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  • 1
    Online Resource
    Online Resource
    Diagnostic accuracy of a point-of-care antigen test for SARS-CoV-2 and influenza in a primary care population (RAPTOR-C19)
    Elsevier BV ; 2024
    In:  Clinical Microbiology and Infection Vol. 30, No. 3 ( 2024-03), p. 380-386
    Details
    In: Clinical Microbiology and Infection, Elsevier BV, Vol. 30, No. 3 ( 2024-03), p. 380-386
    Type of Medium: Online Resource
    ISSN: 1198-743X
    URL: Article
    DOI: 10.1016/j.cmi.2023.12.009
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2024
    detail.hit.zdb_id: 1328418-6
    SSG: 12
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  • 2
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    PREDICTING THE RISK OF SYNCOPE IN PATIENTS WITH AN INDICATION FOR ANTIHYPERTENSIVE TREATMENT: DEVELOPMENT OF THE STRATIFY-SYNCOPE PREDICTION MODEL
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Journal of Hypertension Vol. 40, No. Suppl 1 ( 2022-06), p. e5-
    Details
    In: Journal of Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 40, No. Suppl 1 ( 2022-06), p. e5-
    Abstract: Syncope is one of the most common side effects associated with antihypertensive medication. In patients at increased of syncope, the additional risk of harm from antihypertensive medication may outweigh the potential benefits of treatment in terms of cardiovascular risk reduction. However, it is unclear how to identify patients at most risk of syncope events. This study aimed to develop a clinical prediction model for risk of hospitalisation or death from syncope. Design and method: This was a cohort study using data from the Clinical Practice Research Datalink (CPRD) in the UK. The electronic health records of patients aged greater than 40, with at least one blood pressure measurement between 130–179 mmHg were included. Outcomes were defined as a syncope event resulting in hospitalisation or death within 10 years of baseline. Predictors of syncope were based on the literature and expert opinion and included patient characteristics, past medical history and prescribed treatment (including antihypertensive prescription). A Fine-Gray model was used to adjust for competing risk of mortality and results are reported as subdistribution hazard ratios (SHR). Results: A total of 1,772,617 patients were eligible for the study, with mean age of 59 and 48% males. Median follow up was 6.2 years with 39898 syncope events (2.3%). The antihypertensive medications most strongly associated with syncope were alpha blockers (SHR: 1.21, 95%CI 1.15 to 1.28) and ACE inhibitors (SHR: 1.19, 95%CI 1.16 to 1.22). Other important predictors included age (Figure 1), male sex, high social deprivation, heavy alcohol consumption, previous syncope, diabetes, dementia, structural cardiac problems, arrhythmias, spinal cord injuries, parkinsonism, cardiopulmonary disease and prescription of antidepressants, antipsychotics and opioids (table 1). Conclusions: This prediction model identified a number of strong predictors of syncope which are routinely available in an individual's electronic health records. The accuracy of this model will examined in a further ∼3,000,000 patients from a different electronic health record database. If it is found to perform well, such a model could be used to provide personalised estimates of an individual's risk of harm from antihypertensive treatment, thus facilitating more informed treatment choices.
    Type of Medium: Online Resource
    ISSN: 0263-6352 , 1473-5598
    URL: Article
    DOI: 10.1097/01.hjh.0000835332.55446.ca
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2017684-3
    detail.hit.zdb_id: 605532-1
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  • 3
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    Impact of Changes to National Hypertension Guidelines on Hypertension Management and Outcomes in the United Kingdom
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Hypertension Vol. 75, No. 2 ( 2020-02), p. 356-364
    Details
    In: Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 75, No. 2 ( 2020-02), p. 356-364
    Abstract: In recent years, national and international guidelines have recommended the use of out-of-office blood pressure monitoring for diagnosing hypertension. Despite evidence of cost-effectiveness, critics expressed concerns this would increase cardiovascular morbidity. We assessed the impact of these changes on the incidence of hypertension, out-of-office monitoring and cardiovascular morbidity using routine clinical data from English general practices, linked to inpatient hospital, mortality, and socio-economic status data. We studied 3 937 191 adults with median follow-up of 4.2 years (49% men, mean age=39.7 years) between April 1, 2006 and March 31, 2017. Interrupted time series analysis was used to examine the impact of changes to English hypertension guidelines in 2011 on incidence of hypertension (primary outcome). Secondary outcomes included rate of out-of-office monitoring and cardiovascular events. Across the study period, incidence of hypertension fell from 2.1 to 1.4 per 100 person-years. The change in guidance in 2011 was not associated with an immediate change in incidence (change in rate=0.01 [95% CI, −0.18–0.20]) but did result in a leveling out of the downward trend (change in yearly trend =0.09 [95% CI, 0.04–0.15] ). Ambulatory monitoring increased significantly in 2011/2012 (change in rate =0.52 [95% CI, 0.43–0.60]). The rate of cardiovascular events remained unchanged (change in rate =−0.02 [95% CI, −0.05–0.02] ). In summary, changes to hypertension guidelines in 2011 were associated with a stabilisation in incidence and no increase in cardiovascular events. Guidelines should continue to recommend out-of-office monitoring for diagnosis of hypertension.
    Type of Medium: Online Resource
    ISSN: 0194-911X , 1524-4563
    URL: Article
    DOI: 10.1161/HYPERTENSIONAHA.119.13926
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2094210-2
    detail.hit.zdb_id: 423736-5
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  • 4
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    Predicting Out-of-Office Blood Pressure in the Clinic (PROOF-BP) : Derivation and Validation of a Tool to Improve the Accuracy of Blood Pressure Measurement in Clinical Practice
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Hypertension Vol. 67, No. 5 ( 2016-05), p. 941-950
    Details
    In: Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 67, No. 5 ( 2016-05), p. 941-950
    Abstract: Patients often have lower (white coat effect) or higher (masked effect) ambulatory/home blood pressure readings compared with clinic measurements, resulting in misdiagnosis of hypertension. The present study assessed whether blood pressure and patient characteristics from a single clinic visit can accurately predict the difference between ambulatory/home and clinic blood pressure readings (the home–clinic difference). A linear regression model predicting the home–clinic blood pressure difference was derived in 2 data sets measuring automated clinic and ambulatory/home blood pressure (n=991) using candidate predictors identified from a literature review. The model was validated in 4 further data sets (n=1172) using area under the receiver operator characteristic curve analysis. A masked effect was associated with male sex, a positive clinic blood pressure change (difference between consecutive measurements during a single visit), and a diagnosis of hypertension. Increasing age, clinic blood pressure level, and pulse pressure were associated with a white coat effect. The model showed good calibration across data sets (Pearson correlation, 0.48–0.80) and performed well-predicting ambulatory hypertension (area under the receiver operator characteristic curve, 0.75; 95% confidence interval, 0.72–0.79 [systolic]; 0.87; 0.85–0.89 [diastolic] ). Used as a triaging tool for ambulatory monitoring, the model improved classification of a patient’s blood pressure status compared with other guideline recommended approaches (93% [92% to 95%] classified correctly; United States, 73% [70% to 75%] ; Canada, 74% [71% to 77%]; United Kingdom, 78% [76% to 81%] ). This study demonstrates that patient characteristics from a single clinic visit can accurately predict a patient’s ambulatory blood pressure. Usage of this prediction tool for triaging of ambulatory monitoring could result in more accurate diagnosis of hypertension and hence more appropriate treatment.
    Type of Medium: Online Resource
    ISSN: 0194-911X , 1524-4563
    URL: Article
    DOI: 10.1161/HYPERTENSIONAHA.115.07108
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 2094210-2
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  • 5
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    PREDITING THE RISK OF FRACTURE ASSOCIATED WITH ANTIHYPERTENSIVE TREATMENT: DEVELOPMENT OF THE STRATIFY-FRACTURE PREDICTION MODEL
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Journal of Hypertension Vol. 41, No. Suppl 3 ( 2023-06), p. e3-
    Details
    In: Journal of Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 41, No. Suppl 3 ( 2023-06), p. e3-
    Abstract: The benefits of antihypertensive treatment are well known, but less is known about the potential risk of harm from antihypertensive medication. The STRAtifying Treatments. In the multi-morbid Frail elderlY (STRATIFY) study aimed to better understand the harms of antihypertensive treatment by quantifying an individual's baseline risk of different serious adverse events. This current study aimed to develop a prediction model for an individual's risk of hospitalisation or death from fracture. Design and method: Participants aged 〉  = 40 years, registered to a UK primary care practice within the Clinical Pr: actice Research Datalink (CPRD) GOLD database, with at least one blood pressure measurement between 130-179 mm Hg were included in this cohort study. The outcome investigated was fracture that led to hospital admission or death within 10 years after the index date. The (prespecified) predictor variables based on the literature and expert opinions were patient characteristics, history of falls and fractures (from the age of 40), diagnosis of osteoporosis and rheumatoid arthritis, other comorbidities, and prescribed medications (including antihypertensive medications). Multiple imputation was used to account for missing data. The primary analysis used a Fine-Gray competing risks approach to adjust death from other causes. Results were reported as subdistribution hazard ratios (SHR). Results: A total of 1,772,601 participants were included, with a mean age of 59 years and median follow-up of 6.1 years. The 10-year incidence of fracture was 1.4%. All antihypertensive medications were significantly associated with the risk of fracture, as were a number of patient characteristics and co-morbidities (detailed in Table 1). Potential predictors with no significant association were chronic renal disease, mobility and transfer problems, hypogonadism, vitamin D deficiency and aromatase inhibitors. SHRs and 95% confidence intervals for the predictors are shown in Table 1. Conclusions: In this study, we identified a number of predictors of fracture using UK electronic health record and quantified an individual's baseline risk of fracture. The external validation of this model will use a different database (CPRD AURUM). Our findings could inform clinicians as to when it is appropriate to prescribe and deprescribe antihypertensive treatment.
    Type of Medium: Online Resource
    ISSN: 0263-6352 , 1473-5598
    URL: Article
    DOI: 10.1097/01.hjh.0000938904.16510.79
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2017684-3
    detail.hit.zdb_id: 605532-1
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  • 6
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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 ; 2018
    In:  BMJ Open Vol. 8, No. 9 ( 2018-09), p. e021827-
    Details
    In: BMJ Open, BMJ, Vol. 8, No. 9 ( 2018-09), p. e021827-
    Abstract: Evidence 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. Design Longitudinal cohort study. Setting Primary care practices contributing to the Clinical Practice Research Datalink in England. Participants Data 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 measures The association between policy changes and incidence of lifestyle advice or treatment, examined using an interrupted time-series analysis. Results A 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. Conclusions Despite 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.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    URL: Article
    DOI: 10.1136/bmjopen-2018-021827
    DOI: 10.1136/bmjopen-2018-021827.supp1
    Language: English
    Publisher: BMJ
    Publication Date: 2018
    detail.hit.zdb_id: 2599832-8
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  • 7
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    Cost-Effectiveness of Antihypertensive Deprescribing in Primary Care: a Markov Modelling Study Using Data From the OPTiMISE Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Hypertension Vol. 79, No. 5 ( 2022-05), p. 1122-1131
    Details
    In: Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 79, No. 5 ( 2022-05), p. 1122-1131
    Abstract: Deprescribing of antihypertensive medications for older patients with normal blood pressure is recommended by some clinical guidelines, where the potential harms of treatment may outweigh the benefits. This study aimed to assess the cost-effectiveness of this approach. Methods: A Markov patient-level simulation was undertaken to model the effect of withdrawing one antihypertensive compared with usual care, over a life-time horizon. Model population characteristics were estimated using data from the OPTiMISE antihypertensive deprescribing trial, and the effects of blood pressure changes on outcomes were derived from the literature. Health-related quality of life was modeled in Quality-Adjusted Life Years (QALYs) and presented as costs per QALY gained. Results: In the base-case analysis, medication reduction resulted in lower costs than usual care (mean difference £185), but also lower QALYs (mean difference 0.062) per patient over a life-time horizon. Usual care was cost-effective at £2975 per QALY gained (more costly, but more effective). Medication reduction resulted more heart failure and stroke/TIA events but fewer adverse events. Medication reduction may be the preferred strategy at a willingness-to-pay of £20 000/QALY, where the baseline absolute risk of serious drug-related adverse events was ≥7.7% a year (compared with 1.7% in the base-case). Conclusions: Although there was uncertainty around many of the assumptions underpinning this model, these findings suggest that antihypertensive medication reduction should not be attempted in many older patients with controlled systolic blood pressure. For populations at high risk of adverse effects, deprescribing may be beneficial, but a targeted approach would be required in routine practice.
    Type of Medium: Online Resource
    ISSN: 0194-911X , 1524-4563
    URL: Article
    DOI: 10.1161/HYPERTENSIONAHA.121.18726
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2094210-2
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  • 8
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    Generalizability of Blood Pressure Lowering Trials to Older Patients: Cross‐Sectional Analysis
    Wiley ; 2020
    In:  Journal of the American Geriatrics Society Vol. 68, No. 11 ( 2020-11), p. 2508-2515
    Details
    In: Journal of the American Geriatrics Society, Wiley, Vol. 68, No. 11 ( 2020-11), p. 2508-2515
    Abstract: See related editorial by Jeff D. Williamson in this issue.
    Type of Medium: Online Resource
    ISSN: 0002-8614 , 1532-5415
    URL: Issue
    URL: Article
    DOI: 10.1111/jgs.v68.11
    DOI: 10.1111/jgs.16749
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2040494-3
    detail.hit.zdb_id: 80363-7
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  • 9
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    PREDICTING INDIVIDUAL RISK OF MUSCLE DISORDERS IN PATIENTS ELIGIBLE FOR STATIN TREATMENT: STRATIFY-STATINMD MODEL DERIVATION USING DATA FROM ELECTRONIC HEALTH RECORDS
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Journal of Hypertension Vol. 40, No. Suppl 1 ( 2022-06), p. e76-e77
    Details
    In: Journal of Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 40, No. Suppl 1 ( 2022-06), p. e76-e77
    Abstract: Concerns about muscle-related adverse events have posed a dilemma when considering statin prescription for prevention of cardiovascular disease (CVD). This study aimed to develop a prediction model for an individual’s risk of muscle disorders to support clinical decision making in primary care. Design and method: A prospective cohort design was adopted, using electronic health records from the Clinical Practice Research Datalink in the UK. Males aged over 50 and females aged over 60, who were potentially eligible for statin treatment based on their underlying CVD risk, were followed-up for ten years. The primary outcome was hospitalisation or death in those with a diagnosis of muscle disorders. The Fine-Gray proportional sub-distribution hazards model was fitted to address competing risk of death from other causes. Statin prescriptions within the 12 months before follow up and other predictors were included in the model based on a literature review. Results: The cohort included 1,785,207 patients, with a mean age of 64 and 44% females. Patients prescribed statins were predicted to have a higher risk of muscle disorders (atorvastatin: hazard ratio = 1.77 [95% confidence interval: 1.58 - 1.97]; rosuvastatin: 2.04 [1.58 - 2.63] ; simvastatin: 1.58 [1.45 - 1.71]; other statins (fluvastatin/pravastatin): 1.38 [1.14 - 1.68] ). Female sex, deprivation, smoking, obesity, frailty, liver or kidney disease, rheumatic arthritis, previous muscle problems, degenerative joint disorders, hypothyroidism, vitamin D or B12 deficiency, and the use of drugs that are potentially myotoxic or interact with statins also increased an individual’s risk (Table). An automated risk calculator was developed based on the model (Figure). Conclusions: This model uses routinely available patient characteristics and medical history to predict an individual’s risk of muscle disorders. The calculator may help clinicians and patients communicate the safety concerns and make shared decisions or monitoring strategies on statin treatment. External validation of this model is ongoing to support general application of the risk calculator in clinical practice.
    Type of Medium: Online Resource
    ISSN: 0263-6352 , 1473-5598
    URL: Article
    DOI: 10.1097/01.hjh.0000835944.28117.db
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 10
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    Development and initial validation of a simple clinical decision tool to predict the presence of heart failure in primary care: the MICE (Male, Infarction, Crepitations, Edema, MICE) rule
    Wiley ; 2012
    In:  European Journal of Heart Failure Vol. 14, No. 9 ( 2012-09), p. 1000-1008
    Details
    In: European Journal of Heart Failure, Wiley, Vol. 14, No. 9 ( 2012-09), p. 1000-1008
    Abstract: Diagnosis of heart failure in primary care is often inaccurate, and access to and use of echocardiography is suboptimal. This study aimed to develop and provisionally validate a clinical prediction rule to optimize referral for echocardiography of people identified in primary care with suspected heart failure. Methods and results A systematic review identified studies of diagnosis of heart failure set in primary care. The individual patient data for five of these studies were obtained. Logistic regression models to predict heart failure were developed on one of the data sets and validated on the others using area under the receiver operating characteristic curve (AUROC), and goodness‐of‐fit calibration plots. A model based upon four simple clinical features (Male, history of myocardial Infarction, Crepitations, Edema: MICE) and natriuretic peptide had good validity when applied to other data sets, with AUROCs between 0.84 and 0.93, and reasonable calibration. The rule performed well across the data sets, with sensitivity between 81% and 96% and specificity between 57% and 74%. Conclusions A simple clinical rule based upon gender, history of myocardial infarction, presence of ankle oedema, and presence of basal lung crepitations can discriminate between people with suspected heart failure who should be referred straight for echocardiography and people for whom referral should depend upon the result of a natriuretic peptide test. Prospective validation and an implementation evaluation of the rule is now warranted.
    Type of Medium: Online Resource
    ISSN: 1388-9842 , 1879-0844
    URL: Article
    DOI: 10.1093/eurjhf/hfs089
    Language: English
    Publisher: Wiley
    Publication Date: 2012
    detail.hit.zdb_id: 1500332-2
    detail.hit.zdb_id: 1483672-5
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