scholarly journals Using machine learning to predict anticoagulation control in atrial fibrillation: A UK Clinical Practice Research Datalink study

2021 ◽  
pp. 100688
Author(s):  
Jason Gordon ◽  
Max Norman ◽  
Michael Hurst ◽  
Thomas Mason ◽  
Carissa Dickerson ◽  
...  
Keyword(s):  
Machine Learning ◽  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Anticoagulation Control

scholarly journals Risk of Recurrent Bleeding Events in Nonvalvular Atrial Fibrillation Treated with Vitamin K Antagonists: A Clinical Practice Research Datalink Study

TH Open ◽  
2019 ◽  
Vol 03 (04) ◽  
pp. e316-e324 ◽  
Author(s):  
Raza Alikhan ◽  
Cinira Lefevre ◽  
Ian Menown ◽  
Steven Lister ◽  
Alex Bird ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Recurrent Bleeding ◽  
Bleeding Events ◽  
Nonvalvular Atrial Fibrillation ◽  
The Impact

Abstract Background There is little evidence on how the occurrence of a bleed in individuals on vitamin K antagonists (VKAs) impacts the risk of subsequent bleeds, and thromboembolic and ischemic events. Such information would help to inform treatment decisions following bleeds. Objective To estimate the impact of bleeding events on the risk of subsequent bleeds, venous thromboembolism (VTE), stroke, and myocardial infarction (MI) among patients initiating VKA treatment for new-onset nonvalvular atrial fibrillation (NVAF). Methods We conducted an observational cohort study using a linked Clinical Practice Research Datalink—Hospital Episode Statistics dataset. Among a cohort of individuals with NVAF, the risk of clinically relevant bleeding, VTE, stroke, and MI was compared between the period prior to the first bleed and the periods following each subsequent bleed. The rate and cost of general practitioner (GP) consultations, prescriptions, and hospitalizations were also compared across these periods. Results The risk of clinically relevant bleeding events was observed to be elevated at least twofold in all periods following the first bleeding event. The risk of VTE, stroke, and MI was not found to differ according to the number of clinically relevant bleeding events. The rate and cost of GP consultations, GP prescriptions, and hospitalizations were increased in all periods relative to the period prior to the first bleed. Conclusions The doubling in the risk of bleeding following the first bleed, taken alongside the stable risk of MI, VTE, and stroke, suggests that the risk–benefit balance for VKA treatment should be reconsidered following the first clinically relevant bleed.

scholarly journals Impact of atrial fibrillation awareness campaigns: interrupted time series using the Clinical Practice Research Datalink

2019 ◽  
Vol 15 (4) ◽  
pp. 311-318
Author(s):  
Victoria Allan ◽  
Cormac J Sammon ◽  
Laura McDonald ◽  
Faisal Mehmud ◽  
Raza Alikhan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Poisson Regression ◽  
Heart Rhythm ◽  
Interrupted Time Series ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Short Term ◽  
Awareness Campaigns ◽  
Over Time

Aim: This study investigated whether the rates of atrial fibrillation (AF) consultations changed following AF awareness campaigns in England. Materials & methods: Among adults in the Clinical Practice Research Datalink, Poisson regression was used to model weekly rates of AF-related consultations over time. The models were used to assess whether rates changed in the 8 weeks following World Heart Rhythm Week (WHRW) and Global AF aware week. Results: A higher incidence of pulse checks was observed following WHRW (IRR 1.16 [95% CI 1.08–1.24]). No difference in the incidence of AF diagnoses was noted following WHRW (IRR: 1.03 [95% CI: 0.97–1.09]) or Global AF aware week (IRR: 0.94 [95% CI: 0.88–1.00]). Conclusion: The results suggest AF campaigns may increase awareness but do not bring about short-term increases in the rates of AF diagnoses.

scholarly journals Nonindependence of patient data in the clinical practice research datalink: a case study in atrial fibrillation patients

2020 ◽  
Vol 9 (6) ◽  
pp. 395-403
Author(s):  
Cormac J Sammon ◽  
Thomas P Leahy ◽  
Sreeram Ramagopalan
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Clinical Characteristics ◽  
Patient Data ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Nonvalvular Atrial Fibrillation ◽  
Patient Registration ◽  
The Impact

Aim: The impact of different strategies to handle patients with data recorded under multiple Clinical Practice Research Datalink (CPRD) identifiers (IDs) is unknown. Patients and methods: Six approaches to handling patients appearing under multiple CPRD IDs were defined. The impact of the approaches was illustrated using a case study describing the clinical characteristics of a population of nonvalvular atrial fibrillation patients. Results: 5.6% of patients had more than one CPRD ID. Across all six approaches implemented, no material difference in the characteristics of nonvalvular atrial fibrillation patients were observed. Conclusion: While strategies which longitudinally append patient registration periods under different CPRD IDs maintain independence while using all available data, their implementation had little impact on the results of our case study.

scholarly journals Determinants of oral anticoagulation control in new warfarin patients: analysis using data from Clinical Practice Research Datalink

2015 ◽  
Vol 136 (2) ◽  
pp. 250-260 ◽  
Author(s):  
Ana Filipa Macedo ◽  
James Bell ◽  
Ciaran McCarron ◽  
Rachel Conroy ◽  
James Richardson ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Oral Anticoagulation ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Anticoagulation Control ◽  
Using Data

Abstract 18371: Higher Treatment Persistence of Non-Vitamin K Antagonist Oral Anticoagulants than Vitamin K Antagonists at 1 Year in Non-Valvular Atrial Fibrillation in Real-World Practice

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Carlos Martinez ◽  
Christopher Wallenhorst ◽  
Anja Katholing ◽  
Ben Freedman
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Vitamin K ◽  
Real World ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Ease Of Use ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
One Year

Introduction: Oral anticoagulants (OAC) are under-utilised in atrial fibrillation (AF). Even patients prescribed an OAC may stop taking the drug soon after treatment initiation, particularly with Vitamin K Antagonists (VKA). The Non-VKA OAC (NOAC) drugs offer greater ease of use, and persistence is likely to be higher. Aim: To determine persistence on treatment in the first year after inception of NOACs and VKA in incident AF in real-world clinical practice. Methods: We studied 24,467 OAC-naïve patients with incident non-valvular AF diagnosed between Jan 2011-Feb 2014, mean age 73.9 ± 12.5, 45.6% female, in a very large UK primary care database (Clinical Practice Research Datalink, CRPD), with full linkage to medication use. Follow up was for a mean of 1.2 ± 0.9 years. The proportion of OAC initiation in the 90 days after first-time AF and of those remaining on OAC one year after initiation were estimated using competing risk survival analyses censoring for use of alternative OAC. Results: NOAC drugs prescribed included Rivaroxaban, Dabigatran and Apixaban. Overall, 12,579 (51.4%) were commenced on an OAC: 11,888 on VKA and 691 on NOAC, within 90 days after incident AF. Amongst all OAC users, the proportion taking NOAC increased from 0.3% in 2011 to 12.3% in 2014. Persistence, defined as the proportion still taking the OAC after one year, declined over the 12 months to 54.3% for VKA and 80.7% for NOAC (Table). Persistence was significantly greater for NOAC than VKA at all time points. Conclusions: There is a progressive fall in VKA use amongst OAC naïve patients with AF in real-world practice to only 54% at 1 year. This contributes to under-utilisation of anticoagulation in AF and would result in an increased rate of stroke. Persistence was significantly improved with NOACs compared to VKA, and this factor alone could lead to reduced stroke burden with increasing uptake of the NOACs.

Abstract 19565: SAMeTT2R2 Scores Predict Stroke Risk After Initiation of Vitamin K Antagonist Therapy for Atrial Fibrillation: a Real-world Practice Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Carlos Martinez ◽  
Anja Katholing ◽  
Stephan Reitbrock ◽  
Gregory Y Lip ◽  
Ben Freedman
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Real World ◽  
Stroke Risk ◽  
Vitamin K Antagonist ◽  
Practice Research ◽  
Rank Test ◽  
Clinical Practice Research Datalink ◽  
Stroke Incidence ◽  
Anticoagulation Control

Introduction: Quality and duration of anticoagulation reflected by high proportion of Time in Therapeutic INR range (TTR) is associated with reduced thrombo-embolic and bleeding events in atrial fibrillation (AF). SAMeTT2R2, a novel score incorporating age, sex, ethnicity, smoking, co-morbidities, and interacting drugs, predicts inadequate anticoagulation control (TTR <0.6) after commencing Vitamin K Antagonist (VKA) for AF, with scores ≥2 suggested as a cut-off to predict inadequate control. Aims: To determine whether SAMeTT2R2 score ≥2 at VKA inception is associated with an increased stroke risk in real-world practice. Methods: A cohort of VKA-naïve patients with incident non-valvular AF between 2001 - 2010 was formed from a large UK primary care database (Clinical Practice Research Datalink, CPRD) with linkage to hospital discharges, and death registry. SAMeTT2R2 score was calculated in a subset of 4468 in whom VKA treatment was initiated within 90 days of AF diagnosis, and scores 0-1, ≥2 were related to 3-year stroke incidence. Competing risk analysis accounting for death was performed to compare the risk of stroke between the two groups in an intention-to-treat analysis. Results: Of 4468 patients with incident AF commenced on VKA (mean age 70.7, 41.2% female), 3422 (76.6%) had a SAMeTT2R2 score of 0-1, and 1046 (23.4%) a score of ≥2. During 3-years 138 patients had a stroke and 58 of these occurred in the year following AF. Cumulative risk estimates for stroke in patients with scores ≥2 compared to 0-1 were significantly increased at 1, 2 and 3 years (log rank test, p<0.01)(Figure). The proportion with TTR≥0.6 was 37.1% for scores ≥2 compared to 44.1% for scores 0-1 (p<0.01). Conclusions: SAMeTT2R2 scores ≥2 predict increased stroke risk in the 3 years following incident AF in patients commenced on VKA treatment. These findings suggest that patients with high SAMeTT2R2 scores may require intensified anticoagulation control or use of oral non-VKA anticoagulants.

scholarly journals Use of oral anticoagulants in older people with atrial fibrillation in UK general practice: protocol for a cohort study using the Clinical Practice Research Datalink (CPRD) database

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e032646
Author(s):  
Anneka Mitchell ◽  
Tomas J Welsh ◽  
Margaret C Watson ◽  
Julia Snowball ◽  
Anita McGrogan
Keyword(s):  
Atrial Fibrillation ◽  
General Practice ◽  
Cohort Study ◽  
Clinical Practice ◽  
Older People ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Standard Data

IntroductionWarfarin has frequently been underused in older people for stroke prevention in atrial fibrillation (AF). Direct oral anticoagulants (DOACs) entered the UK market from 2008 and have been recommended as an alternative to warfarin. This study aimed to describe any changes in the prescribing of oral anticoagulants (OACs) to people aged ≥75 years in UK general practice before and after the introduction of DOACs, to examine differences in patient characteristics which may influence prescribers’ decisions regarding anticoagulation, to evaluate the time people stay on OACs and switching between OACs.Methods and analysisA retrospective cohort study design will be used. Patients with a diagnosis of AF will be identified from the Clinical Practice Research Datalink (CPRD). The study period will run from 1 January 2003 to 27 December 2017. Patients enter the cohort at the latest date of the start of the study period, first AF diagnosis, 75th birthday or a year from when they started to contribute research standard data. Follow-up continues until they leave the practice, death, the date the practice stops contributing research standard data or the end of the study period (27 December 2017). Exposure to OACs will be defined as ≥1 prescription issued for an OAC of interest during the study period. Patients issued an OAC in the year preceding study entry will be defined as ‘prevalent users’. Patients starting on an OAC during the study period will be defined as ‘incident users’. Incidence and prevalence of OAC prescribing, patient demographics and characteristics will be described during three time periods: 2003–2007, 2008–2012 and 2013–2017. Persistence (defined as the time from initiation to discontinuation of medication) with and switching between different OACs will be described.Ethics and disseminationThe protocol for this study was approved by the CPRD Independent Scientific Advisory Committee. The results will be disseminated in a peer-reviewed journal and at conferences.Trial registration numberEUPAS29923.

scholarly journals Real-world effects of medications for stroke prevention in atrial fibrillation: protocol for a UK population-based non-interventional cohort study with validation against randomised trial results

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e042947
Author(s):  
Emma Maud Powell ◽  
Ian J Douglas ◽  
Usha Gungabissoon ◽  
Liam Smeeth ◽  
Kevin Wing
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Treatment Effectiveness ◽  
Vitamin K Antagonists ◽  
Randomised Trial ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Drug Effectiveness ◽  
Treatment Groups ◽  
Increased Risk

IntroductionPatients with atrial fibrillation experience an irregular heart rate and have an increased risk of stroke; prophylactic treatment with anticoagulation medication reduces this risk. Direct-acting oral anticoagulants (DOACs) have been approved providing an alternative to vitamin K antagonists such as warfarin. There is interest from regulatory bodies on the effectiveness of medications in routine clinical practice; however, uncertainty remains regarding the suitability of non-interventional data for answering questions on drug effectiveness and on the most suitable methods to be used. In this study, we will use data from Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE)—the pivotal trial for the DOAC apixaban—to validate non-interventional methods for assessing treatment effectiveness of anticoagulants. These methods could then be applied to analyse treatment effectiveness in people excluded from or under-represented in ARISTOTLE.Methods and analysisPatient characteristics from ARISTOTLE will be used to select a cohort of patients with similar baseline characteristics from two UK electronic health record (EHR) databases, Clinical Practice Research Datalink Gold and Aurum (between 1 January 2013 and 31 July 2019). Methods such as propensity score matching and coarsened exact matching will be explored in matching between EHR treatment groups to determine the optimal method of obtaining a balanced cohort.Absolute and relative risk of outcomes in the EHR trial-analogous cohort will be calculated and compared with the ARISTOTLE results; if results are deemed compatible the methods used for matching EHR treatment groups can then be used to examine drug effectiveness over a longer duration of exposure and in special patient groups of interest not studied in the trial.Ethics and disseminationThe study has been approved by the Independent Scientific Advisory Committee of the UK Medicines and Healthcare Products Regulatory Agency. Results will be disseminated in scientific publications and at relevant conferences.

Sign in / Sign up

Export Citation Format

Share Document