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Subramanian A, Han D, Braithwaite T, Thayakaran R, Zemedikun DT, Gokhale KM, Lee WH, Coker J, Keane PA, Denniston AK, Nirantharakumar K, Azoulay L, Adderley NJ. Angiotensin-converting enzyme inhibitors and risk of age-related macular degeneration in individuals with hypertension. Br J Clin Pharmacol 2022; 88:4199-4210. [PMID: 35474585 PMCID: PMC9541840 DOI: 10.1111/bcp.15366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/19/2022] [Accepted: 04/04/2022] [Indexed: 11/27/2022] Open
Abstract
AIMS Several observational studies have examined the potential protective effect of angiotensin-converting enzyme inhibitor (ACE-I) use on the risk of age-related macular degeneration (AMD) and have reported contradictory results owing to confounding and time-related biases. We aimed to assess the risk of AMD in a base cohort of patients aged 40 years and above with hypertension among new users of ACE-I compared to an active comparator cohort of new users of calcium channel blockers (CCB) using data obtained from IQVIA Medical Research Data, a primary care database in the UK. METHODS In this study, 53 832 and 43 106 new users of ACE-I and CCB were included between 1995 and 2019, respectively. In an on-treatment analysis, patients were followed up from the time of index drug initiation to the date of AMD diagnosis, loss to follow-up, discontinuation or switch to the comparator drug. A comprehensive range of covariates were used to estimate propensity scores to weight and match new users of ACE-I and CCB. Standardized mortality ratio weighted Cox proportional hazards model was used to estimate hazard ratios of developing AMD. RESULTS During a median follow-up of 2 years (interquartile range 1-5 years), the incidence rate of AMD was 2.4 (95% confidence interval 2.2-2.6) and 2.2 (2.0-2.4) per 1000 person-years among the weighted new users of ACE-I and CCB, respectively. There was no association of ACE-I use on the risk of AMD compared to CCB use in either the propensity score weighted or matched, on-treatment analysis (adjusted hazard ratio: 1.07 [95% confidence interval 0.90-1.27] and 0.87 [0.71-1.07], respectively). CONCLUSION We found no evidence that the use of ACE-I is associated with risk of AMD in patients with hypertension.
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Affiliation(s)
| | - Diana Han
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tasanee Braithwaite
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,The School of Immunology and Microbial Sciences and The School of Life Course Sciences, Kings College London, London, UK.,The Medical Eye Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rasiah Thayakaran
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Dawit T Zemedikun
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Krishna M Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Wen Hwa Lee
- Action Against Age-Related Macular Degeneration, London, UK
| | - Jesse Coker
- Action Against Age-Related Macular Degeneration, London, UK
| | - Pearse A Keane
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and Institute of Ophthalmology, University College London, London, UK
| | - Alastair K Denniston
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and Institute of Ophthalmology, University College London, London, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Health Data Research UK (HDRUK), London, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Health Data Research UK (HDRUK), London, UK
| | - Laurent Azoulay
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute, Montreal, Canada.,Gerald Bronfman Department of Oncology, McGill University, Montreal, Canada
| | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Hoare S, Powell A, Modi RN, Armstrong N, Griffin SJ, Mant J, Burt J. Why do people take part in atrial fibrillation screening? Qualitative interview study in English primary care. BMJ Open 2022; 12:e051703. [PMID: 35296474 PMCID: PMC8928318 DOI: 10.1136/bmjopen-2021-051703] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES There is insufficient evidence to support national screening programmes for atrial fibrillation (AF). Nevertheless, some practitioners, policy-makers and special interest groups have encouraged introduction of opportunistic screening in primary care in order to reduce the incidence of stroke through earlier detection and treatment of AF. The attitudes of the public towards AF screening are unknown. We aimed to explore why AF screening participants took part in the screening. DESIGN Semistructured longitudinal interview study of participant engagement in the SAFER study (Screening for Atrial Fibrillation with ECG to Reduce stroke). We undertook initial interviews face to face, with up to two follow-up telephone interviews during the screening process. We thematically analysed and synthesised these data to understand shared views of screening participation. SETTING 5 primary care practices in the East of England, UK. PARTICIPANTS 23 people taking part in the SAFER study first feasibility phase. RESULTS Participants were supportive of screening for AF, explaining their participation in screening as a 'good thing to do'. Participants suggested screening could facilitate earlier diagnosis, more effective treatment, and a better future outcome, despite most being unfamiliar with AF. Participating in AF screening helped attenuate participants' concerns about stroke and demonstrated their commitment to self-care and being a 'good patient'. Participants felt that the screening test was non-invasive, and they were unlikely to have AF; they therefore considered engaging in AF screening was low risk, with few perceived harms. CONCLUSIONS Participants assessed the SAFER AF screening programme to be a legitimate, relevant and safe screening opportunity, and complied obediently with what they perceived to be a recommendation to take part. Their unreserved acceptance of screening benefit and lack of awareness of potential harms suggests that uptake would be high but reinforces the importance of ensuring participants receive balanced information about AF screening initiatives. TRIAL REGISTRATION NUMBER ISRCTN16939438; Pre-results.
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Affiliation(s)
- Sarah Hoare
- The Healthcare Improvement Studies Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alison Powell
- The Healthcare Improvement Studies Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Rakesh Narendra Modi
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Natalie Armstrong
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Simon J Griffin
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- MRC Epidemiology Unit, Institute of Metabolic Science, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jenni Burt
- The Healthcare Improvement Studies Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Gebreyohannes EA, Mill D, Salter S, Chalmers L, Bereznicki L, Lee K. Strategies for improving guideline adherence of anticoagulants for patients with atrial fibrillation in primary healthcare: A systematic review. Thromb Res 2021; 205:128-136. [PMID: 34333301 DOI: 10.1016/j.thromres.2021.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/06/2021] [Accepted: 07/22/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Clinical guidelines on atrial fibrillation management help optimize the use of oral anticoagulants. However, guideline non-adherence is common, particularly in the primary care setting. The primary aim of this systematic review was to identify effective strategies for improving adherence to guideline-directed thromboprophylaxis to patients with atrial fibrillation in the primary care setting. METHODS A search was conducted on 6 electronic databases (Medline, Embase, ScienceDirect, Scopus, the Cumulative Indexing of Nursing and Allied Health Literature, and Web of Science) supplemented by a Google advanced search. Studies aimed at improving oral thromboprophylaxis guideline adherence in patients with atrial fibrillation, in the primary care setting, were included in the study. RESULTS A total of 33 studies were included in this review. Nine studies employed electronic decision support (EDS), of which 4 reported modest improvements in guideline adherence. Five of 6 studies that utilized local guidelines as quality improvement measures reported improvement in guideline adherence. All 5 studies that employed coordinated care and the use of specialist support and 4 of the 5 studies that involved pharmacist-led interventions reported improvements in guideline adherence. Interventions based mainly on feedback from audits were less effective. CONCLUSIONS Multifaceted interventions, especially those incorporating coordinated care and specialist support, pharmacists, or local adaptations to and implementation of national and/or international guidelines appear to be more consistently effective in improving guideline adherence in the primary care setting than interventions based mainly on EDS and feedback from audits.
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Affiliation(s)
| | - Deanna Mill
- Division of Pharmacy, School of Allied Health, University of Western Australia, WA, Australia
| | - Sandra Salter
- Division of Pharmacy, School of Allied Health, University of Western Australia, WA, Australia
| | | | - Luke Bereznicki
- School of Pharmacy and Pharmacology, University of Tasmania, TAS, Australia
| | - Kenneth Lee
- Division of Pharmacy, School of Allied Health, University of Western Australia, WA, Australia
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