Prescription patterns of lipid lowering agents among older patients in general practice: an analysis from a national database in the Netherlands

Dyslipidemia is a major risk factor for atherosclerotic cardiovascular disease (ASCVD) in older people. In spite of the higher absolute risk in older patients, plasma lipids lose their ability to predict the development of ASCVD along with ageing, especially over 80 years old. However, lipid-lowering agents like statins can significantly inhibit the development of ASCVD in older patients as well as in younger patients. Current consensus about the lipid-lowering treatment in older patients is that we should treat early old patients (75 years old and younger) with or without ASCVD and in patients more than 75 years old with ASCVD as in the non-elderly by taking care of the drug-induced adverse effects. However, the treatment of the oldest patients without ASCVD with statins should be individualized and the statin treatment for those over 85 years old is under discretion of the physician.

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Benefits of Lipid-Lowering Agents Persists After Trials End

Clinical Endocrinology News ◽

10.1016/s1558-0164(11)70229-2 ◽

2011 ◽

Vol 6 (5) ◽

pp. 14

Author(s):

CAROLINE HELWICK

Keyword(s):

Lipid Lowering ◽

Lipid Lowering Agents

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Risk Estimate of Duodenoscope-Associated Infections in The Netherlands

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1102 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s436-s437

Author(s):

M. Vos ◽

Judith Kwakman ◽

Marco Bruno

Keyword(s):

The Netherlands ◽

Multidrug Resistant ◽

National Database ◽

Clinical Infection ◽

Minimum Risk ◽

Medical Practitioners ◽

Healthcare Facilities ◽

Calculated Risk ◽

Original Calculation ◽

Bare Minimum

Background: The likelihood of endoscopy-associated infections (EAIs) is often referenced from a paper published in 1993 by Kimmery et al1 in which a risk of 1 exogenous infection for every 1.8 million endoscopies (0.00006%) is proclaimed. Even though Ofstead et al2 pointed out in 2013 that this was at least an underestimation by 6-fold because of erroneous assumptions and mathematical errors, the original calculation is still often referred to. In the past decade, multiple outbreaks of multidrug-resistant microorganisms (MDROs) related to contaminated duodenoscopes have been reported worldwide. This leads to the assumption that the former risk calculation is indeed incorrect. Objective: We calculated the duodenoscope-associated infection (DAI) risk for the Dutch ERCP practice. Methods: We searched and consolidated all Dutch patients reported in the literature to have suffered from a clinical infection linked to a contaminated duodenoscope between 2008 and 2018. From a national database, the number of ERCPs performed per year in The Netherlands were retrieved. Actual numbers were available from 2012 to 2018. Numbers from 2008 to 2011 were estimated and assumed to be equal to 2012. Results: In 2008–2018, 3 MDRO outbreaks in Dutch hospitals were reported in the literature, with 21 patients suffering from a clinical infection based on a microorganism proven to be transmitted by a duodenoscope. In that period, ∼203,500 ERCP procedures were performed. Hence, for every 9,690 procedures, 1 patient developed a clinically relevant infection (DAI risk, 0.010%). Conclusions: The risk of developing a DAI is at least 30–180 times higher than the risks that were previously reported for all types of endoscopy-associated infections. Importantly, the current calculated risk of 0.010% constitutes a bare minimum risk of DAI because endoscope-related infections are underreported. Apart from DAI risk, a patient is also at risk of becoming colonized with a microorganism through contaminated endoscopes but without developing symptoms of clinical infection. These data call for consorted action of medical practitioners, industry, and government agencies to minimize and ultimately eliminate the risk of exogenous endoscope-associated infections and contamination. As a first step, the FDA recently recommended that healthcare facilities and manufacturers begin transitioning to duodenoscopes with disposable components.3Funding: NoneDisclosures: None

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On the Mode of Action of Lipid-lowering Agents

Journal of Biological Chemistry ◽

10.1016/s0021-9258(18)62498-6 ◽

1971 ◽

Vol 246 (2) ◽

pp. 348-358 ◽

Cited By ~ 6

Author(s):

Michael E. Maragoudakis ◽

Hilda Hankin

Keyword(s):

Mode Of Action ◽

Lipid Lowering ◽

Lipid Lowering Agents

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From evidence to practice: development of web-based Dutch lipid reference values

Netherlands Heart Journal ◽

10.1007/s12471-021-01562-x ◽

2021 ◽

Author(s):

N. S. Nurmohamed ◽

D. Collard ◽

J. W. Balder ◽

J. A. Kuivenhoven ◽

E. S. G. Stroes ◽

...

Keyword(s):

The Netherlands ◽

Reference Values ◽

Plasma Lipids ◽

Digital Health ◽

Reference Value ◽

Lipid Lowering ◽

Lipid Lowering Therapy ◽

Lowering Therapy ◽

Cascading Style Sheets ◽

Age And Sex

Abstract Introduction In the Netherlands, the total number of yearly measured lipid profiles exceeds 500,000. While lipid values are strongly affected by age and sex, until recently, no up-to-date age- and sex-specific lipid reference values were available. We describe the translation of big-cohort lipid data into accessible reference values, which can be easily incorporated in daily clinical practice. Methods Lipid values (total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides) from all healthy adults and children in the LifeLines cohort were used to generate age- and sex-specific percentiles. A combination of RStudio, Cascading Style Sheets and HyperText Markup Language was used to interactively display the percentiles in a responsive web layout. Results After exclusion of subjects reporting cardiovascular disease or lipid-lowering therapy at baseline, 141,611 subjects were included. On the website, input fields were created for age, sex and all main plasma lipids. Upon input of these values, corresponding percentiles are calculated, and output is displayed in a table and an interactive graph for each lipid. The website has been made available in both Dutch and English and can be accessed at www.lipidtools.com. Conclusion We constructed the first searchable, national lipid reference value tool with graphical display in the Netherlands to use in screening for dyslipidaemias and to reduce the underuse of lipid-lowering therapy in Dutch primary prevention. This study illustrates that data collected in big-cohort studies can be made easily accessible with modern digital techniques and preludes the digital health revolution yet to come.

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Awareness of limited joint mobility in type 2 diabetes in general practice in the Netherlands: an online questionnaire survey

BMC Family Practice ◽

10.1186/s12875-019-0987-7 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 3

Author(s):

Login Ahmed S. Alabdali ◽

Jasmien Jaeken ◽

Geert-Jan Dinant ◽

Ramon P. G. Ottenheijm

Keyword(s):

Type 2 Diabetes ◽

General Practice ◽

The Netherlands ◽

Questionnaire Survey ◽

Joint Mobility ◽

Online Questionnaire ◽

Limited Joint Mobility

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Trends in treatment for patients with depression in general practice in Norway, 2009–2015: nationwide registry-based cohort study (The Norwegian GP-DEP Study)

BMC Health Services Research ◽

10.1186/s12913-021-06712-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sabine Ruths ◽

Inger Haukenes ◽

Øystein Hetlevik ◽

Tone Smith-Sivertsen ◽

Stefan Hjørleifsson ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

General Practice ◽

Cohort Study ◽

Drug Treatment ◽

Time Trends ◽

Older Patients ◽

Antidepressant Drug ◽

Depression Care ◽

Patient Gender

Abstract Background Depression is highly prevalent, but knowledge is scarce as to whether increased public awareness and strengthened government focus on mental health have changed how general practitioners (GPs) help their depressed patients. This study aimed to examine national time trends in GP depression care and whether trends varied regarding patient gender, age, and comorbidity. Methods Nationwide registry-based cohort study, Norway. The study population comprised all residents aged 20 years or older with new depression diagnoses recorded in general practice, 2009–2015. We linked reimbursement claims data from all consultations in general practice for depression with information on demographics and antidepressant medication. The outcome was type(s) of GP depression care during 12 months from the date of diagnosis: (long) consultation, talking therapy, antidepressant drug treatment, sickness absence certification, and referral to secondary mental health care. Covariates were patient gender, age, and comorbidity. The data are presented as frequencies and tested with generalized linear models. Results We included 365,947 new depression diagnoses. Mean patient age was 44 years (SD = 16), 61.9 % were women, 41.2 % had comorbidity. From 2009 to 2015, proportions of patients receiving talking therapy (42.3–63.4 %), long consultations (56.4–71.8 %), and referral to secondary care (16.6–21.6 %) increased, while those receiving drug treatment (31.3–25.9 %) and sick-listing (58.1–50 %) decreased. The trends were different for gender (women had a greater increase in talking therapy and a smaller decrease in sick-listing, compared to men), age (working-aged patients had a smaller increase in talking therapy, a greater increase in long consultations, and a smaller decrease in antidepressant drug use, compared to older patients) and comorbidity (patients with mental comorbidity had a smaller increase in talking therapy and a greater increase in long consultations, compared to those with no comorbidity and somatic comorbidity). Conclusions The observed time trends in GP depression care towards increased provision of psychological treatment and less drug treatment and sick-listing were in the desired direction according to Norwegian health care policy. However, the large and persistent differences in treatment rates between working-aged and older patients needs further investigation.

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