scholarly journals Changes in the Diagnosis of Stroke and Cardiovascular Conditions in Primary Care During First 2 COVID-19 Waves in the Netherlands

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000013145
Author(s):  
Premysl Velek ◽  
Marije J. Splinter ◽  
M. Kamran Ikram ◽  
M. Arfan Ikram ◽  
Maarten J.G. Leening ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Primary Care ◽  
The Netherlands ◽  
Cardiovascular Events ◽  
Lipid Disorders ◽  
Improve Symptom ◽  
Cerebrovascular Events ◽  
Primary Care Patients ◽  
General Practices ◽  
Cardiovascular Care

Background and objectivesAlthough there is evidence of disruption in acute cerebrovascular and cardiovascular care during the COVID-19 pandemic, its downstream effect in primary care is less clear. We investigated how the pandemic affected utilization of cerebrovascular and cardiovascular care in general practices (GPs) and determined changes in GP-recorded diagnoses of selected cerebrovascular and cardiovascular outcomes.MethodsFrom electronic health records of 166,929 primary care patients aged 30 or over within the Rotterdam region, the Netherlands, we extracted the number of consultations related to cerebrovascular and cardiovascular care, and first diagnoses of selected cerebrovascular and cardiovascular risk factors (hypertension, diabetes, lipid disorders), conditions and events (angina, atrial fibrillation, TIA, myocardial infarction, stroke). We quantified changes in those outcomes during the first COVID-19 wave (March-May 2020) and thereafter (June-December 2020) by comparing them to the same period in 2016-2019. We also estimated the number of potentially missed diagnoses for each outcome.ResultsThe number of GP consultations related to cerebrovascular and cardiovascular care declined by 38% (0.62, 95% CI: 0.56-0.68) during the first wave, as compared to expected counts based on pre-pandemic levels. Substantial declines in the number of new diagnoses were observed for cerebrovascular events: 37% for TIA (0.63, 0.41-0.96), and 29% for stroke (0.71, 0.59 to 0.84), while no significant changes were observed for cardiovascular events (myocardial infarction (0.91, 0.74-1.14), angina (0.77, 0.48-1.25)). The counts across individual diagnoses recovered following June 2020, but the number of GP consultations related to cerebrovascular and cardiovascular care remained lower than expected also throughout the June-December period (0.93, 0.88-0.98).DiscussionWhile new diagnoses of acute cardiovascular events remained stable during the COVID19 pandemic, diagnoses of cerebrovascular events declined substantially compared to pre-pandemic levels, possibly due to incorrect perception of risk by patients. These findings emphasize the need to improve symptom recognition of cerebrovascular events among the general public and to encourage urgent presentation despite any physical distancing measures.

scholarly journals Health care costs of depression in primary care patients in The Netherlands

2010 ◽  
Vol 27 (5) ◽  
pp. 542-548 ◽  
Author(s):  
J. E. Bosmans ◽  
M. C. de Bruijne ◽  
M. R. de Boer ◽  
H. van Hout ◽  
P. van Steenwijk ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
The Netherlands ◽  
Health Care Costs ◽  
Primary Care Patients ◽  
Care Costs

scholarly journals Depression and Anxiety Screens as Predictors of 8-Year Incidence of Myocardial Infarction and Stroke in Primary Care Patients

2016 ◽  
Vol 78 (5) ◽  
pp. 593-601 ◽  
Author(s):  
Jesse C. Stewart ◽  
Misty A.W. Hawkins ◽  
Tasneem Khambaty ◽  
Anthony J. Perkins ◽  
Christopher M. Callahan
Keyword(s):  
Myocardial Infarction ◽  
Primary Care ◽  
Depression And Anxiety ◽  
Primary Care Patients

scholarly journals Quality Use of Medicines in Patients With Chronic Kidney Disease

2020 ◽  
Author(s):  
Ronald L Castelino ◽  
Timothy Saunder ◽  
Alex Kitsos ◽  
Greg Peterson ◽  
Matthew Jose ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Inappropriate Prescribing ◽  
High Dose ◽  
Australian General Practice ◽  
Primary Care Patients ◽  
Potential Alternative ◽  
General Practices

Abstract Objective: To determine the extent of potentially inappropriate prescribing (PIP; defined as the use of a contraindicated medication or inappropriately high dose according to the kidney function) of renally-cleared medications commonly prescribed in Australian primary care, based on two measures of kidney function. A secondary aim was to assess agreement between the two measures.Design: Retrospective analysis of routinely collected de-identified Australian general practice patient data (NPS MedicineWise MedicineInsight from January 1, 2013, to June 1, 2016; collected from 329 general practices). Setting & Participants: All adults (aged ≥18 years) with chronic kidney disease (CKD) presenting to general practices across Australia.Results: A total of 48,731 patients met the Kidney Health Australia (KHA) definition for CKD and had prescriptions recorded within 90 days of measuring serum creatinine (SCr)/estimated glomerular filtration rate (eGFR). Overall, 28,729 patients were prescribed one or more of the 49 medications of interest. Approximately 35% (n=9,926) of these patients had at least one PIP based on either the Cockcroft-Gault (CG) equation or eGFR (CKD-EPI; CKD-Epidemiology Collaboration Equation). There was good agreement between CG and eGFR while determining the appropriateness of medications, with approximately 97% of the medications classified as appropriate by eGFR also being considered appropriate by the CG equation.Conclusion: This study highlights that PIP commonly occurs in primary care patients with CKD and the need for further research to understand why and how this can be minimised. The findings also show that the eGFR provides clinicians a potential alternative to the CG formula when estimating kidney function to guide drug appropriateness and dosing.

scholarly journals The development of a minimal intervention strategy to address overweight and obesity in adult primary care patients in The Netherlands

2008 ◽  
Vol 25 (Supplement 1) ◽  
pp. i112-i115 ◽  
Author(s):  
G. Fransen ◽  
G. Hiddink ◽  
M. Koelen ◽  
S. van Dis ◽  
A. Drenthen ◽  
...  
Keyword(s):  
Primary Care ◽  
The Netherlands ◽  
Intervention Strategy ◽  
Overweight And Obesity ◽  
Minimal Intervention ◽  
Primary Care Patients

scholarly journals The effects of acarbose therapy on reductions of myocardial infarction and all-cause death in T2DM during 10-year multifactorial interventions (The Beijing Community Diabetes Study 24)

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Xue-Lian Zhang ◽  
Shen-Yuan Yuan ◽  
Gang Wan ◽  
Ming-Xia Yuan ◽  
Guang-Ran Yang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Type 2 Diabetes ◽  
Cardiovascular Events ◽  
Long Term Effects ◽  
Cerebrovascular Events ◽  
Significant Difference ◽  
Target Control

AbstractTo investigate the potential benefits of acarbose therapy on cardiovascular events (CVD) in Type 2 diabetes (T2DM) in an urban community over 10-year follow-up. The study population of Beijing Community Diabetes Study (BCDS) were type 2 diabetes (T2DM) living in 21 communities in Beijing. All patients received comprehensive intervention in accordance with the Chinese guidelines for the prevention and treatment of diabetes. Professors in endocrinology from top tier hospitals regularly visited the communities for consultations, which was a feature of this study. A total of 1797 T2DM in BCDS study had complete screening data, including blood glucose, blood pressure, lipid profiles and acarbose continuous therapy. After 10-year follow-up, the risks of CVD outcomes were assessed according to whether patients had received acarbose therapy or not. All patients were followed-up to assess the long-term effects of the multifactorial interventions. At baseline, compared with the acarbose therapy free in T2DM, there was no significant difference in achieving the joint target control in patients with acarbose therapy. From the beginning of 8th year follow-up, the joint target control rate in patients with acarbose therapy was significantly higher than that of acarbose therapy free. During the 10-year follow-up, a total of 446 endpoint events occurred, including all-cause death, cardiovascular events, cerebrovascular events. The incidences of myocardial infarction (from the 4th year of follow-up) and all-cause death (from the 2nd year of follow-up) in patients who received acarbose therapy were significantly lower than that of acarbose therapy free respectively. In Cox multivariate analyses, there were significant differences in incidences of myocardial infarction and all-cause death between afore two groups during the 10-year follow-up, and the adjusted HRs were 0.50 and 0.52, respectively. After multifactorial interventions, T2DM with acarbose therapy revealed significant reductions of myocardial infarction and all-cause death. The long-term effects of with acarbose therapy on improving joint target control might be one of the main reasons of myocardial infarction and all-cause death reduction.Trial Registration: ChiCTR-TRC-13003978, ChiCTR-OOC-15006090.

scholarly journals The Risk of Cardiovascular Events in Primary Care Patients Following an Episode of Severe Hypertension

2009 ◽  
Vol 11 (4) ◽  
pp. 175-182 ◽  
Author(s):  
Edward Ewen ◽  
Zugui Zhang ◽  
Paul Kolm ◽  
Claudine Jurkovitz ◽  
Joseph Jackson ◽  
...  
Keyword(s):  
Primary Care ◽  
Cardiovascular Events ◽  
Severe Hypertension ◽  
Primary Care Patients

scholarly journals Measurement of ECG abnormalities and cardiovascular risk classification: a cohort study of primary care patients in the Netherlands

2014 ◽  
Vol 65 (630) ◽  
pp. e1-e8 ◽  
Author(s):  
Anne Groot ◽  
Michiel L Bots ◽  
Frans H Rutten ◽  
Hester M den Ruijter ◽  
Mattijs E Numans ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Cardiovascular Risk ◽  
The Netherlands ◽  
Risk Classification ◽  
Primary Care Patients ◽  
Ecg Abnormalities

scholarly journals Quality Use Of Medicines In Patients With Chronic Kidney Disease

2019 ◽  
Author(s):  
Ronald L Castelino ◽  
Timothy Saunder ◽  
Alex Kitsos ◽  
Greg Peterson ◽  
Matthew Jose ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Inappropriate Prescribing ◽  
High Dose ◽  
Australian General Practice ◽  
Primary Care Patients ◽  
General Practices ◽  
Two Measures

Abstract Objective: To determine the extent of potentially inappropriate prescribing (PIP; defined as the use of a contraindicated medication or inappropriately high dose according to the kidney function) of renally-cleared medications commonly prescribed in Australian primary care, based on two measures of kidney function. A secondary aim was to assess agreement between the two measures. Design: Retrospective analysis of routinely collected de-identified Australian general practice patient data (NPS MedicineWise MedicineInsight from January 1, 2013, to June 1, 2016; collected from 329 general practices). Setting & Participants: All adults (aged ≥18 years) with chronic kidney disease (CKD) presenting to general practices across Australia. Results: A total of 48,731 patients met the Kidney Health Australia (KHA) definition for CKD and had prescriptions recorded within 90 days of measuring serum creatinine (SCr)/estimated glomerular filtration rate (eGFR). Overall, 28,729 patients were prescribed one or more of the 49 medications of interest. Approximately 35% (n=9,926) of these patients had at least one PIP based on either the Cockcroft-Gault (CG) equation or eGFR (CKD-EPI; CKD-Epidemiology Collaboration Equation). There was good agreement between CG and eGFR while determining the appropriateness of medications, with approximately 97% of the medications classified as appropriate by eGFR also being considered appropriate by the CG equation. Conclusion: This study highlights that PIP commonly occurs in primary care patients with CKD and the need for further research to understand why and how this can be minimised. The findings also show that the eGFR provides clinicians a potential alternative to the CG formula when estimating kidney function to guide drug appropriateness and dosing.

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