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van der Hulst HC, van der Bol JM, Bastiaannet E, Portielje JEA, Dekker JWT. Age-specific impact of comorbidity on postoperative outcomes in older patients with colorectal cancer. J Geriatr Oncol 2024; 15:101836. [PMID: 39112129 DOI: 10.1016/j.jgo.2024.101836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 06/16/2024] [Accepted: 07/16/2024] [Indexed: 09/09/2024]
Abstract
INTRODUCTION Age and comorbidity are considered the strongest predictors for adverse events after colorectal cancer (CRC) surgery. We aimed to study the interaction of age and comorbidity and to gain better insight in options to improve care for the growing group of older patients. MATERIALS AND METHODS We included all patients ≥70 years undergoing elective surgery for non-metastatic CRC between 2011 and 2019 in the Netherlands. Baseline characteristics, surgical and non-surgical complications, readmission, and short-term mortality were collected from the Dutch Colorectal Audit (DCRA). The cohort was stratified by 70-79, 80-89, and ≥ 90 years. Comorbidity prevalence and postoperative outcomes were determined per age group. We analyzed the interaction (age-group*comorbidity) with all outcomes using multivariate logistic regression analysis. Age-stratified analysis was indicated if the interaction was significant. RESULTS We included 25,727 patients of 70-79 years, 12,198 patients of 80-89 years, and 713 of ≥90 years. Non-surgical complications and mortality increased with older age, while surgical complications significantly decreased. However, the association of a Charlson Comorbidity Index (CCI) score ≥ 3, cardiovascular, and cardiopulmonary disease with adverse postoperative outcome decreased with older age. For example, the odds ratio (OR) of a CCI score ≥ 3 for non-surgical complications was 1.79 (confidence interval [CI] 95% 1.66-1.94), 1.50 (CI 95% 1.36-1.65), and 1.21 (CI 95% 0.80-1.81) for, respectively, 70-79, 80-89, and ≥ 90 years. DISCUSSION The rate of non-surgical complications after CRC surgery increased with older age, although older age itself became less associated with comorbidity. Perhaps risk assessment in the oldest patients should shift towards other predictors, such as frailty.
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Affiliation(s)
| | | | - Esther Bastiaannet
- Institute of Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
| | - Johanna E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
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Tian J, Wang HY, Peng SH, Tao YM, Cao J, Zhang XG. Experiences of older people with multimorbidity regarding self-management of diseases: A systematic review and qualitative meta-synthesis. Int J Nurs Pract 2024:e13289. [PMID: 39075877 DOI: 10.1111/ijn.13289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/03/2024] [Accepted: 07/13/2024] [Indexed: 07/31/2024]
Abstract
AIM This qualitative systematic review aimed to consolidate existing evidence on the self-management experience of older patients with multimorbidity worldwide. METHODS Nine databases were searched, for papers published from database inception to April 2023. The systematic review was conducted according to the systematic review method of qualitative evidence by the Joanna Briggs Institute (JBI). RESULTS Seven studies were included. Finally, four themes and 12 subthemes were formed: (1) physical level: reduced physical function and lack of coordinated care; (2) psychological level: mental state of anxiety and positive attitude towards life; (3) social level: technical support, support from family, support from healthcare workers and support from others; and (4) practical level: economic burden, lifestyle changes, self-care in daily life and compliance was much lower than expected. CONCLUSIONS To improve self-management in older people with multimorbidity, nurses should provide more guidance to patients to improve their self-management skills, and clinicians should recommend effective self-management behaviours.
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Affiliation(s)
- Jing Tian
- West China Second Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hong Yan Wang
- Southwest University, Chongqing, China
- Sichuan Nursing Vocational College, Chengdu, Sichuan, China
| | - Si Han Peng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yan Min Tao
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jun Cao
- Sichuan Nursing Vocational College, Chengdu, Sichuan, China
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Black JE, Kueper JK, Terry AL, Lizotte DJ. Development of a prognostic prediction model to estimate the risk of multiple chronic diseases: constructing a copula-based model using Canadian primary care electronic medical record data. Int J Popul Data Sci 2021; 6:1395. [PMID: 34007897 PMCID: PMC8112224 DOI: 10.23889/ijpds.v5i1.1395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The ability to estimate risk of multimorbidity will provide valuable information to patients and primary care practitioners in their preventative efforts. Current methods for prognostic prediction modelling are insufficient for the estimation of risk for multiple outcomes, as they do not properly capture the dependence that exists between outcomes. Objectives We developed a multivariate prognostic prediction model for the 5-year risk of diabetes, hypertension, and osteoarthritis that quantifies and accounts for the dependence between each disease using a copula-based model. Methods We used data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) from 2009 onwards, a collection of electronic medical records submitted by participating primary care practitioners across Canada. We identified patients 18 years and older without all three outcome diseases and observed any incident diabetes, osteoarthritis, or hypertension within 5-years, resulting in a large retrospective cohort for model development and internal validation (n=425,228). First, we quantified the dependence between outcomes using unadjusted and adjusted Ø coefficients. We then estimated a copula-based model to quantify the non-linear dependence between outcomes that can be used to derive risk estimates for each outcome, accounting for the observed dependence. Copula-based models are defined by univariate models for each outcome and a dependence function, specified by the parameter θ. Logistic regression was used for the univariate models and the Frank copula was selected as the dependence function. Results All outcome pairs demonstrated statistically significant dependence that was reduced after adjusting for covariates. The copula-based model yielded statistically significant θ parameters in agreement with the adjusted and unadjusted Ø coefficients. Our copula-based model can effectively be used to estimate trivariate probabilities. Discussion Quantitative estimates of multimorbidity risk inform discussions between patients and their primary care practitioners around prevention in an effort to reduce the incidence of multimorbidity.
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Affiliation(s)
- Jason E Black
- Department of Epidemiology & Biostatistics, Western University, 1151 Richmond Street London, Ontario, Canada, N6A 3K7
| | - Jacqueline K Kueper
- Department of Computer Science, Department of Epidemiology & Biostatistics, Western University, 1151 Richmond Street London, Ontario, Canada, N6A 3K7
| | - Amanda L Terry
- Department of Family Medicine, Department of Epidemiology & Biostatistics, Western University, 1151 Richmond Street London, Ontario, Canada, N6A 3K7
| | - Daniel J Lizotte
- Department of Computer Science, Department of Epidemiology & Biostatistics, Western University, 1151 Richmond Street London, Ontario, Canada, N6A 3K7
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van Maanen R, Rutten FH, Klok FA, Huisman MV, Blom JW, Moons KGM, Geersing GJ. Validation and impact of a simplified clinical decision rule for diagnosing pulmonary embolism in primary care: design of the PECAN prospective diagnostic cohort management study. BMJ Open 2019; 9:e031639. [PMID: 31601598 PMCID: PMC6797359 DOI: 10.1136/bmjopen-2019-031639] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Combined with patient history and physical examination, a negative D-dimer can safely rule-out pulmonary embolism (PE). However, the D-dimer test is frequently false positive, leading to many (with hindsight) 'unneeded' referrals to secondary care. Recently, the novel YEARS algorithm, incorporating flexible D-dimer thresholds depending on pretest risk, was developed and validated, showing its ability to safely exclude PE in the hospital environment. Importantly, this was accompanied with 14% fewer computed tomographic pulmonary angiography than the standard, fixed D-dimer threshold. Although promising, in primary care this algorithm has not been validated yet. METHODS AND ANALYSIS The PECAN (Diagnosing Pulmonary Embolism in the context of Common Alternative diagNoses in primary care) study is a prospective diagnostic study performed in Dutch primary care. Included patients with suspected acute PE will be managed by their general practitioner according to the YEARS diagnostic algorithm and followed up in primary care for 3 months to establish the final diagnosis. To study the impact of the use of the YEARS algorithm, the primary endpoints are the safety and efficiency of the YEARS algorithm in primary care. Safety is defined as the proportion of false-negative test results in those not referred. Efficiency denotes the proportion of patients classified in this non-referred category. Additionally, we quantify whether C reactive protein measurement has added diagnostic value to the YEARS algorithm, using multivariable logistic and polytomous regression modelling. Furthermore, we will investigate which factors contribute to the subjective YEARS item 'PE most likely diagnosis'. ETHICS AND DISSEMINATION The study protocol was approved by the Medical Ethical Committee Utrecht, the Netherlands. Patients eligible for inclusion will be asked for their consent. Results will be disseminated by publication in peer-reviewed journals and presented at (inter)national meetings and congresses. TRIAL REGISTRATION NTR 7431.
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Affiliation(s)
- Rosanne van Maanen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frederikus A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Menno V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeanet W Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Geert-Jan Geersing
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Vetrano DL, Calderón-Larrañaga A, Marengoni A, Onder G, Bauer JM, Cesari M, Ferrucci L, Fratiglioni L. An International Perspective on Chronic Multimorbidity: Approaching the Elephant in the Room. J Gerontol A Biol Sci Med Sci 2018; 73:1350-1356. [PMID: 28957993 PMCID: PMC6132114 DOI: 10.1093/gerona/glx178] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/15/2017] [Indexed: 01/07/2023] Open
Abstract
Multimorbidity is a common and burdensome condition that may affect quality of life, increase medical needs, and make people live more years of life with disability. Negative outcomes related to multimorbidity occur beyond what we would expect from the summed effect of single conditions, as chronic diseases interact with each other, mutually enhancing their negative effects, and eventually leading to new clinical phenotypes. Moreover, multimorbidity mirrors an accelerated global susceptibility and a loss of resilience, which are both hallmarks of aging. Due to the complexity of its assessment and definition, and the lack of clear evidence steering its management, multimorbidity represents one of the main current challenges for clinicians, researchers, and policymakers. The authors of this article recently reflected on these issues during two twin international symposia at the 2016 European Union Geriatric Medicine Society (EUGMS) meeting in Lisbon, Portugal, and the 2016 Gerontological Society of America (GSA) meeting in New Orleans, USA. The present work summarizes the most relevant aspects related to multimorbidity, with the ultimate goal to identify knowledge gaps and suggest future directions to approach this condition.
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Affiliation(s)
- Davide L Vetrano
- Aging Research Center, Karolinska Institutet and Stockholm University, Sweden
- Department of Geriatrics, Catholic University of Rome, Italy
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Karolinska Institutet and Stockholm University, Sweden
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), Spain
| | - Alessandra Marengoni
- Aging Research Center, Karolinska Institutet and Stockholm University, Sweden
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Graziano Onder
- Department of Geriatrics, Catholic University of Rome, Italy
| | - Jürgen M Bauer
- Center for Geriatric Medicine, University of Heidelberg, Germany
| | - Matteo Cesari
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse III, France
| | - Luigi Ferrucci
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland
| | - Laura Fratiglioni
- Aging Research Center, Karolinska Institutet and Stockholm University, Sweden
- Stockholm Gerontology Research Center, Sweden
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van Doorn S, Tavenier A, Rutten FH, Hoes AW, Moons KGM, Geersing GJ. Risk of cardiac and non-cardiac adverse events in community-dwelling older patients with atrial fibrillation: a prospective cohort study in the Netherlands. BMJ Open 2018; 8:e021681. [PMID: 30139900 PMCID: PMC6112390 DOI: 10.1136/bmjopen-2018-021681] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Patients with atrial fibrillation (AF) are at increased risk of many adverse events, notably stroke. To prevent all adverse outcomes, integrated AF care is advocated though the potential domain for such multidisciplinary management is still unclear. Therefore, insight in the systemic nature of AF and identifying patients at risk of adverse events after oral anticoagulation is needed. The aim of this study is to first describe the risk of hospitalisation and mortality in community-dwelling older patients with AF using anticoagulants, and second to assess the association between traditional cardiac risk factors and these outcomes. DESIGN A prospective cohort. SETTING General practice. PARTICIPANTS 2068 patients with AF using oral anticoagulants. OUTCOME MEASURES We calculated incidence rates (IRs) of ischaemic stroke, bleeding, hospitalisations and mortality, and compared risk factors using Cox regression between those with and without an adverse event, both for cardiac and non-cardiac causes. RESULTS During a median follow-up of 2.7 (IQR 2.2-3.0) years, the IR per 100 person-years was 22.1 for hospitalisations and 6.7 for mortality. Non-cardiac events outnumbered cardiac events (IRs 15.7 vs 7.6 per 100 person-years for hospitalisation, p<0.001 and 5.0 vs 1.7, p<0.001 for mortality). As a comparison, the IRs for stroke and major bleeding were 1.7 and 0.8 per 100 person years, respectively. In multivariate models, high age, heart failure and vascular disease were independently associated with all-cause hospitalisation and- in addition to diabetes, previous stroke and renal disease-for all-cause mortality. CONCLUSIONS In anticoagulated community-dwelling patients with AF, stroke risk is effectively reduced and thus fairly low, whereas risks of hospitalisation and mortality remain high, importantly mainly for non-cardiac causes. Notably high age, heart failure and vascular disease are predictive for such outcomes and may be of value in identifying high-risk patients in the future. TRIAL REGISTRATION NUMBER NTR3741.
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Affiliation(s)
- Sander van Doorn
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annerien Tavenier
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geert-Jan Geersing
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, The Netherlands
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7
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Geersing GJ, Kraaijpoel N, Büller HR, van Doorn S, van Es N, Le Gal G, Huisman MV, Kearon C, Kline JA, Moons KGM, Miniati M, Righini M, Roy PM, van der Wall SJ, Wells PS, Klok FA. Ruling out pulmonary embolism across different subgroups of patients and healthcare settings: protocol for a systematic review and individual patient data meta-analysis (IPDMA). Diagn Progn Res 2018; 2:10. [PMID: 31093560 PMCID: PMC6460525 DOI: 10.1186/s41512-018-0032-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 05/18/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Diagnosing pulmonary embolism in suspected patients is notoriously difficult as signs and symptoms are non-specific. Different diagnostic strategies have been developed, usually combining clinical probability assessment with D-dimer testing. However, their predictive performance differs across different healthcare settings, patient subgroups, and clinical presentation, which are currently not accounted for in the available diagnostic approaches. METHODS This is a protocol for a large diagnostic individual patient data meta-analysis (IPDMA) of currently available diagnostic studies in the field of pulmonary embolism. We searched MEDLINE (search date January 1, 1995, till August 25, 2016) to retrieve all primary diagnostic studies that had evaluated diagnostic strategies for pulmonary embolism. Two authors independently screened titles, abstracts, and subsequently full-text articles for eligibility from 3145 individual studies. A total of 40 studies were deemed eligible for inclusion into our IPDMA set, and principal investigators from these studies were invited to participate in a meeting at the 2017 conference from the International Society on Thrombosis and Haemostasis. All authors agreed on data sharing and participation into this project. The process of data collection of available datasets as well as potential identification of additional new datasets based upon personal contacts and an updated search will be finalized early 2018. The aim is to evaluate diagnostic strategies across three research domains: (i) the optimal diagnostic approach for different healthcare settings, (ii) influence of comorbidity on the predictive performance of each diagnostic strategy, and (iii) optimize and tailor the efficiency and safety of ruling out PE across a broad spectrum of patients with a new, patient-tailored clinical decision model that combines clinical items with quantitative D-dimer testing. DISCUSSION This pre-planned individual patient data meta-analysis aims to contribute in resolving remaining diagnostic challenges of time-efficient diagnosis of pulmonary embolism by tailoring available diagnostic strategies for different healthcare settings and comorbidity. SYSTEMATIC REVIEW REGISTRATION Prospero trial registration: ID 89366.
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Affiliation(s)
- G.-J. Geersing
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - N. Kraaijpoel
- 0000000084992262grid.7177.6Academic Medical Center, Vascular Medicine, University of Amsterdam, Amsterdam, the Netherlands
| | - H. R. Büller
- 0000000084992262grid.7177.6Academic Medical Center, Vascular Medicine, University of Amsterdam, Amsterdam, the Netherlands
| | - S. van Doorn
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - N. van Es
- 0000000084992262grid.7177.6Academic Medical Center, Vascular Medicine, University of Amsterdam, Amsterdam, the Netherlands
| | - G. Le Gal
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Thrombosis Research Group, Ottawa, Canada
| | - M. V. Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - C. Kearon
- 0000 0004 1936 8227grid.25073.33Department of Medicine, The Thrombosis and Atherosclerosis Research Institute, Mc Master University, Hamilton, Canada
| | - J. A. Kline
- 0000 0001 2287 3919grid.257413.6School of Medicine, Indiana University, Indianapolis, IN USA
| | - K. G. M. Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - M. Miniati
- 0000 0004 1757 2304grid.8404.8Department of Medicine, University of Florence, Florence, Italy
| | - M. Righini
- 0000 0001 0721 9812grid.150338.cDivision of Angiology and Haemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - P.-M. Roy
- 0000 0001 2248 3363grid.7252.2Emergency Department, University of Angers, Angers, France
| | - S. J. van der Wall
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - P. S. Wells
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Thrombosis Research Group, Ottawa, Canada
| | - F. A. Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
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van den Dries CJ, Oudega R, Elvan A, Rutten FH, van de Leur SJCM, Bilo HJG, Hoes AW, Moons KGM, Geersing GJ. Integrated management of atrial fibrillation including tailoring of anticoagulation in primary care: study design of the ALL-IN cluster randomised trial. BMJ Open 2017; 7:e015510. [PMID: 28928175 PMCID: PMC5623539 DOI: 10.1136/bmjopen-2016-015510] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION In our ageing society, we are at the merge of an expected epidemic of atrial fibrillation (AF). AF management requires an integrated approach, including rate or rhythm control, stroke prevention with anticoagulation and treatment of comorbidities such as heart failure or type 2 diabetes. As such, primary care seems to be the logical healthcare setting for the chronic management of patients with AF. However, primary care has not yet played a dominant role in AF management, which has been in fact more fragmented between different healthcare providers. This fragmentation might have contributed to high healthcare costs. To demonstrate the feasibility of managing AF in primary care, studies are needed that evaluate the safety and (cost-)effectiveness of integrated AF management in primary care. METHODS AND ANALYSIS The ALL-IN trial is a multicentre, pragmatic, cluster randomised, non-inferiority trial performed in primary care practices in a suburban region in the Netherlands. We aim to include a minimum of 1000 patients with AF aged 65 years or more from around 18 to 30 practices. Duration of the study is 2 years. Practices will be randomised to either the intervention arm (providing integrated AF management, involving a trained practice nurse and collaboration with secondary care) or the control arm (care as usual). The primary endpoint is all-cause mortality. Secondary endpoints are cardiovascular mortality, (non)-cardiovascular hospitalisation, major adverse cardiac events, stroke, major bleeding, clinically relevant non-major bleeding, quality of life and cost-effectiveness. ETHICS AND DISSEMINATION The protocol was approved by the Medical Ethical Committee of the Isala Hospital Zwolle, the Netherlands. Patients in the intervention arm will be asked informed consent for participating in the intervention. Results are expected in 2019 and will be disseminated through both national and international journals and conferences. TRIAL REGISTRATION NUMBER This trial is registered at the Netherlands Trial Register (NTR5532).
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Affiliation(s)
- Carline J van den Dries
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - Ruud Oudega
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - Arif Elvan
- Department of Cardiology, Isala Hospital Zwolle, Zwolle, The Netherlands
| | - Frans H Rutten
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | | | - Henk J G Bilo
- Department of Internal Medicine, Isala Hospital Zwolle, Zwolle, The Netherlands
| | - Arno W Hoes
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - Karel G M Moons
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - Geert-Jan Geersing
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
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Dacks PA, Armstrong JJ, Brannan SK, Carman AJ, Green AM, Kirkman MS, Krakoff LR, Kuller LH, Launer LJ, Lovestone S, Merikle E, Neumann PJ, Rockwood K, Shineman DW, Stefanacci RG, Velentgas P, Viswanathan A, Whitmer RA, Williamson JD, Fillit HM. A call for comparative effectiveness research to learn whether routine clinical care decisions can protect from dementia and cognitive decline. ALZHEIMERS RESEARCH & THERAPY 2016; 8:33. [PMID: 27543171 PMCID: PMC4992192 DOI: 10.1186/s13195-016-0200-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Common diseases like diabetes, hypertension, and atrial fibrillation are probable risk factors for dementia, suggesting that their treatments may influence the risk and rate of cognitive and functional decline. Moreover, specific therapies and medications may affect long-term brain health through mechanisms that are independent of their primary indication. While surgery, benzodiazepines, and anti-cholinergic drugs may accelerate decline or even raise the risk of dementia, other medications act directly on the brain to potentially slow the pathology that underlies Alzheimer’s and other dementia. In other words, the functional and cognitive decline in vulnerable patients may be influenced by the choice of treatments for other medical conditions. Despite the importance of these questions, very little research is available. The Alzheimer’s Drug Discovery Foundation convened an advisory panel to discuss the existing evidence and to recommend strategies to accelerate the development of comparative effectiveness research on how choices in the clinical care of common chronic diseases may protect from cognitive decline and dementia.
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Affiliation(s)
- Penny A Dacks
- Alzheimer's Drug Discovery Foundation, 57 West 57th St. Suite 901, New York, NY, 10019, USA.
| | - Joshua J Armstrong
- Geriatric Medicine Research Unit, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | | | - Aaron J Carman
- Alzheimer's Drug Discovery Foundation, 57 West 57th St. Suite 901, New York, NY, 10019, USA
| | | | - M Sue Kirkman
- Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Lewis H Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lenore J Launer
- Intramural Research Program, National Institute on Aging, NIH, Bethesda, MD, USA
| | | | | | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Kenneth Rockwood
- Geriatric Medicine Research Unit, Department of Medicine, Dalhousie University, Halifax, NS, Canada.,DGI Clinical, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
| | - Diana W Shineman
- Alzheimer's Drug Discovery Foundation, 57 West 57th St. Suite 901, New York, NY, 10019, USA
| | - Richard G Stefanacci
- Thomas Jefferson College of Population Health, The Access Group, Philadelphia, PA, USA
| | - Priscilla Velentgas
- Scientific Affairs, Quintiles Real World Late Phase Research, Cambridge, MA, USA
| | - Anand Viswanathan
- Representative for the American Heart Association; Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Rachel A Whitmer
- Kaiser Permanente Division of Research, Population Science and Brain Aging, Oakland, CA, USA
| | | | - Howard M Fillit
- Alzheimer's Drug Discovery Foundation, 57 West 57th St. Suite 901, New York, NY, 10019, USA
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Abstract
PURPOSE OF REVIEW Classic descriptions of chronic obstructive pulmonary disease (COPD) centered on its impact on respiratory function. It is currently recognized that comorbidities contribute to the severity of symptoms and COPD progression. Understanding COPD-comorbidities associations could provide innovative treatment strategies and identify new mechanistic pathways to be targeted. RECENT FINDINGS Some comorbidities are clustered with specific COPD phenotypes. There are stronger associations between airway-predominant disease and cardio-metabolic comorbidities, whereas in emphysema-predominant COPD sarcopenia and osteoporosis are frequent. These patterns suggest different inflammatory pathways acting by COPD phenotype. Osteoporosis is a major concern in COPD, particularly among men. Although β-blockers use for cardiac indications in COPD remains low, recent evidence suggests that this medication group could decrease COPD exacerbations. Gastroesophageal reflux is consistently associated with poor COPD outcomes, but mechanisms and impact of treatment are still unclear. Nontraditional comorbid conditions, such as cognitive impairment, anxiety, and depression have significant impact in COPD outcomes. SUMMARY Clinicians should screen their COPD patients for the presence of cardiovascular disease, diabetes, osteoporosis, sleep apnea, and sarcopenia, comorbidities for which specific treatments are available and associated with better COPD outcomes. The impact of interventions to treat gastroesophageal reflux disease, anxiety and depression is still to be defined.
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