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Lau WCY, Torre CO, Man KKC, Stewart HM, Seager S, Van Zandt M, Reich C, Li J, Brewster J, Lip GYH, Hingorani AD, Wei L, Wong ICK. Comparative Effectiveness and Safety Between Apixaban, Dabigatran, Edoxaban, and Rivaroxaban Among Patients With Atrial Fibrillation : A Multinational Population-Based Cohort Study. Ann Intern Med 2022; 175:1515-1524. [PMID: 36315950 DOI: 10.7326/m22-0511] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Current guidelines recommend using direct oral anticoagulants (DOACs) over warfarin in patients with atrial fibrillation (AF), but head-to-head trial data do not exist to guide the choice of DOAC. OBJECTIVE To do a large-scale comparison between all DOACs (apixaban, dabigatran, edoxaban, and rivaroxaban) in routine clinical practice. DESIGN Multinational population-based cohort study. SETTING Five standardized electronic health care databases, which covered 221 million people in France, Germany, the United Kingdom, and the United States. PARTICIPANTS Patients who were newly diagnosed with AF from 2010 through 2019 and received a new DOAC prescription. MEASUREMENTS Database-specific hazard ratios (HRs) of ischemic stroke or systemic embolism, intracranial hemorrhage (ICH), gastrointestinal bleeding (GIB), and all-cause mortality between DOACs were estimated using a Cox regression model stratified by propensity score and pooled using a random-effects model. RESULTS A total of 527 226 new DOAC users met the inclusion criteria (apixaban, n = 281 320; dabigatran, n = 61 008; edoxaban, n = 12 722; and rivaroxaban, n = 172 176). Apixaban use was associated with lower risk for GIB than use of dabigatran (HR, 0.81 [95% CI, 0.70 to 0.94]), edoxaban (HR, 0.77 [CI, 0.66 to 0.91]), or rivaroxaban (HR, 0.72 [CI, 0.66 to 0.79]). No substantial differences were observed for other outcomes or DOAC-DOAC comparisons. The results were consistent for patients aged 80 years or older. Consistent associations between lower GIB risk and apixaban versus rivaroxaban were observed among patients receiving the standard dose (HR, 0.72 [CI, 0.64 to 0.82]), those receiving a reduced dose (HR, 0.68 [CI, 0.61 to 0.77]), and those with chronic kidney disease (HR, 0.68 [CI, 0.59 to 0.77]). LIMITATION Residual confounding is possible. CONCLUSION Among patients with AF, apixaban use was associated with lower risk for GIB and similar rates of ischemic stroke or systemic embolism, ICH, and all-cause mortality compared with dabigatran, edoxaban, and rivaroxaban. This finding was consistent for patients aged 80 years or older and those with chronic kidney disease, who are often underrepresented in clinical trials. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Wallis C Y Lau
- Research Department of Practice and Policy, University College London School of Pharmacy, London, United Kingdom, Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, United Kingdom, Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, and Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong (W.C.Y.L., K.K.C.M.)
| | - Carmen Olga Torre
- IQVIA, Real-World Solutions, Brighton, United Kingdom (C.O.T., H.M.S., S.S.)
| | - Kenneth K C Man
- Research Department of Practice and Policy, University College London School of Pharmacy, London, United Kingdom, Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, United Kingdom, Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, and Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong (W.C.Y.L., K.K.C.M.)
| | | | - Sarah Seager
- IQVIA, Real-World Solutions, Brighton, United Kingdom (C.O.T., H.M.S., S.S.)
| | - Mui Van Zandt
- IQVIA, Real-World Solutions, Plymouth Meeting, Pennsylvania (M.V., C.R.)
| | - Christian Reich
- IQVIA, Real-World Solutions, Plymouth Meeting, Pennsylvania (M.V., C.R.)
| | - Jing Li
- IQVIA, Real-World Solutions, Durham, North Carolina (J.L., J.B.)
| | - Jack Brewster
- IQVIA, Real-World Solutions, Durham, North Carolina (J.L., J.B.)
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom, and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.)
| | - Aroon D Hingorani
- Institute of Cardiovascular Sciences, University College London, and University College London British Heart Foundation Research Accelerator, London, United Kingdom (A.D.H.)
| | - Li Wei
- Research Department of Practice and Policy, University College London School of Pharmacy, London, United Kingdom, Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, United Kingdom, and Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong (L.W.)
| | - Ian C K Wong
- Aston Pharmacy School, Aston University, Birmingham, United Kingdom, Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, United Kingdom, Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, and Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong (I.C.K.W.)
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Yang C, Williams RD, Swerdel JN, Almeida JR, Brouwer ES, Burn E, Carmona L, Chatzidionysiou K, Duarte-Salles T, Fakhouri W, Hottgenroth A, Jani M, Kolde R, Kors JA, Kullamaa L, Lane J, Marinier K, Michel A, Stewart HM, Prats-Uribe A, Reisberg S, Sena AG, Torre CO, Verhamme K, Vizcaya D, Weaver J, Ryan P, Prieto-Alhambra D, Rijnbeek PR. Development and external validation of prediction models for adverse health outcomes in rheumatoid arthritis: A multinational real-world cohort analysis. Semin Arthritis Rheum 2022; 56:152050. [PMID: 35728447 DOI: 10.1016/j.semarthrit.2022.152050] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/11/2022] [Accepted: 06/10/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Identification of rheumatoid arthritis (RA) patients at high risk of adverse health outcomes remains a major challenge. We aimed to develop and validate prediction models for a variety of adverse health outcomes in RA patients initiating first-line methotrexate (MTX) monotherapy. METHODS Data from 15 claims and electronic health record databases across 9 countries were used. Models were developed and internally validated on Optum® De-identified Clinformatics® Data Mart Database using L1-regularized logistic regression to estimate the risk of adverse health outcomes within 3 months (leukopenia, pancytopenia, infection), 2 years (myocardial infarction (MI) and stroke), and 5 years (cancers [colorectal, breast, uterine] after treatment initiation. Candidate predictors included demographic variables and past medical history. Models were externally validated on all other databases. Performance was assessed using the area under the receiver operator characteristic curve (AUC) and calibration plots. FINDINGS Models were developed and internally validated on 21,547 RA patients and externally validated on 131,928 RA patients. Models for serious infection (AUC: internal 0.74, external ranging from 0.62 to 0.83), MI (AUC: internal 0.76, external ranging from 0.56 to 0.82), and stroke (AUC: internal 0.77, external ranging from 0.63 to 0.95), showed good discrimination and adequate calibration. Models for the other outcomes showed modest internal discrimination (AUC < 0.65) and were not externally validated. INTERPRETATION We developed and validated prediction models for a variety of adverse health outcomes in RA patients initiating first-line MTX monotherapy. Final models for serious infection, MI, and stroke demonstrated good performance across multiple databases and can be studied for clinical use. FUNDING This activity under the European Health Data & Evidence Network (EHDEN) has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 806968. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation programme and EFPIA.
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Affiliation(s)
- Cynthia Yang
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Ross D Williams
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joel N Swerdel
- Janssen Research and Development, Titusville, NJ, United States
| | | | - Emily S Brouwer
- Janssen Research and Development, Titusville, NJ, United States
| | - Edward Burn
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | | | | | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Walid Fakhouri
- Eli Lilly and Company, Windlesham, Surrey, United Kingdom
| | | | - Meghna Jani
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
| | - Raivo Kolde
- Institute of Computer Science, University of Tartu, Tartu, Estonia
| | - Jan A Kors
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lembe Kullamaa
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia; Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; European Patients' Forum, Brussels, Belgium
| | - Jennifer Lane
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | | | | | | | - Albert Prats-Uribe
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Sulev Reisberg
- Institute of Computer Science, University of Tartu, Tartu, Estonia; STACC, Tartu, Estonia; Quretec, Tartu, Estonia
| | - Anthony G Sena
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands; Janssen Research and Development, Titusville, NJ, United States
| | | | - Katia Verhamme
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - James Weaver
- Janssen Research and Development, Titusville, NJ, United States; Observational Health Data Sciences and Informatics, New York, NY, United States
| | - Patrick Ryan
- Janssen Research and Development, Titusville, NJ, United States; Observational Health Data Sciences and Informatics, New York, NY, United States
| | - Daniel Prieto-Alhambra
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Peter R Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
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Burn E, Li X, Kostka K, Stewart HM, Reich C, Seager S, Duarte‐Salles T, Fernandez‐Bertolin S, Aragón M, Reyes C, Martinez‐Hernandez E, Marti E, Delmestri A, Verhamme K, Rijnbeek P, Horban S, Morales DR, Prieto‐Alhambra D. Background rates of five thrombosis with thrombocytopenia syndromes of special interest for COVID-19 vaccine safety surveillance: Incidence between 2017 and 2019 and patient profiles from 38.6 million people in six European countries. Pharmacoepidemiol Drug Saf 2022; 31:495-510. [PMID: 35191114 PMCID: PMC9088543 DOI: 10.1002/pds.5419] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 01/22/2023]
Abstract
AbstractBackgroundThrombosis with thrombocytopenia syndrome (TTS) has been reported among individuals vaccinated with adenovirus‐vectored COVID‐19 vaccines. In this study, we describe the background incidence of non‐vaccine induced TTS in six European countries.MethodsElectronic medical records from France, the Netherlands, Italy, Germany, Spain, and the United Kingdom informed the study. Incidence rates of cerebral venous sinus thrombosis (CVST), splanchnic vein thrombosis (SVT), deep vein thrombosis (DVT), pulmonary embolism (PE), and myocardial infarction or ischemic stroke, all with concurrent thrombocytopenia, were estimated among the general population of persons in a database between 2017 and 2019. A range of additional potential adverse events of special interest for COVID‐19 vaccinations were also studied in a similar manner.FindingsA total of 38 611 617 individuals were included. Background rates ranged from 1.0 (95% CI: 0.7–1.4) to 8.5 (7.4–9.9) per 100 000 person‐years for DVT with thrombocytopenia, from 0.5 (0.3–0.6) to 20.8 (18.9–22.8) for PE with thrombocytopenia, from 0.1 (0.0–0.1) to 2.5 (2.2–2.7) for SVT with thrombocytopenia, and from 1.0 (0.8–1.2) to 43.4 (40.7–46.3) for myocardial infarction or ischemic stroke with thrombocytopenia. CVST with thrombocytopenia was only identified in one database, with incidence rate of 0.1 (0.1–0.2) per 100 000 person‐years. The incidence of non‐vaccine induced TTS increased with age, and was typically greater among those with more comorbidities and greater medication use than the general population. It was also more often seen in men than women. A large proportion of those affected were seen to have been taking antithrombotic and anticoagulant therapies prior to their event.InterpretationAlthough rates vary across databases, non‐vaccine induced TTS has consistently been seen to be a very rare event among the general population. While still remaining very rare, rates were typically higher among older individuals, and those affected were also seen to generally be male and have more comorbidities and greater medication use than the general population.
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Affiliation(s)
- Edward Burn
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain
- Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS)University of OxfordOxfordUK
| | - Xintong Li
- Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS)University of OxfordOxfordUK
| | - Kristin Kostka
- Real World Solutions, IQVIACambridgeMassachusettsUSA
- The OHDSI Center at The Roux InstituteNortheastern UniversityPortlandMaineUSA
| | | | | | - Sarah Seager
- Real World Solutions, IQVIACambridgeMassachusettsUSA
| | - Talita Duarte‐Salles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain
| | - Sergio Fernandez‐Bertolin
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain
| | - María Aragón
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain
| | - Carlen Reyes
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain
| | | | - Edelmira Marti
- Hemostasis and Thrombosis Unit, Hematology DepartmentHospital Clínico Universitario de ValenciaValenciaSpain
| | - Antonella Delmestri
- Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS)University of OxfordOxfordUK
| | - Katia Verhamme
- Department of Medical InformaticsErasmus University Medical CenterRotterdamThe Netherlands
| | - Peter Rijnbeek
- Department of Medical InformaticsErasmus University Medical CenterRotterdamThe Netherlands
| | - Scott Horban
- Division of Population Health and GenomicsUniversity of DundeeDundeeUK
| | - Daniel R. Morales
- Division of Population Health and GenomicsUniversity of DundeeDundeeUK
| | - Daniel Prieto‐Alhambra
- Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS)University of OxfordOxfordUK
- Department of Medical InformaticsErasmus University Medical CenterRotterdamThe Netherlands
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Vora P, Soriano-Gabarró M, Russell B, Morgan Stewart H. Long-Term Adherence and Persistence to Low-Dose Aspirin for the Prevention of Cardiovascular Disease: A Population-Based Cohort Study. Int J Clin Pract 2022; 2022:7786174. [PMID: 36540065 PMCID: PMC9734008 DOI: 10.1155/2022/7786174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 12/03/2022] Open
Abstract
METHODS Using information from electronic health records in Germany and the United Kingdom (UK) in a common data model, we followed adults with ≥2 low-dose aspirin prescriptions (75-100 mg) during 2007-2018 for up to 10 years. Included individuals had no low-dose aspirin prescriptions in the year before the follow-up started (date of first low-dose aspirin prescription) and ≥12 months' observation. Adherence was determined using the medication possession ratio (MPR), and persistence was defined as continuous treatment disregarding gaps between prescriptions of <60 days; analyses were undertaken according to indication (primary/secondary CVD prevention). RESULTS We identified 144,717 low-dose aspirin users from Germany and 190,907 from the UK. Among patients with 5-10 years' follow-up, median adherence among secondary CVD prevention users was 60% in Germany and 75% in the UK. Among primary prevention users, median adherence was 50% for both countries. Persistence among secondary CVD prevention users was 58.3% at 2 years, 47.0% at 5 years, 35.2% at 10 years (Germany), and 67.5% at 2 years, 58.0% at 5 years, and 46.8% at 10 years (UK). Among primary CVD prevention users, persistence was 52.8% at 2 years, 41.6% at 5 years, 32.1% at 10 years (Germany), 56.3% at 2 years, 45.4% at 5 years, and 33.8% at 10 years (UK). CONCLUSIONS Long-term adherence and persistence to low-dose aspirin are suboptimal; efforts for improvement could translate into a lower CVD burden in the general population.
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Affiliation(s)
- Pareen Vora
- Integrated Evidence Generation, Bayer AG, Berlin, Germany
| | | | - Beth Russell
- Comprehensive Cancer Centre, Kings College London, London, UK
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Vora P, Morgan Stewart H, Russell B, Asiimwe A, Brobert G. Time Trends and Treatment Pathways in Prescribing Individual Oral Anticoagulants in Patients with Nonvalvular Atrial Fibrillation: An Observational Study of More than Three Million Patients from Europe and the United States. Int J Clin Pract 2022; 2022:6707985. [PMID: 35685531 PMCID: PMC9159118 DOI: 10.1155/2022/6707985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/04/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Data directly comparing trends in the use of different oral anticoagulants (OACs) among patients with atrial fibrillation (AF) from different countries are limited. We addressed this using a large-scale network cohort study in the United States (US), Belgium, France, Germany, and the United Kingdom (UK). METHODS We used nine databases (claims or electronic health records) that had been converted into the Observational Medical Outcomes Partnership Common Data Model with analysis performed using open-source analytical tools. We identified adults with AF and a first OAC prescription, either vitamin K antagonist (VKA) or direct oral anticoagulant (DOAC), from 2010 to 2017. We described time trends in use, continuation, and switching. RESULTS In 2010, 87.5%-99.8% of patients started on a VKA. By 2017, the majority started on a DOAC: 87.0% (US), 88.3% (Belgium), 93.1% (France), 88.4% (Germany), and 86.1%-86.7% (UK). In the UK, DOACs became the most common starting OAC in 2015, 2-3 years later than elsewhere. Apixaban was the most common starting OAC by 2017, 50.2%-57.8% (US), 31.4% (Belgium), 45.9% (France), 39.5% (Germany), and 49.8%-50.5% (UK), followed by rivaroxaban, 24.8%-32.5% (US), 25.7% (Belgium), 38.4% (France), 24.9% (Germany), and 30.2%-31.2% (UK). Long-term treatment was less common in the US than in Europe, especially the UK. A minority of patients switched from their index OAC in the short and long term. CONCLUSIONS From 2010 to 2017, VKA use had significantly declined and DOAC use had significantly increased in the US and Europe. Apixaban was the most prescribed OAC in 2017, followed by rivaroxaban.
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Mozaffari E, Liang S, Stewart HM, Thrun M, Hodgkins P, Haubrich R. 459. COVID-19 Hospitalization and 30-Day Readmission: A Cohort Study of U.S. Hospitals. Open Forum Infect Dis 2021. [DOI: 10.1093/ofid/ofab466.658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Evidence on outcomes after COVID-19 hospitalization is limited. This study aimed to characterize 30-day readmission beyond the initial COVID-19 hospitalization.
Methods
This descriptive retrospective cohort study included adult patients admitted between 07/01/2020 and 01/31/2021 with a discharge diagnosis of COVID-19 (ICD-10-CM: U07.1), using a large hospital inpatient chargemaster with a linked open claims dataset. The first COVID-19 hospitalization was considered index hospitalization; baseline was defined as first 2 days of index hospitalization; readmission was assessed within 30 days of discharge from index hospitalization. We describe the demographics, treatments and outcomes of the index hospitalization and readmission.
Results
For index hospitalization, we identified 111,624 COVID-19 patients from 327 hospitals across US. Mean age was 63 and 54% were male. Over the study period, use of remdesivir (RDV) increased from 11% to 50% while use of steroids (66% -73%) and anticoagulants (32% - 35%) remained relatively stable (Figure 1). Overall, 21% required ICU or CCU admission, 13% died, and median length of stay (LOS) was 7 days (range 4 -11 days). Among 61,182 (55%) with ≥ 30-day follow-up post discharge, all-cause 30-day readmission was 16% and remained stable (15% - 17%) over the study period; median days to readmission was 6 days (range 1-30). All-cause readmission (13 % vs 17%) was lower in patients treated with RDV during index hospitalization over time (Figure 2), particularly in those requiring high flow oxygen (17% vs 18%), low flow oxygen (13% vs 16%) or no oxygen (12% vs 17%), but not in ECMO or invasive ventilation (33% vs 29%). Compared to non-readmitted, readmitted patients were older (60 vs 65), had more comorbidities such as COPD (24% vs 37%) (see Table 1) and LOS (6 vs 7 days) in index hospitalization. Overall, the most frequent diagnoses of readmission were COVID-19 (63%), other viral pneumonia (36%), and acute respiratory failure with hypoxia (34%).
Conclusion
In a large, geographically diverse cohort of hospitalized COVID-19 patients, 16% required readmission, especially in those with greater age and comorbidities. Over the study period, all-cause readmission remained stable and was lower in RDV treated patients.
Disclosures
Essy Mozaffari, PharmD, MPH, MBA, Gilead Sciences (Employee, Shareholder) Shuting Liang, MPH, Gilead Sciences (Employee) Henry Morgan Stewart, PhD, IQVIA (Employee) Mark Thrun, MD, Gilead Sciences (Employee, Shareholder) Paul Hodgkins, PhD, MSc, Gilead Sciences (Employee, Shareholder) Richard Haubrich, MD, Gilead Sciences (Employee, Shareholder)
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Belenkaya R, Gurley MJ, Golozar A, Dymshyts D, Miller RT, Williams AE, Ratwani S, Siapos A, Korsik V, Warner J, Campbell WS, Rivera D, Banokina T, Modina E, Bethusamy S, Stewart HM, Patel M, Chen R, Falconer T, Park RW, You SC, Jeon H, Shin SJ, Reich C. Extending the OMOP Common Data Model and Standardized Vocabularies to Support Observational Cancer Research. JCO Clin Cancer Inform 2021; 5:12-20. [PMID: 33411620 PMCID: PMC8140810 DOI: 10.1200/cci.20.00079] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Michael J Gurley
- Clinical and Translational Sciences Institute, Northwestern University, Evanston, IL
| | | | | | - Robert T Miller
- Tufts Clinical and Translational Science Institute, Boston, MA
| | - Andrew E Williams
- Tufts Institute for Clinical Research and Health Policy Studies, Boston, MA
| | | | | | | | | | | | | | | | | | | | | | | | - Ruijun Chen
- Department of Biomedical Informatics, Columbia University, New York City, NY
| | - Thomas Falconer
- Department of Biomedical Informatics, Columbia University, New York City, NY
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
| | - Seng Chan You
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
| | - Hokyun Jeon
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
| | - Soe Jeong Shin
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
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Wang Q, Reps JM, Kostka KF, Ryan PB, Zou Y, Voss EA, Rijnbeek PR, Chen R, Rao GA, Morgan Stewart H, Williams AE, Williams RD, Van Zandt M, Falconer T, Fernandez-Chas M, Vashisht R, Pfohl SR, Shah NH, Kasthurirathne SN, You SC, Jiang Q, Reich C, Zhou Y. Development and validation of a prognostic model predicting symptomatic hemorrhagic transformation in acute ischemic stroke at scale in the OHDSI network. PLoS One 2020; 15:e0226718. [PMID: 31910437 PMCID: PMC6946584 DOI: 10.1371/journal.pone.0226718] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/02/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND PURPOSE Hemorrhagic transformation (HT) after cerebral infarction is a complex and multifactorial phenomenon in the acute stage of ischemic stroke, and often results in a poor prognosis. Thus, identifying risk factors and making an early prediction of HT in acute cerebral infarction contributes not only to the selections of therapeutic regimen but also, more importantly, to the improvement of prognosis of acute cerebral infarction. The purpose of this study was to develop and validate a model to predict a patient's risk of HT within 30 days of initial ischemic stroke. METHODS We utilized a retrospective multicenter observational cohort study design to develop a Lasso Logistic Regression prediction model with a large, US Electronic Health Record dataset which structured to the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM). To examine clinical transportability, the model was externally validated across 10 additional real-world healthcare datasets include EHR records for patients from America, Europe and Asia. RESULTS In the database the model was developed, the target population cohort contained 621,178 patients with ischemic stroke, of which 5,624 patients had HT within 30 days following initial ischemic stroke. 612 risk predictors, including the distance a patient travels in an ambulance to get to care for a HT, were identified. An area under the receiver operating characteristic curve (AUC) of 0.75 was achieved in the internal validation of the risk model. External validation was performed across 10 databases totaling 5,515,508 patients with ischemic stroke, of which 86,401 patients had HT within 30 days following initial ischemic stroke. The mean external AUC was 0.71 and ranged between 0.60-0.78. CONCLUSIONS A HT prognostic predict model was developed with Lasso Logistic Regression based on routinely collected EMR data. This model can identify patients who have a higher risk of HT than the population average with an AUC of 0.78. It shows the OMOP CDM is an appropriate data standard for EMR secondary use in clinical multicenter research for prognostic prediction model development and validation. In the future, combining this model with clinical information systems will assist clinicians to make the right therapy decision for patients with acute ischemic stroke.
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Affiliation(s)
- Qiong Wang
- Biomedical Engineering School, Sun Yat-Sen University, Guangzhou, China
- The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Observational Health Data Sciences and Informatics, New York, New York, United States of America
| | - Jenna M. Reps
- Observational Health Data Sciences and Informatics, New York, New York, United States of America
- Janssen Research and Development, Raritan, New Jersey, United States of America
| | - Kristin Feeney Kostka
- Observational Health Data Sciences and Informatics, New York, New York, United States of America
- IQVIA, Durham, North Carolina, United States of America
| | - Patrick B. Ryan
- Observational Health Data Sciences and Informatics, New York, New York, United States of America
- Janssen Research and Development, Raritan, New Jersey, United States of America
- Department of Biomedical Informatics, Columbia University, New York, New York, United States of America
| | - Yuhui Zou
- Department of Neurosurgery, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Erica A. Voss
- Observational Health Data Sciences and Informatics, New York, New York, United States of America
- Janssen Research and Development, Raritan, New Jersey, United States of America
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Peter R. Rijnbeek
- Observational Health Data Sciences and Informatics, New York, New York, United States of America
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - RuiJun Chen
- Observational Health Data Sciences and Informatics, New York, New York, United States of America
- Department of Biomedical Informatics, Columbia University, New York, New York, United States of America
- Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
| | - Gowtham A. Rao
- Observational Health Data Sciences and Informatics, New York, New York, United States of America
- Janssen Research and Development, Raritan, New Jersey, United States of America
| | - Henry Morgan Stewart
- Observational Health Data Sciences and Informatics, New York, New York, United States of America
- IQVIA, Durham, North Carolina, United States of America
| | - Andrew E. Williams
- Observational Health Data Sciences and Informatics, New York, New York, United States of America
- Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, Massachusetts, United States of America
| | - Ross D. Williams
- Observational Health Data Sciences and Informatics, New York, New York, United States of America
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mui Van Zandt
- Observational Health Data Sciences and Informatics, New York, New York, United States of America
- IQVIA, Durham, North Carolina, United States of America
| | - Thomas Falconer
- Observational Health Data Sciences and Informatics, New York, New York, United States of America
- Department of Biomedical Informatics, Columbia University, New York, New York, United States of America
| | - Margarita Fernandez-Chas
- Observational Health Data Sciences and Informatics, New York, New York, United States of America
- IQVIA, Durham, North Carolina, United States of America
| | - Rohit Vashisht
- Observational Health Data Sciences and Informatics, New York, New York, United States of America
- Stanford Center for Biomedical Informatics Research, Stanford, California, United States of America
| | - Stephen R. Pfohl
- Observational Health Data Sciences and Informatics, New York, New York, United States of America
- Stanford Center for Biomedical Informatics Research, Stanford, California, United States of America
| | - Nigam H. Shah
- Observational Health Data Sciences and Informatics, New York, New York, United States of America
- Stanford Center for Biomedical Informatics Research, Stanford, California, United States of America
| | - Suranga N. Kasthurirathne
- Observational Health Data Sciences and Informatics, New York, New York, United States of America
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, United States of America
- Department of Epidemiology, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, United States of America
| | - Seng Chan You
- Observational Health Data Sciences and Informatics, New York, New York, United States of America
- Department of Biomedical informatics, Ajou University School of Medicine, Suwon, Korea
| | - Qing Jiang
- Biomedical Engineering School, Sun Yat-Sen University, Guangzhou, China
| | - Christian Reich
- Observational Health Data Sciences and Informatics, New York, New York, United States of America
- IQVIA, Durham, North Carolina, United States of America
| | - Yi Zhou
- Department of Biomedical Engineering, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
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9
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Morgan Stewart H, Shevlin SA, Catlow CRA, Guo ZX. Compressive straining of bilayer phosphorene leads to extraordinary electron mobility at a new conduction band edge. Nano Lett 2015; 15:2006-2010. [PMID: 25692995 DOI: 10.1021/nl504861w] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
By means of hybrid DFT calculations and the deformation potential approximation, we show that bilayer phosphorene under slight compression perpendicular to its surface exhibits extraordinary room temperature electron mobility of order 7 × 10(4) cm(2) V(-1) s(-1). This is approximately 2 orders of magnitude higher than is widely reported for ground state phosphorenes and is the result of the emergence of a new conduction band minimum that is decoupled from the in-plane acoustic phonons that dominate carrier scattering.
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Affiliation(s)
- Henry Morgan Stewart
- Department of Chemistry, University College London , London WC1E 6BT, United Kingdom
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10
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Han X, Stewart HM, Shevlin SA, Catlow CRA, Guo ZX. Strain and orientation modulated bandgaps and effective masses of phosphorene nanoribbons. Nano Lett 2014; 14:4607-4614. [PMID: 24992160 DOI: 10.1021/nl501658d] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Passivated phosphorene nanoribbons, armchair (a-PNR), diagonal (d-PNR), and zigzag (z-PNR), were investigated using density functional theory. Z-PNRs demonstrate the greatest quantum size effect, tuning the bandgap from 1.4 to 2.6 eV when the width is reduced from 26 to 6 Å. Strain effectively tunes charge carrier transport, leading to a sudden increase in electron effective mass at +8% strain for a-PNRs or hole effective mass at +3% strain for z-PNRs, differentiating the (mh*/me*) ratio by an order of magnitude in each case. Straining of d-PNRs results in a direct to indirect band gap transition at either -7% or +5% strain and therein creates degenerate energy valleys with potential applications for valleytronics and/or photocatalysis.
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Affiliation(s)
- Xiaoyu Han
- Department of Chemistry, University College London , London WC1E 6BT, United Kingdom
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11
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Stewart HM, Hann JR, DeTomasi DC, Neville BW, DeChamplain RW. Histologic fate of dermal grafts following implantation for temporomandibular joint meniscal perforation: a preliminary study. Oral Surg Oral Med Oral Pathol 1986; 62:481-5. [PMID: 3537891 DOI: 10.1016/0030-4220(86)90307-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A study was carried out to evaluate the histologic changes of meniscus perforation repair associated with dermal grafts to the temporomandibular joint of cynomolgus monkeys (Macaca fascicularis) following surgical perforation of the meniscus. Dermal grafts were studied histologically at 3-week, 6-week, 3-month, and 6-month intervals. Results showed early attachment of the dermal graft to the meniscus, followed by gradual incorporation of the graft into the meniscus and subsequent return of the meniscal-graft complex to a normal meniscal architecture.
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Abstract
A case of nonfamilial cherubism and a review of literature have been reported. A diagnosis of cherubism was based on clinical and histopathologic examinations.
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