The prevalence and patient outcomes of adult primary hypercholesterolaemia and dyslipidaemia in the UK: a longitudinal retrospective study using a primary care dataset from 2008 to 2018

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Bilitou ◽  
A Rabe ◽  
L Inema ◽  
G Alamgir ◽  
K Dunton
Keyword(s):  
Primary Care ◽  
Adult Population ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Funding Source ◽  
Private Company ◽  
Primary Hypercholesterolaemia ◽  
The Uk

Abstract Background Cardiovascular disease (CVD) remains the leading cause of death and morbidity in Europe and United Kingdom (UK). Increased low-density lipoprotein cholesterol (LDL-C), implicated in primary hypercholesterolaemia and mixed dyslipidaemia (PH/MD), is an extensively studied risk factor, with proven direct and linear causality of CVD. Lowering LDL-C remains a primary goal in the treatment and prevention of atherosclerotic CVD. Objectives This study aimed to quantify adult prevalence and incidence of PH/MD in the UK. Methods We used an anonymised dataset covering primary care practices across the UK, accessed through the Clinical Practice Research Datalink (CPRD GOLD). Ethics approval was sought and provided (Protocol 19_238R). Using a validated set of clinical codes as well as pre-treatment lipid profile levels for total cholesterol (TC) (>8 mmol/L), LDL-C (>4.9 mmol/L), we calculated prevalent and new adult cases starting from 2009 to 2018. Our denominator population was the CPRD GOLD GP-registered adult population each calendar year, adjusted for mortality. Results There were 1,514,916 adults in the CPRD GOLD GP register for the period from 2009 to 2018. During that period there were 354,444 patients diagnosed with PH/MD. Males comprised 46.5%, mean age on diagnosis was 58.2 years. Mean follow-up time was 104 months. The annual prevalence of PH/MD increased from 2009 to 2019 (see graph). The overall prevalence across the period was 22.7%. Mean annual incidence across the decade was 1.7%. Mean LDL-C levels were 4.7 mmol/L and mean TC level was 6.8 mmol/L. In this cohort, 15.9% experienced cardiovascular events (see table). Nearly all patients have used lipid lowering therapies. Only 2.2% achieved at least 40% reduction of LDL-C from baseline. Conclusions The prevalence of PH/MD has been increasing despite the availability of interventions. Considering guidelines, only a small proportion of patients have achieved LDL-C goals. Est prevalence of PH/MD in the UK Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Daiichi Sankyo Europe, Health iQ Ltd

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

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.

scholarly journals O16 Incidence, prevalence and associated comorbidity of axSpA within the UK: a retrospective database analysis

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Christopher L. I Morgan ◽  
Abigail White ◽  
Mark Tomlinson ◽  
Amie Scott ◽  
Haijun Tian
Keyword(s):  
Primary Care ◽  
Index Date ◽  
Practice Research ◽  
Care Practice ◽  
Clinical Practice Research Datalink ◽  
Case Ascertainment ◽  
International Statistical Classification ◽  
The Uk ◽  
Primary Care Practices ◽  
Incident Cases

Abstract Background This study reports the incidence and prevalence of axial spondyloarthritis (axSpA) in the UK, and describes the baseline characteristics and comorbidities associated with the condition. Methods This study was conducted using the Clinical Practice Research Datalink, a large routine primary care database in the UK. Approximately 60% of contributing English primary care practices are linked to Hospital Episode Statistics (HES) secondary care data. AxSpA and relevant comorbidities were identified from Read or International Statistical Classification of Diseases and Related Health Problems-10 codes in primary care or HES datasets, respectively. The date of first axSpA diagnosis defined the index date. Patients with ≥90 days between practice registration and first axSpA diagnosis were classified as incident cases. The incidence and prevalence of axSpA were calculated annually from 2003-2017 for the UK as a whole, each constituent nation and English practices linked to HES data, to maximise case ascertainment. Comorbidities occurring prior to the index date (inclusive) were reported and compared with non-axSpA patients matched for age, sex, primary care practice and concurrent practice registration. Results Overall, 20,199 axSpA patients were identified, of whom 8,387 (41.5%) were classified as incident cases. Of the incident cases, 2,600 (31.0%) were female. Mean age at first diagnosis was 45.5 years (standard deviation [SD]: 17.2), mean body mass index was 27.2 kg/m2 (SD: 5.9) and 2,481 (29.6%) patients were current smokers. In 2017, the incidence of axSpA was 8.0 per 100,000 person-years and the prevalence was 15.8 per 10,000 population, an increase from 12.7 per 10,000 population in 2003. For patients from English practices linked to HES data, the incidence was 10.8 per 100,000 person-years and the prevalence was 17.5 per 10,000 population. 8,385 (∼100.0%) axSpA patients could be matched to non-axSpA controls. At baseline, all selected comorbidities were significantly increased in axSpA cases vs controls (Table). Conclusion This study reports an increasing prevalence of axSpA over the study period and higher rates of specific comorbidities in patients with axSpA vs matched controls. Caveats related to routine database studies, including secular changes in case ascertainment and observation bias, should be considered when interpreting these results. Disclosures C.L.I. Morgan: Other; Employee of: Pharmatelligence. A. White: Shareholder/stock ownership; Novartis. Other; Employee of: Novartis. M. Tomlinson: Consultancies; Novartis. A. Scott: Consultancies; Novartis. H. Tian: Other; Employee of: Novartis.

scholarly journals Concomitant diagnosis of asthma and COPD: a quantitative study in UK primary care

2018 ◽  
Vol 68 (676) ◽  
pp. e775-e782 ◽  
Author(s):  
Francis Nissen ◽  
Daniel R Morales ◽  
Hana Mullerova ◽  
Liam Smeeth ◽  
Ian J Douglas ◽  
...  
Keyword(s):  
Primary Care ◽  
Practice Research ◽  
Chronic Obstructive ◽  
Clinical Practice Research Datalink ◽  
Read Code ◽  
Care Environment ◽  
Missed Opportunities ◽  
Obstructive Pulmonary Disease ◽  
Additional Information ◽  
The Uk

BackgroundAsthma and chronic obstructive pulmonary disease (COPD) share many characteristics and symptoms, and the differential diagnosis between the two diseases can be difficult in primary care. This study explored potential overlap between both diseases in a primary care environment.AimTo quantify how commonly patients with COPD have a concomitant diagnosis of asthma, and how commonly patients with asthma have a concomitant diagnosis of COPD in UK primary care. Additionally, the study aimed to determine the extent of possible misdiagnosis and missed opportunities for diagnosis.Design and settingPatients with validated asthma and patients with validated COPD in primary care were identified from the UK Clinical Practice Research Datalink (CPRD) in separate validation studies, and the diseases were confirmed by review of GP questionnaires.MethodThe prevalence of concurrent asthma and COPD in validated cases of either disease was examined based on CPRD coding, GP questionnaires, and requested additional information.ResultsIn total, 400 patients with COPD and 351 patients with asthma in primary care were identified. Of the patients with validated asthma, 15% (n = 52) had previously received a diagnostic COPD Read code, although COPD was only likely in 14.8% (95% confidence interval [CI] = 11.3 to 19.0) of patients with validated asthma. More than half (52.5%, n = 210) of patients with validated COPD had previously received a diagnostic asthma Read code. However, when considering additional evidence to support a diagnosis of asthma, concurrent asthma was only likely in 14.5% (95% CI = 11.2 to 18.3) of patients with validated COPD.ConclusionA concurrent asthma and COPD diagnosis appears to affect a relative minority of patients with COPD (14.5%) or asthma (14.8%). Asthma diagnosis may be over-recorded in people with COPD.

scholarly journals Drug therapy for alcohol dependence in primary care in the UK: A Clinical Practice Research Datalink study

PLoS ONE ◽  
2017 ◽  
Vol 12 (3) ◽  
pp. e0173272 ◽  
Author(s):  
Andrew Thompson ◽  
Darren M. Ashcroft ◽  
Lynn Owens ◽  
Tjeerd P. van Staa ◽  
Munir Pirmohamed
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Drug Therapy ◽  
Alcohol Dependence ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
The Uk

scholarly journals Retrospective, multicohort analysis of the Clinical Practice Research Datalink (CPRD) to determine differences in the cost of medication wastage, dispensing fees and prescriber time of issuing either short (<60 days) or long (≥60 days) prescription lengths in primary care for common, chronic conditions in the UK

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e019382 ◽  
Author(s):  
Brett Doble ◽  
Rupert Payne ◽  
Amelia Harshfield ◽  
Edward C F Wilson
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Secondary Outcome ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Lipid Management ◽  
Medication Wastage ◽  
The Uk ◽  
The Cost ◽  
Repeat Prescriptions

ObjectivesTo investigate patterns of early repeat prescriptions and treatment switching over an 11-year period to estimate differences in the cost of medication wastage, dispensing fees and prescriber time for short (<60 days) and long (≥60 days) prescription lengths from the perspective of the National Health Service in the UK.SettingRetrospective, multiple cohort study of primary care prescriptions from the Clinical Practice Research Datalink.ParticipantsFive random samples of 50 000 patients each prescribed oral drugs for (1) glucose control in type 2 diabetes mellitus (T2DM); (2) hypertension in T2DM; (3) statins (lipid management) in T2DM; (4) secondary prevention of myocardial infarction; and (5) depression.Primary and secondary outcome measuresThe volume of medication wastage from early repeat prescriptions and three other types of treatment switches was quantified and costed. Dispensing fees and prescriber time were also determined. Total unnecessary costs (TUC; cost of medication wastage, dispensing fees and prescriber time) associated with <60 day and ≥60 day prescriptions, standardised to a 120-day period, were then compared.ResultsLonger prescription lengths were associated with more medication waste per prescription. However, when including dispensing fees and prescriber time, longer prescription lengths resulted in lower TUC. This finding was consistent across all five cohorts. Savings ranged from £8.38 to £12.06 per prescription per 120 days if a single long prescription was issued instead of multiple short prescriptions. Prescriber time costs accounted for the largest component of TUC.ConclusionsShorter prescription lengths could potentially reduce medication wastage, but they may also increase dispensing fees and/or the time burden of issuing prescriptions.

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