Rheumatoid arthritis and excess mortality: down but not out. A primary care cohort study using data from Clinical Practice Research Datalink

Abstract Objectives To examine the association between β-blocker prescription and knee or hip total joint replacement (TJR) in a UK primary-care population with incident knee or hip osteoarthritis (OA).Methods Cohort study using data from the Clinical Practice Research Datalink. Participants aged ≥40 years with incident knee or hip OA, exposed to β-blockers after OA diagnosis (new-user design), were matched to one control for age, sex, OA location and propensity score (PS) for β-blocker prescription. Cox-proportional hazard ratios (HRs) and 95% confidence intervals (CI) were calculated. The analyses were adjusted for factors that influence health-seeking behaviour, progression of OA, and stratified according to β-blocker classification. Data analysis was conducted using Stata.Results Data for 6,970 PS-matched β-blocker exposed and unexposed participants were included. Any β-blocker prescription was not associated with knee or hip TJR (aHR 1.11; 95% CI 0.98 – 1.25). However, prescription of lipophilic non-selective β-blockers having membrane stabilising effects associated with reduced risk of knee or hip TJR (aHR 0.69; 95% CI 0.52 – 0.93). Of these, there was a protective effect for propranolol (aHR 0.71; 95% CI 0.53 – 0.95), the commonest prescribed drug in this class. The number needed to treat (95% CI) with propranolol for two years in order to prevent one TJR was 32 (23-52).Conclusion Propranolol, a non-selective β-blocker, reduces the risk of knee and hip TJR. This is consistent with its analgesic effects in other conditions and a randomised controlled trial is required to further evaluate its analgesic potential and safety in OA.

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Pharmacoepidemiology in pregnancy: analysis protocol for an observational cohort study in the UK Clinical Practice Research Datalink

Wellcome Open Research ◽

10.12688/wellcomeopenres.17523.1 ◽

2022 ◽

Vol 7 ◽

pp. 12

Author(s):

Ciarrah-Jane Barry ◽

Christy Burden ◽

Neil Davies ◽

Venexia Walker

Keyword(s):

Cohort Study ◽

Clinical Practice ◽

Drug Exposure ◽

Negative Control ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Control Analysis ◽

Definitive Evidence ◽

Using Data ◽

The Uk

Large numbers of women take prescription and over-the-counter medications during pregnancy. However, there is very little definitive evidence about the potential effects of these drugs on the mothers and offspring. We will investigate the risks and benefits of continuing prescriptive drug use for chronic pre-existing maternal conditions such as diabetes, hypertension and thyroid related conditions throughout pregnancy. If left untreated, these conditions are established risk factors for adverse neonatal and maternal outcomes. However, some treatments for these conditions are associated with adverse neonatal outcomes. Our primary aims are twofold. Firstly, we aim to estimate the beneficial effect on the mother of continuing treatment during pregnancy. Second, we aim to determine whether there is an associated detrimental impact on the neonate of continuation of maternal treatment during pregnancy. To establish this evidence, we will investigate the relationship between maternal drug prescriptions and adverse and beneficial offspring outcomes to provide evidence to guide clinical decisions. We will conduct a hypothesis testing observational intergenerational cohort study using data from the UK Clinical Practice Research Datalink (CPRD). We will apply four statistical methods: multivariable adjusted regression, propensity score regression, instrumental variables analysis and negative control analysis. These methods should account for potential confounding when estimating the association between the drug exposure and maternal or neonatal outcome. In this protocol we describe the aims, motivation, study design, cohort and statistical analyses of our study to aid reproducibility and transparency within research.

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Association of guideline and policy changes with incidence of lifestyle advice and treatment for uncomplicated mild hypertension in primary care: a longitudinal cohort study in the Clinical Practice Research Datalink

BMJ Open ◽

10.1136/bmjopen-2018-021827 ◽

2018 ◽

Vol 8 (9) ◽

pp. e021827 ◽

Cited By ~ 5

Author(s):

James P Sheppard ◽

Sarah Stevens ◽

Richard J Stevens ◽

Jonathan Mant ◽

Una Martin ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Clinical Practice ◽

Mild Hypertension ◽

Secular Trends ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Lifestyle Advice ◽

Policy Changes ◽

Cvd Risk

ObjectivesEvidence to support initiation of pharmacological treatment in patients with uncomplicated (low risk) mild hypertension is inconclusive. As such, clinical guidelines are contradictory and healthcare policy has changed regularly. The aim of this study was to determine the incidence of lifestyle advice and drug therapy in this population and whether secular trends were associated with policy changes.DesignLongitudinal cohort study.SettingPrimary care practices contributing to the Clinical Practice Research Datalink in England.ParticipantsData were extracted from the linked electronic health records of patients aged 18–74 years, with stage 1 hypertension (blood pressure between 140/90 and 159/99 mm Hg), no cardiovascular disease (CVD) risk factors and no treatment, from 1998 to 2015. Patients exited if follow-up records became unavailable, they progressed to stage 2 hypertension, developed a CVD risk factor or received lifestyle advice/treatment.Primary outcome measuresThe association between policy changes and incidence of lifestyle advice or treatment, examined using an interrupted time-series analysis.ResultsA total of 108 843 patients were defined as having uncomplicated mild hypertension (mean age 51.9±12.9 years, 60.0% female). Patientsspent a median 2.6 years (IQR 0.9–5.5) in the study, after which 12.2% (95% CI 12.0% to 12.4%) were given lifestyle advice, 29.9% (95% CI 29.7% to 30.2%) were prescribed medication and 19.4% (95% CI 19.2% to 19.6%) were given both. The introduction of the quality outcomes framework (QOF) and subsequent changes to QOF indicators were followed by significant increases in the incidence of lifestyle advice. Treatment prescriptions decreased slightly over time, but were not associated with policy changes.ConclusionsDespite secular trends that accord with UK guidance, many patients are still prescribed treatment for mild hypertension. Adequately powered studies are needed to determine if this is appropriate.

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