◽

Stroke Risk ◽

Practice Research ◽

Mortality Data ◽

Clinical Practice Research Datalink ◽

Primary Hospital ◽

Ischemic Stroke Risk ◽

The Uk

Background: It is uncertain whether stroke risk of asymptomatic ambulatory atrial fibrillation (AA-AF) incidentally-detected in primary care is comparable with other clinical AF presentations in primary care or hospital. Methods: The stoke risk of 22,035 patients with incident non-valvular AF from the UK primary care Clinical Practice Research Datalink with linkage to hospitalization and mortality data, was compared to 23,605 controls without AF (age and sex-matched 5:1 to 5,409 AA-AF patients). Incident AF included 5,913 with symptomatic ambulatory AF (SA-AF); 4,989 with Primary and 5,724 with non-Primary Hospital AF discharge diagnosis (PH-AF and Non-PH-AF); and 5,409 with AA-AF. Ischemic stroke adjusted subhazard ratios (aSHR) within 3 years of AA-AF were compared with SA-AF, PH-AF, Non-PH-AF and controls, accounting for mortality as competing risk and adjusted for ischemic stroke risk factors. Results: There were 1026 ischemic strokes in 49,544 person-years in patients with incident AF (crude incidence rate 2.1 ischemic strokes/100 person-years). Ischemic stroke aSHR over 3 years showed no differences between AA-AF, and SA-AF, PH-AF and nonPH-AF groups (aSHR 0.87-1.01 vs AA-AF). All AF groups showed a significantly higher aSHR compared to controls. (subhazard rate ratio 0.40 [0.34 - 0.47]. Conclusion: Ischemic stroke risk in patients with AA-AF incidentally-detected in primary care is far from benign, and not less than incident AF presenting clinically in general practice or hospital. This provides justification for identification of previously undetected AF, e.g. by opportunistic screening, and subsequent stroke prevention with thromboprophylaxis, to reduce the approximately 10% of ischemic strokes related to unrecognized AF.

Download Full-text

How effective are dose-adjusted warfarin and aspirin for the prevention of stroke in patients with chronic atrial fibrillation?

Thrombosis and Haemostasis ◽

10.1160/th08-08-0499 ◽

2009 ◽

Vol 101 (03) ◽

pp. 527-534 ◽

Cited By ~ 26

Author(s):

Stephan Rietbrock ◽

Jonathan M. Plumb ◽

Arlene M. Gallagher ◽

Tjeerd P. van Staa

Keyword(s):

Atrial Fibrillation ◽

Clinical Practice ◽

Risk Reduction ◽

Relative Rate ◽

General Practice Research Database ◽

Chronic Atrial Fibrillation ◽

Practice Research ◽

Research Database ◽

Warfarin Treatment ◽

The Uk

SummaryThe objective of this study was to evaluate the rate of stroke associated with aspirin and warfarin in routine clinical practice. The study included patients aged 40+ with chronic atrial fibrillation (cAF) registered in the UK General Practice Research Database. The outcome was the rate of stroke during current, past and no use of aspirin and warfarin. The study included 51,807 cAF patients. There was no difference in the rate of stroke between current and past use of aspirin (relative rate [RR]=1.04 [95% confidence interval (CI) 0.94 – 1.15]), while the rate of stroke was reduced during current warfarin use compared to past use (RR=0.62 [95% CI 0.54 – 0.71]). For warfarin, a pattern of lower rates of stroke during current exposure and higher rates with past exposure was seen only in patients treated for at least 6–12 months. For aspirin, no changes in the rates of stroke were observed with discontinuation of aspirin. The effectiveness of warfarin was dependent on the level of anticoagulation, with optimal risk reduction occurring within the recommended international normalised ratio (INR) range of 2.0 to 3.0. The proportion of patients achieving a stable INR within the target therapeutic range was at its lowest during the first three months of warfarin treatment. In conclusion, the results of this study support the effectiveness of warfarin treatment to reduce the rate of stroke in cAF patients in the general clinical practice setting, however the risk reduction is lower than that reported in clinical trials.

Download Full-text