Corrigendum to: Subtypes of atrial fibrillation with concomitant valvular heart disease derived from electronic health records: phenotypes, population prevalence, trends and prognosis

Purpose: In conjunction with women being diagnosed earlier with breast cancer and a rapidly aging population, advances in cancer therapies have swiftly propelled cardiotoxicity as a major health concern for breast cancer patients. Frequent cardiotoxicity outcomes include: reduced left ventricular ejection fraction (LVEF), myocardial infarction, asymptomatic or hospitalized heart failure, arrhythmias, hypertension, and thromboembolism. The purpose of this study was to use an electronic health records system determine if an increased odds of heart disease was present among women with breast cancer. Methods: Data from the Research Action for Health Network (REACHnet) was used for the analysis. REACHnet is a clinical data research network that uses the common data model to extract electronic health records (EHR) from health networks in Louisiana (n=100,000).Women over the age of 30 with data (n=35,455) were included in the analysis. ICD-9 diagnosis codes were used to classify heart disease (HD) (Hypertensive HD, Ischemic HD, Pulmonary HD, and Other HD) and identify breast cancer patients. Additional EHR variables considered were smoking status, and patient vitals. Chi-square tests, crude, and adjusted logistic regression models were computed utilizing SAS 9.4. Results: Utilizing diagnoses codes our study team has estimated 28.6% of women over the age of 30 with a breast cancer diagnosis (n=816) also had a heart disease diagnosis, contrasted with 15.6% of women without a breast cancer diagnosis. Among patients with heart disease, there was no significant difference in the distribution of the type of heart disease diagnoses by breast cancer status (p=0.87). There was a 2.21 (1.89, 2.58) crude odds ratio of having a CVD diagnoses among breast cancer cases when referenced to cancer free women. After adjusting for age (30-49, 50-64, 65+), race (black/white), and comorbidities (obesity/overweight, diabetes, current smoker) there was an increased risk of heart disease (OR: 1.24 (1.05, 1.47)). Conclusion: The short-term and long-term consequences of cardiotoxicity on cancer treatment risk-to-benefit ratio, survivorship issues, and competing causes of mortality are increasingly being acknowledged. Our next efforts will include making advances in predictive risk modeling. Maximizing benefits while reducing cardiac risks needs to become a priority in oncologic management and monitoring for late-term toxic effects.

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Combining Inpatient and Outpatient Data for Diagnosis of Non-Valvular Atrial Fibrillation Using Electronic Health Records: A Validation Study

Clinical Epidemiology ◽

10.2147/clep.s230677 ◽

2020 ◽

Vol Volume 12 ◽

pp. 477-483

Author(s):

Orna Reges ◽

Hagay Weinberg ◽

Moshe Hoshen ◽

Philip Greenland ◽

Hana'a Rayyan-Assi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Electronic Health Records ◽

Validation Study ◽

Health Records ◽

Electronic Health

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Defining Disease Phenotypes Using National Linked Electronic Health Records: A Case Study of Atrial Fibrillation

PLoS ONE ◽

10.1371/journal.pone.0110900 ◽

2014 ◽

Vol 9 (11) ◽

pp. e110900 ◽

Cited By ~ 42

Author(s):

Katherine I. Morley ◽

Joshua Wallace ◽

Spiros C. Denaxas ◽

Ross J. Hunter ◽

Riyaz S. Patel ◽

...

Keyword(s):

Atrial Fibrillation ◽

Electronic Health Records ◽

Health Records ◽

Disease Phenotypes ◽

Electronic Health

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Statins and new-onset atrial fibrillation in a cohort of patients with hypertension. Analysis of electronic health records, 2006–2015

PLoS ONE ◽

10.1371/journal.pone.0186972 ◽

2017 ◽

Vol 12 (10) ◽

pp. e0186972 ◽

Cited By ~ 7

Author(s):

Lia Alves-Cabratosa ◽

Maria García-Gil ◽

Marc Comas-Cufí ◽

Anna Ponjoan ◽

Ruth Martí-Lluch ◽

...

Keyword(s):

Atrial Fibrillation ◽

Electronic Health Records ◽

Health Records ◽

Electronic Health ◽

Onset Atrial Fibrillation ◽

New Onset

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Data-driven discovery of changes in clinical code usage over time: a case-study on changes in cardiovascular disease recording in two English electronic health records databases (2001–2015)

BMJ Open ◽

10.1136/bmjopen-2019-034396 ◽

2020 ◽

Vol 10 (2) ◽

pp. e034396 ◽

Cited By ~ 1

Author(s):

Patrick Rockenschaub ◽

Vincent Nguyen ◽

Robert W Aldridge ◽

Dionisio Acosta ◽

Juan Miguel García-Gómez ◽

...

Keyword(s):

Cardiovascular Disease ◽

Coronary Heart Disease ◽

Heart Disease ◽

Cardiovascular Diseases ◽

Electronic Health Records ◽

Temporal Variability ◽

Data Driven ◽

Health Records ◽

Electronic Health ◽

Coding Guidelines

ObjectivesTo demonstrate how data-driven variability methods can be used to identify changes in disease recording in two English electronic health records databases between 2001 and 2015.DesignRepeated cross-sectional analysis that applied data-driven temporal variability methods to assess month-by-month changes in routinely collected medical data. A measure of difference between months was calculated based on joint distributions of age, gender, socioeconomic status and recorded cardiovascular diseases. Distances between months were used to identify temporal trends in data recording.Setting400 English primary care practices from the Clinical Practice Research Datalink (CPRD GOLD) and 451 hospital providers from the Hospital Episode Statistics (HES).Main outcomesThe proportion of patients (CPRD GOLD) and hospital admissions (HES) with a recorded cardiovascular disease (CPRD GOLD: coronary heart disease, heart failure, peripheral arterial disease, stroke; HES: International Classification of Disease codes I20-I69/G45).ResultsBoth databases showed gradual changes in cardiovascular disease recording between 2001 and 2008. The recorded prevalence of included cardiovascular diseases in CPRD GOLD increased by 47%–62%, which partially reversed after 2008. For hospital records in HES, there was a relative decrease in angina pectoris (−34.4%) and unspecified stroke (−42.3%) over the same time period, with a concomitant increase in chronic coronary heart disease (+14.3%). Multiple abrupt changes in the use of myocardial infarction codes in hospital were found in March/April 2010, 2012 and 2014, possibly linked to updates of clinical coding guidelines.ConclusionsIdentified temporal variability could be related to potentially non-medical causes such as updated coding guidelines. These artificial changes may introduce temporal correlation among diagnoses inferred from routine data, violating the assumptions of frequently used statistical methods. Temporal variability measures provide an objective and robust technique to identify, and subsequently account for, those changes in electronic health records studies without any prior knowledge of the data collection process.

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Bisoprolol transdermal patch treatment for patients with atrial fibrillation after noncardiac surgery: A single-center retrospective study of 61 patients

SAGE Open Medicine ◽

10.1177/2050312120907817 ◽

2020 ◽

Vol 8 ◽

pp. 205031212090781

Author(s):

Taku Yasui ◽

Toru Oka ◽

Wataru Shioyama ◽

Makiko Oboshi ◽

Masashi Fujita

Keyword(s):

Atrial Fibrillation ◽

Heart Rate ◽

Electronic Health Records ◽

Sinus Rhythm ◽

Noncardiac Surgery ◽

Additional Treatment ◽

Postoperative Atrial Fibrillation ◽

Transdermal Patch ◽

Health Records ◽

Electronic Health

Objectives: Atrial fibrillation after surgery is associated with increased rates of heart failure and ischemic stroke, and extension of hospitalization. Bisoprolol is a β-blocker used to reduce heart rate and manage arrhythmias during atrial fibrillation. However, the safety and efficacy of bisoprolol transdermal patch treatment in patients with postoperative atrial fibrillation remain unclear. Methods: We retrospectively assessed the electronic health records of our hospital between September 2013 and July 2018 and identified patients with postoperative atrial fibrillation who had been treated with a bisoprolol transdermal patch. We excluded patients with sinus rhythm using bisoprolol transdermal patch to prevent atrial fibrillation recurrence and those with sustained atrial fibrillation before surgery. Data on heart rhythm, heart rate, and blood pressure at the baseline and after 24 h of treatment were obtained from the electronic health records. Results: Of the 603 patients treated with the bisoprolol transdermal patch, 61 patients with postoperative atrial fibrillation after noncardiac surgery were included. The bisoprolol transdermal patch was discontinued due to bradycardia in two patients (3.3%). In both cases, the heart rate increased after the removal of the bisoprolol transdermal patch and no additional treatment was necessary. Among the 61 patients, sinus rhythm was restored within 24 h of bisoprolol treatment in 47 patients (77.0%). The heart rate significantly decreased from 124.8 ± 26.3 bpm at the baseline to 78.9 ± 16.6 bpm at 24 h after treatment ( p < 0.001). There were no significant differences in the systolic and diastolic blood pressures between patients before and at 24 h after treatment. Conclusion: The results of this study indicate that the bisoprolol transdermal patch is well tolerated and effective in patients with atrial fibrillation after noncardiac surgery.

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DISCOVERY OF ATRIAL FIBRILLATION SUBTYPES WITH ELECTRONIC HEALTH RECORDS AND MACHINE LEARNING

10.26226/morressier.5ebc4ac6ffea6f735881a431 ◽

2020 ◽

Author(s):

Adam J. Russak

Keyword(s):

Machine Learning ◽

Atrial Fibrillation ◽

Electronic Health Records ◽

Health Records ◽

Electronic Health

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Dabigatran and vitamin K antagonists’ use in naïve patients with non-valvular atrial fibrillation: a cross-sectional study of primary care-based electronic health records

European Journal of Clinical Pharmacology ◽

10.1007/s00228-017-2305-4 ◽

2017 ◽

Vol 73 (10) ◽

pp. 1323-1330 ◽

Cited By ~ 4

Author(s):

Bogdan Vlacho ◽

Maria Giner-Soriano ◽

Edurne Zabaleta-del-Olmo ◽

Albert Roso-Llorach ◽

Ana García-Sangenís ◽

...

Keyword(s):

Atrial Fibrillation ◽

Primary Care ◽

Electronic Health Records ◽

Vitamin K ◽

Vitamin K Antagonists ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Health Records ◽

Electronic Health

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Subtypes of atrial fibrillation with concomitant valvular heart disease derived from electronic health records: phenotypes, population prevalence, trends and prognosis

EP Europace ◽

10.1093/europace/euz220 ◽

2019 ◽

Vol 21 (12) ◽

pp. 1776-1784 ◽

Cited By ~ 5

Author(s):

Amitava Banerjee ◽

Victoria Allan ◽

Spiros Denaxas ◽

Anoop Shah ◽

Dipak Kotecha ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Disease ◽

Aortic Stenosis ◽

Valvular Heart Disease ◽

Absolute Risk ◽

Composite Endpoint ◽

Population Based ◽

Cox Models ◽

Mechanical Valves ◽

Electronic Health

Abstract Aims To evaluate population-based electronic health record (EHR) definitions of atrial fibrillation (AF) and valvular heart disease (VHD) subtypes, time trends in prevalence and prognosis. Methods and results A total of 76 019 individuals with AF were identified in England in 1998–2010 in the CALIBER resource, linking primary and secondary care EHR. An algorithm was created, implemented, and refined to identify 18 VHD subtypes using 406 diagnosis, procedure, and prescription codes. Cox models were used to investigate associations with a composite endpoint of incident stroke (ischaemic, haemorrhagic, and unspecified), systemic embolism (SSE), and all-cause mortality. Among individuals with AF, the prevalence of AF with concomitant VHD increased from 11.4% (527/4613) in 1998 to 17.6% (7014/39 868) in 2010 and also in individuals aged over 65 years. Those with mechanical valves, mitral stenosis (MS), or aortic stenosis had highest risk of clinical events compared to AF patients with no VHD, in relative [hazard ratio (95% confidence interval): 1.13 (1.02–1.24), 1.20 (1.05–1.36), and 1.27 (1.19–1.37), respectively] and absolute (excess risk: 2.04, 4.20, and 6.37 per 100 person-years, respectively) terms. Of the 95.2% of individuals with indication for warfarin (men and women with CHA2DS2-VASc ≥1 and ≥2, respectively), only 21.8% had a prescription 90 days prior to the study. Conclusion Prevalence of VHD among individuals with AF increased from 1998 to 2010. Atrial fibrillation associated with aortic stenosis, MS, or mechanical valves (compared to AF without VHD) was associated with an excess absolute risk of stroke, SSE, and mortality, but anticoagulation was underused in the pre-direct oral anticoagulant (DOAC) era, highlighting need for urgent clarity regarding DOACs in AF and concomitant VHD.

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