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Sökning: onr:"swepub:oai:DiVA.org:uu-320631" > Personalising the d...

Personalising the decision for prolonged dual antiplatelet therapy development, validation and potential impact of prognosticmodels for cardiovascular events and bleeding in myocardial infarction survivors

Pasea, Laura, (författare)
UCL, Farr Inst Hlth Informat Res, London, England.
Chung, Sheng-Chia, (författare)
UCL, Farr Inst Hlth Informat Res, London, England.
Pujades-Rodriguez, Mar, (författare)
UCL, Farr Inst Hlth Informat Res, London, England.;Univ Leeds, MRC Med Bioinformat Ctr, Leeds Inst Biomed & Clin Sci, Leeds LS2 9JT, W Yorkshire, England.
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Moayyeri, Alireza, (författare)
UCL, Farr Inst Hlth Informat Res, London, England.
Denaxas, Spiros, (författare)
UCL, Farr Inst Hlth Informat Res, London, England.
Fox, Keith A. A., (författare)
Univ Edinburgh, Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland.;Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland.
Wallentin, Lars, 1943- (författare)
Uppsala universitet, Uppsala kliniska forskningscentrum (UCR), Uppsala universitet, Kardiologi
Pocock, Stuart J., (författare)
London Sch Hyg & Trop Med, Dept Med Stat, London, England.
Timmis, Adam, (författare)
Barts & London Natl Inst Hlth Res Cardiovasc Biom, Barts Heart Ctr, London, England.
Banerjee, Amitava, (författare)
UCL, Farr Inst Hlth Informat Res, London, England.
Patel, Riyaz, (författare)
UCL, Farr Inst Hlth Informat Res, London, England.
Hemingway, Harry, (författare)
UCL, Farr Inst Hlth Informat Res, London, England.
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2017
Engelska.
Ingår i: European Heart Journal. - 0195-668X .- 1522-9645. ; 38:14, s. 1048-1055A

  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
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  • <p>Aims The aim of this study is to develop models to aid the decision to prolong dual antiplatelet therapy (DAPT) that requires balancing an individual patient's potential benefits and harms Methods and results Using population-based electronic health records (EHRs) (CALIBER, England, 2000-10), of patients evaluated 1 year after acute myocardial infarction (MI), we developed (n= 12 694 patients) and validated (n= 5613) prognostic models for cardiovascular (cardiovascular death, MI or stroke) events and three different bleeding endpoints. We applied trial effect estimates to determine potential benefits and harms of DAPT and the net clinical benefit of individuals. Prognostic models for cardiovascular events (c-index: 0.75 (95% CI: 0.74, 0.77)) and bleeding (c index 0.72 (95% CI: 0.67, 0.77)) were well calibrated: 3-year risk of cardiovascular events was 16.5% overall (5.2% in the lowest-and 46.7% in the highest-risk individuals), while for major bleeding, it was 1.7% (0.3% in the lowest-and 5.4% in the highest-risk patients). For every 10 000 patients treated per year, we estimated 249 (95% CI: 228, 269) cardiovascular events prevented and 134 (95% CI: 87, 181) major bleeding events caused in the highest-risk patients, and 28 (95% CI: 19, 37) cardiovascular events prevented and 9 (95% CI: 0, 20) major bleeding events caused in the lowest-risk patients. There was a net clinical benefit of prolonged DAPT in 63-99% patients depending on how benefits and harms were weighted Conclusion Prognostic models for cardiovascular events and bleeding using population-based EHRs may help to personalise decisions for prolonged DAPT 1-year following acute MI.</p>

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Nyckelord

Prognosis
Myocardial infarction
Bleeding

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