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- Cea Soriano, Lucía, et al.
(author)
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Predictors and time trends in clopidogrel and proton pump inhibitor coprescription with low-dose acetylsalicylic acid
- 2012
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In: Pharmacoepidemiology and Drug Safety. - : Wiley. - 1053-8569 .- 1099-1557. ; 21, s. 463-469
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Journal article (peer-reviewed)abstract
- Purpose: To determine trends and predictors of clopidogrel and proton pump inhibitor (PPI) coprescription with low-dose acetylsalicylic acid (ASA) prescribed for secondary cardiovascular or cerebrovascular disease (CVD) prevention in UK primary care. Methods: Patients aged 50-84years who received a first prescription for low-dose ASA for secondary CVD prevention in 2000-2001 (n=10 330) or 2006-2007 (n=8154) were identified in The Health Improvement Network UK primary care database. Clopidogrel or PPI coprescriptions received within 15days after the first low-dose ASA prescription were ascertained. Results: Clopidogrel coprescription with low-dose ASA increased from 1.6% to 25.2% between the two study periods; PPI coprescription increased from 11.6% to 28.3%. Low-dose ASA indications of myocardial infarction [odds ratio (OR) 11.7, 95% confidence interval (CI) 10.2 to 13.4] and unstable angina (OR 1.73, 95%CI 1.09 to 2.75) were positive predictors of clopidogrel coprescription in 2006-2007, relative to chronic ischaemic heart disease. Patients at high risk of upper gastrointestinal bleeding were more likely to receive a PPI than those at lower risk in 2006-2007 (OR 4.36, 95%CI 3.93 to 4.84). In this period, 65.5% of patients who required a clopidogrel coprescription according to guideline recommendations received one, and 44.3% of patients at high risk of upper gastrointestinal bleeding received a PPI. Conclusion: Clopidogrel and PPI coprescription with low-dose ASA increased markedly between 2000-2001 and 2006-2007; however, many patients on low-dose ASA did not receive the recommended coprescriptions at the end of the study period. © 2012 John Wiley & Sons, Ltd.
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- García Rodríguez, Luis A, et al.
(author)
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Chronic obstructive pulmonary disease in UK primary care : incidence and risk factors
- 2009
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In: COPD: Journal of Chronic Obstructive Pulmonary Disease. - : Informa UK Limited. - 1541-2555 .- 1541-2563. ; 6:5, s. 369-379
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Journal article (peer-reviewed)abstract
- We evaluated the association of chronic obstructive pulmonary disease (COPD) with modifiable risk factors such as smoking and prescription medications, and investigated possible risk factors unique to patients who had never smoked. The UK General Practice Research Database was used to identify a cohort of patients with a first diagnosis of COPD (n = 1927) along with age- and sex-matched controls without COPD (n = 16 546). The incidence of COPD diagnoses and the risks associated with medication use, co-morbidities, and demographic factors, were estimated. The incidence of COPD was 2.6 per 1000 person-years (95% confidence interval [CI]: 2.5-2.7) among 40-89 year-olds. The risk significantly increased in current and former smokers (OR: 6.15 [95% CI: 5.41-7.00] and 3.45 [95% CI: 2.96-4.02]), respectively. The risk was significantly lower in former smokers than current smokers (OR: 0.61; 95% CI: 0.52-0.71). Current statin use was significantly associated with a reduced risk (OR: 0.45; 95% CI: 0.25-0.80). In never smokers, risk factors included advanced age and obesity. The risk in never smokers was more strongly related to paracetamol use (OR: 1.82; 95% CI: 1.33-2.49) than in current and former smokers (OR: 1.48; 95% CI: 1.18-1.86). In summary, COPD is associated with a range of cardiovascular and respiratory conditions and the risk is influenced by current and past medications. While the risk factors are similar in smokers and never smokers, some were unique to never smokers. Moreover, subjects who stopped smoking had a substantially lower COPD risk than those who continued smoking.
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- Garcia Rodriguez, Luis A., et al.
(author)
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Heart failure, myocardial infarction, lung cancer and death in COPD patients : A UK primary care study
- 2010
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In: Respiratory Medicine. - : Elsevier BV. - 0954-6111 .- 1532-3064. ; 104:11, s. 1691-1699
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Journal article (peer-reviewed)abstract
- Background: The leading comorbidities and causes of death in patients with chronic obstructive pulmonary disease (COPD) are lung cancer and cardiovascular disease. The aim of this study was to establish the incidence of lung cancer, myocardial infarction and heart failure in patients with COPD in UK primary care. Methods: The General Practice Research Database (GPRD) was used to identify a cohort of 1927 patients with a first recorded diagnosis of COPD. This cohort was followed for up to 5 years to identify new diagnoses of lung cancer, myocardial infarction and heart failure. Mortality was also assessed. The relative risk (RR) of each outcome in the COPD cohort was compared with that in a control cohort with no diagnosis of COPD. Results: The risk of lung cancer was significantly increased in individuals with a diagnosis of COPD compared with those with no COPD diagnosis (RR: 3.33; 95% confidence interval [Cl]: 2.33-4.75; adjusted for age, sex and smoking status). A diagnosis of COPD was also associated with a significant increase in the risk of heart failure (age- and sex-adjusted RR: 2.94; 95% CI: 2.46-3.51) and death (age- and sex-adjusted RR: 2.76; 95% Cl: 2.45-3.12), but not myocardial infarction (age- and sex-adjusted RR: 1.18; 95% Cl: 0.81-1.71). Conclusions: Patients with a diagnosis of COPD are at significantly increased risk of lung cancer, heart failure and death compared with the general population. They do not appear to be at increased risk of myocardial infarction.
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- García Rodríguez, Luis A, et al.
(author)
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Relationship between gastroesophageal reflux disease and COPD in UK primary care
- 2008
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In: Chest. - : Elsevier BV. - 0012-3692 .- 1931-3543. ; 134:6, s. 1223-1230
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Journal article (peer-reviewed)abstract
- BACKGROUND: Gastroesophageal reflux symptoms may be more common in patients with COPD than in control subjects. The aim of this study was to investigate the relationship between diagnoses of COPD and gastroesophageal reflux disease (GERD) in primary care. METHODS: We used the UK General Practice Research Database to identify a cohort of patients with a first diagnosis of GERD (n = 4,391) and another cohort of patients with a first diagnosis of COPD (n = 1,628) during 1996, which we compared with age-matched and sex-matched comparison cohorts without either diagnosis. We calculated the incidence of a GERD diagnosis among the patients with COPD and control subjects, and of a COPD diagnosis among the patients with GERD and control subjects. We also calculated the relative risk (RR) estimates of these diagnoses using the Mantel-Haenszel test. Risks associated with medication use, comorbidities, and demographic and lifestyle factors were examined using a nested case-control analysis. RESULTS: During the 5-year follow-up, the RR of an incident COPD diagnosis in patients with a diagnosis of GERD was 1.17 (95% confidence interval [CI], 0.91 to 1.49), while the RR of an incident GERD diagnosis among patients with a diagnosis of COPD was 1.46 (95% CI, 1.19 to 1.78). A COPD diagnosis was associated with current or former smoking, prior diagnosis of asthma, or the use of asthma medication. A GERD diagnosis was associated with a prior diagnosis of ischemic heart disease. CONCLUSIONS: Patients with a diagnosis of COPD are at a significantly increased risk of a diagnosis of GERD compared with individuals with no COPD diagnosis.
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- Huerta, Consuelo, et al.
(author)
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Risk of myocardial infarction and overall mortality in survivors of venous thromboembolism.
- 2008
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In: Thrombosis Journal. - : Springer Science and Business Media LLC. - 1477-9560. ; 6, s. 10-
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Journal article (peer-reviewed)abstract
- BACKGROUNDVenous thromboembolism (VTE) and thromboembolic arterial diseases are usually considered to be distinct entities, but there is evidence to suggest that these disorders may be linked. The aim of this study was to determine whether a diagnosis of VTE increases the long-term risk of myocardial infarction (MI).METHODSThe incidence rate (IR) and relative risk (RR) of MI in a cohort of patients with a diagnosis of VTE (n = 4890) compared with that of a control cohort without prior VTE (n = 43 382) were evaluated in the UK General Practice Research Database (GPRD). Death during follow-up was also determined. Patients were followed for up to 8 years (mean of 3 years).RESULTSThe IR of MI per 1000 person-years was 4.1 (95% CI: 3.1-5.3) for the VTE cohort and 3.5 (95% CI: 3.2-3.8) for the control cohort. The IR of MI was highest in the first year after the VTE episode, but overall differences between the two cohorts were not significant (RR of MI associated with VTE: 1.2; 95% CI: 0.9-1.6). The risk of death was higher in the VTE cohort than the control cohort, even after adjustment for cancer, heart failure and ischaemic heart disease (RR: 2.4; 95% CI: 2.2-2.6), particularly during the first year after VTE (RR: 3.8; 95% CI: 3.4-4.3).CONCLUSIONA VTE episode does not significantly increase the risk of MI, but does increase the risk of death, particularly in the first year following VTE diagnosis.
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- Johansson, Saga, et al.
(author)
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Prospective Drug Safety Monitoring Using the UK Primary-Care General Practice Research Database Theoretical Framework, Feasibility Analysis and Extrapolation to Future Scenarios
- 2010
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In: Drug Safety. - : Springer Science and Business Media LLC. - 0114-5916 .- 1179-1942. ; 33:3, s. 223-232
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Journal article (peer-reviewed)abstract
- Background: Post-launch drug safety monitoring is essential for the detection of adverse drug signals that may be missed during preclinical trials. Traditional methods of postmarketing surveillance such as spontaneous reporting have intrinsic limitations, many of which can be overcome by the additional application of structured pharmacoepidemiological approaches. However, further improvement in drug safety monitoring requires a shift towards more proactive pharmacoepidemiological methods that can detect adverse drug signals as they occur in the population. Objective: To assess the feasibility of using proactive monitoring of an electronic medical record system, in combination with an independent endpoint adjudication committee, to detect adverse events among users of selected drugs. Methods: UK General Practice Research Database (GPRD) information was used to detect acute liver disorder associated with the use of amoxicillin/clavulanic acid (hepatotoxic) or low-dose aspirin (acetylsalicylic acid [non-hepatotoxic]). Individuals newly prescribed these drugs between 1 October 2005 and 31 March 2006 were identified. Acute liver disorder cases were assessed using GPRD computer records in combination with case validation by an independent endpoint adjudication committee. Signal generation thresholds were based on the background rate of acute liver disorder in the general population. Results: Over a 6-month period, 8148 patients newly prescribed amoxicillin/clavulanic acid and 5577 patients newly prescribed low-dose aspirin were identified. Within this cohort, searches identified 11 potential liver disorder cases from computerized records: six for amoxicillin/clavulanic acid and five for low-dose aspirin. The independent endpoint adjudication committee refined this to four potential acute liver disorder cases for whom paper-based information was requested for final case assessment. Final case assessments confirmed no cases of acute liver disorder. The time taken for this study was 18 months (6 months for recruitment and 12 months for data management and case validation). To reach the estimated target exposure necessary to raise or rule out a signal of concern to public health, we determined that a recruitment period 2-3 times longer than that used in this study would be required. Based on the real market uptake of six commonly used medicinal products launched between 2001 and 2006 in the UK (budesonide/eformoterol [fixed-dose combination], duloxetine, ezetimibe, metformin/rosiglitazone [fixed-dose combination], tiotropium bromide and tadalafil) the target exposure would not have been reached until the fifth year of marketing using a single database. Conclusions: It is feasible to set Lip a system that actively monitors drug safety using a healthcare database and an independent endpoint adjudication committee. However, future successful implementation will require multiple databases to be queried so that larger study populations are included. This requires further development and harmonization of international healthcare databases.
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