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Lefeber GJ, Koek HL, Souverein PC, Bouvy ML, de Boer A, Knol W. Statins After Myocardial Infarction in the Oldest: A Cohort Study in the Clinical Practice Research Datalink Database. J Am Geriatr Soc 2020; 68:329-336. [PMID: 31647578 PMCID: PMC7028025 DOI: 10.1111/jgs.16227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To explore the effect of initiating statins for secondary prevention after a first myocardial infarction (MI) in patients aged 80 years and older. DESIGN Retrospective cohort study. SETTING Clinical Practice Research Datalink (1999-2016). PARTICIPANTS Patients, aged 65 years and older, hospitalized after a first MI without a statin prescription in the year before hospitalization. The age group of 65 to 80 years was included to compare our results to current evidence. MEASUREMENTS The primary outcome was a composite of recurrent MI, stroke, and cardiovascular mortality; and the secondary outcome was all-cause mortality. A time-varying Cox model was used to account for statin prescription over time. We compared at least 2 years of statin prescription time with untreated and less than 2 years of prescription time. Analyses were adjusted for potential confounders. The number needed to treat (NNT) was calculated based on the adjusted hazard ratios (HRs) and corrected for deaths during the first 2 years of follow-up. RESULTS A total of 9020 patients were included. Among the 3900 patients aged 80 years and older, 2 years of statin prescriptions resulted in a lower risk of the composite outcome (adjusted HR = 0.81; 95% confidence interval [CI] = 0.66-0.99) and of all-cause mortality (adjusted HR = 0.84; 95% CI = 0.73-0.97). During 4.5 years of median follow-up, the NNT for prevention of the primary outcome was 59; and for mortality, the NNT was 36. Correcting for 36.2% deaths during the first 2 years increased the NNT on the primary outcome to 93 and to 61 on all-cause mortality. CONCLUSION Our data support statin initiation after a first MI in patients aged 80 years and older if continued for at least 2 years. Especially in patients with a low risk of 2-year mortality, statins should be considered. J Am Geriatr Soc 68:329-336, 2020.
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Affiliation(s)
- Geert J. Lefeber
- Department of Geriatrics, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
- Expertise Centre Pharmacotherapy in Old PersonsUtrechtThe Netherlands
| | - Huiberdina L. Koek
- Department of Geriatrics, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
- Expertise Centre Pharmacotherapy in Old PersonsUtrechtThe Netherlands
| | - Patrick C. Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
| | - Marcel L. Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
| | - Wilma Knol
- Department of Geriatrics, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
- Expertise Centre Pharmacotherapy in Old PersonsUtrechtThe Netherlands
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Retornaz F, Beliard S, Gremeaux E, Chiche L, Lagarde L, Andrianasolo M, Molines C, Oliver C. [Statin and cardiovascular diseases after 75 years]. Rev Med Interne 2016; 37:625-31. [PMID: 27389014 DOI: 10.1016/j.revmed.2016.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/15/2016] [Accepted: 06/02/2016] [Indexed: 11/16/2022]
Abstract
Statin prescription in persons older than 75 years or with frailty signs raises questions on the role of cholesterol in the genesis of atherosclerosis in this population, on the benefit of this treatment in primary or secondary prevention, and on their side effects in a context of multiple pathology and multiple medications. These questions are approached with the available literature data for this population. In secondary prevention, statin prescription is recommended whatever the age although intensive treatment should be avoided. In primary prevention, in the absence of consensus, their prescription depends on both geriatric and cardiovascular risk assessment.
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Affiliation(s)
- F Retornaz
- Centre gérontologique départemental, 176, avenue de Montolivet, 13012 Marseille, France; Institut Silvermed, 176, avenue de Montolivet, 13012 Marseille, France; Laboratoire de santé publique, évaluation des systèmes de soins et santé perçue, EA 3279 UFR médecine Aix-Marseille université, 27, boulevard Jean-Moulin, 13385 Marseille Cedex 05, France; Unité de recherche et de soins en médecine interne et maladies infectieuses, hôpital européen, 6, rue Desirée-Clary, 13003 Marseille, France.
| | - S Beliard
- Service d'endocrinologie, CHU de Conception, 47, boulevard Baille, 13005 Marseille, France; Faculté de médecine, boulevard Pierre-Dramard, 13005 Marseille, France
| | - E Gremeaux
- Centre gérontologique départemental, 176, avenue de Montolivet, 13012 Marseille, France
| | - L Chiche
- Unité de recherche et de soins en médecine interne et maladies infectieuses, hôpital européen, 6, rue Desirée-Clary, 13003 Marseille, France
| | - L Lagarde
- Centre gérontologique départemental, 176, avenue de Montolivet, 13012 Marseille, France
| | - M Andrianasolo
- Centre gérontologique départemental, 176, avenue de Montolivet, 13012 Marseille, France
| | - C Molines
- Centre gérontologique départemental, 176, avenue de Montolivet, 13012 Marseille, France; Institut Silvermed, 176, avenue de Montolivet, 13012 Marseille, France
| | - C Oliver
- Centre gérontologique départemental, 176, avenue de Montolivet, 13012 Marseille, France; Institut Silvermed, 176, avenue de Montolivet, 13012 Marseille, France; Faculté de médecine, boulevard Pierre-Dramard, 13005 Marseille, France
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Mazzali C, Paganoni AM, Ieva F, Masella C, Maistrello M, Agostoni O, Scalvini S, Frigerio M. Methodological issues on the use of administrative data in healthcare research: the case of heart failure hospitalizations in Lombardy region, 2000 to 2012. BMC Health Serv Res 2016; 16:234. [PMID: 27391599 PMCID: PMC4939041 DOI: 10.1186/s12913-016-1489-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 06/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Administrative data are increasingly used in healthcare research. However, in order to avoid biases, their use requires careful study planning. This paper describes the methodological principles and criteria used in a study on epidemiology, outcomes and process of care of patients hospitalized for heart failure (HF) in the largest Italian Region, from 2000 to 2012. METHODS Data were extracted from the administrative data warehouse of the healthcare system of Lombardy, Italy. Hospital discharge forms with HF-related diagnosis codes were the basis for identifying HF hospitalizations as clinical events, or episodes. In patients experiencing at least one HF event, hospitalizations for any cause, outpatient services utilization, and drug prescriptions were also analyzed. RESULTS Seven hundred one thousand, seven hundred one heart failure events involving 371,766 patients were recorded from 2000 to 2012. Once all the healthcare services provided to these patients after the first HF event had been joined together, the study database totalled about 91 million records. Principles, criteria and tips utilized in order to minimize errors and characterize some relevant subgroups are described. CONCLUSIONS The methodology of this study could represent the basis for future research and could be applied in similar studies concerning epidemiology, trend analysis, and healthcare resources utilization.
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Affiliation(s)
- Cristina Mazzali
- />Department of Management Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Anna Maria Paganoni
- />MOX–Department of Mathematics, Politecnico di Milano, Via Bonardi 9, 20133 Milan, Italy
| | - Francesca Ieva
- />Department of Mathematics, Università degli Studi di Milano, Milan, Italy
| | - Cristina Masella
- />Department of Management Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | | | | | | | - Maria Frigerio
- />De Gasperis Cardiocenter, Niguarda-Ca’Granda hospital, Milan, Italy
| | - On behalf of the HF Data Project
- />Department of Management Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
- />MOX–Department of Mathematics, Politecnico di Milano, Via Bonardi 9, 20133 Milan, Italy
- />Department of Mathematics, Università degli Studi di Milano, Milan, Italy
- />Ospedale Uboldo, AO Melegnano, Milan, Italy
- />AO San Carlo di Milano, Milan, Italy
- />IRCCS Fondazione S. Maugeri di Lumezzane, Brescia, Italy
- />De Gasperis Cardiocenter, Niguarda-Ca’Granda hospital, Milan, Italy
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Strowd RE, Wise SM, Umesi UN, Bishop L, Craig J, Lefkowitz D, Reynolds PS, Tegeler C, Arnan M, Duncan PW, Bushnell CD. Predictors of 30-day hospital readmission following ischemic and hemorrhagic stroke. Am J Med Qual 2014; 30:441-6. [PMID: 24919597 DOI: 10.1177/1062860614535838] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stroke patients have a high rate of 30-day readmission. Understanding the characteristics of patients at high risk of readmission is critical. A retrospective case-control study was designed to determine factors associated with 30-day readmission after stroke. A total of 79 cases with acute ischemic or hemorrhagic strokes readmitted to the same hospital within 30 days were compared with 86 frequency-matched controls. Readmitted patients were more likely to have had ≥2 hospitalizations in the year prior to stroke (21.5% vs 2.3% in controls, P < .001), and in the multivariate model, admission National Institutes of Health Stroke Score (NIHSS; odds ratio [OR] = 1.072; 95% confidence interval [CI] = 1.021-1.126 per 1 point increase; P = .005), prior hospitalizations (OR = 2.205; 95% CI = 1.426-3.412 per admission; P < .001), and absence of hyperlipidemia (OR = 0.444; 95% CI = 0.221-0.894; P = .023) were independently associated with readmission. The research team concludes that admission NIHSS and frequent prior hospitalizations are associated with 30-day readmission after stroke. If validated, these characteristics identify high-risk patients and focus efforts to reduce readmission.
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Affiliation(s)
- Roy E Strowd
- Wake Forest School of Medicine, Winston Salem, NC
| | | | | | - Laura Bishop
- Wake Forest School of Medicine, Winston Salem, NC
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Fisher J, Urquhart R, Johnston G. Use of opioid analgesics among older persons with colorectal cancer in two health districts with palliative care programs. J Pain Symptom Manage 2013; 46:20-9. [PMID: 23017627 PMCID: PMC3747099 DOI: 10.1016/j.jpainsymman.2012.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 07/05/2012] [Accepted: 07/11/2012] [Indexed: 11/30/2022]
Abstract
CONTEXT Prescription of opioid analgesics is a key component of pain management among persons with cancer at the end of life. OBJECTIVES To use a population-based method to assess the use of opioid analgesics within the community among older persons with colorectal cancer (CRC) before death and determine factors associated with the use of opioid analgesics. METHODS Data were derived from a retrospective, linked administrative database study of all persons who were diagnosed with CRC between January 1, 2001 and December 31, 2005 in Nova Scotia, Canada. This study included all persons who 1) were 66 years or older at the date of diagnosis; 2) died between January 1, 2001 and April 1, 2008; and 3) resided in health districts with formal palliative care programs (PCPs) (n=657). Factors associated with having filled at least one prescription for a so-called "strong" opioid analgesic in the six months before death were examined using multivariate logistic regression. RESULTS In all, 36.7% filled at least one prescription for any opioid in the six months before death. Adjusting for all covariates, filling a prescription for a strong opioid was associated with enrollment in a PCP (odds ratio [OR]=3.18, 95% CI=2.05-4.94), residence in a long-term care facility (OR=2.19, 95% CI=1.23-3.89), and a CRC cause of death (OR=1.75, 95% CI=1.14-2.68). Persons were less likely to fill a prescription for a strong opioid if they were older (OR=0.97, 95% CI=0.95-0.99), male (OR=0.59, 95% 0.40-0.86), and diagnosed less than six months before death (OR=0.62, 95% CI=0.41-0.93). CONCLUSION PCPs may play an important role in enabling access to end-of-life care within the community.
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Affiliation(s)
- Judith Fisher
- Pharmaceutical Services, Department of Health and Wellness, Halifax, Nova Scotia, Canada.
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Allonen J, Nieminen MS, Lokki M, Parkkonen O, Vaara S, Perola M, Hiekkalinna T, Strandberg TE, Sinisalo J. Mortality rate increases steeply with nonadherence to statin therapy in patients with acute coronary syndrome. Clin Cardiol 2012; 35:E22-7. [PMID: 22961648 DOI: 10.1002/clc.22056] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 08/11/2012] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND In a prospective cohort of consecutive acute coronary syndrome (ACS) patients, we compared the adherence rate of statin usage and mortality rate during a median follow-up of 23 months. HYPOTHESIS Adherence to statin therapy after acute coronary syndrome affects mortality rate. METHODS We analyzed ACS patients (N = 1969; age, 65.9 ± 11.8 years; female 30.4%) who underwent angiography between March 2006 and March 2008. The postdischarge usage of statins was based on the purchase register of the Social Insurance Institution of Finland. The death rate was verified from Statistics Finland. RESULTS At discharge, the rate of statin prescription to patients was 95.4% (n = 1878). When comparing adherent patients (n = 1200; 61.7%), who purchased the medication systematically until the end of the median 23-month follow-up, with nonadherent patients (n = 94; 4.8%), who did not use the medication at all, there was a vast difference in absolute death rate between the groups: 4.9% vs 14.9%, respectively (P < 0.001). We conducted Cox proportional hazards model with ACS type, cerebrovascular attack, diabetes, age, 3-artery disease, and cancer as adjusted confounders. Compared with regular statin users, nonusers were associated with a >2× increased hazard ratio of mortality (hazard ratio: 2.70, 95% confidence interval: 1.49-4.90, P = 0.001). CONCLUSIONS Statin medication is essential for discharged ACS patients. They should be strongly encouraged to purchase and use it.
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Affiliation(s)
- Jaakko Allonen
- Department of Medicine, Division of Cardiology, Helsinki University Central Hospital, Finland
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Danaei G, Tavakkoli M, Hernán MA. Bias in observational studies of prevalent users: lessons for comparative effectiveness research from a meta-analysis of statins. Am J Epidemiol 2012; 175:250-62. [PMID: 22223710 PMCID: PMC3271813 DOI: 10.1093/aje/kwr301] [Citation(s) in RCA: 183] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 08/03/2011] [Indexed: 01/14/2023] Open
Abstract
Randomized clinical trials (RCTs) are usually the preferred strategy with which to generate evidence of comparative effectiveness, but conducting an RCT is not always feasible. Though observational studies and RCTs often provide comparable estimates, the questioning of observational analyses has recently intensified because of randomized-observational discrepancies regarding the effect of postmenopausal hormone replacement therapy on coronary heart disease. Reanalyses of observational data that excluded prevalent users of hormone replacement therapy led to attenuated discrepancies, which begs the question of whether exclusion of prevalent users should be generally recommended. In the current study, the authors evaluated the effect of excluding prevalent users of statins in a meta-analysis of observational studies of persons with cardiovascular disease. The pooled, multivariate-adjusted mortality hazard ratio for statin use was 0.77 (95% confidence interval (CI): 0.65, 0.91) in 4 studies that compared incident users with nonusers, 0.70 (95% CI: 0.64, 0.78) in 13 studies that compared a combination of prevalent and incident users with nonusers, and 0.54 (95% CI: 0.45, 0.66) in 13 studies that compared prevalent users with nonusers. The corresponding hazard ratio from 18 RCTs was 0.84 (95% CI: 0.77, 0.91). It appears that the greater the proportion of prevalent statin users in observational studies, the larger the discrepancy between observational and randomized estimates.
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Affiliation(s)
- Goodarz Danaei
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
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