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Durand A, Morgan CL, Tinsley S, Hughes E, McCormack T, Bitchell CL, Lahoz R. Familial hypercholesterolaemia in UK primary care: a Clinical Practice Research Datalink study of an under-recognised condition. Br J Gen Pract 2024; 74:BJGP.2023.0010. [PMID: 38325890 PMCID: PMC10877619 DOI: 10.3399/bjgp.2023.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 07/20/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Studies utilising genotyping methods report the prevalence of familial hypercholesterolaemia to be as high as one in 137 of the adult population. AIM To estimate the prevalence of familial hypercholesterolaemia measured by clinically coded diagnosis, associated treatments, and lipid measurements observed in UK primary care. DESIGN AND SETTING This was a retrospective analysis using the Clinical Practice Research Datalink (CPRD) GOLD database. METHOD Patients aged ≥18 years and actively registered on the index date (30 June 2018) formed the study cohort. Point prevalence of familial hypercholesterolaemia for 2018 was estimated overall and for each nation of the UK. Patients with familial hypercholesterolaemia were stratified into primary and secondary prevention groups, defined as those with/without a prior diagnosis of atherosclerotic cardiovascular disease. Prevalence estimates and extrapolations were replicated for these subgroups. Baseline demographic, lipid, and clinical characteristics for the prevalent cohort were presented. RESULTS In total, 4048 patients with familial hypercholesterolaemia formed the study cohort. The estimated familial hypercholesterolaemia prevalence for the UK was 16.4 per 10 000 (95% confidence interval [CI] = 16.0 to 16.9). Of these, 2646 (65.4%) patients with familial hypercholesterolaemia had a recent prescription for lipid-lowering therapy. Mean lipid levels were lower for those treated with lipid-lowering therapy compared with those untreated: 5.34 mmol/L (SD 1.50) versus 6.25 mmol/L (SD 1.55) for total cholesterol and 3.15 mmol/L (SD 1.34) versus 3.96 mmol/L (SD 1.36) for low-level density lipoprotein cholesterol. CONCLUSION The estimated prevalence of familial hypercholesterolaemia was one in 608 of the population, less than expected from other studies, which may indicate that familial hypercholesterolaemia is under-recognised in UK primary care. Over one-third of diagnosed patients were undertreated and many did not achieve target goals, placing them at risk of cardiovascular events.
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Affiliation(s)
| | | | | | - Elizabeth Hughes
- Sandwell and West Birmingham Hospitals NHS Trust and University of Aston Medical School, Birmingham, UK
| | - Terry McCormack
- Institute of Clinical and Applied Health Research, Hull York Medical School, Hull, UK
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de Diego C, Lasierra AB, López-Vergara L, Torralba L, Ruiz de Gopegui P, Lahoz R, Abadía C, Godino J, Cebollada A, Jimeno B, Bello C, Tejada A, Bello S. What is the actual relationship between neutrophil extracellular traps and COVID-19 severity? A longitudinal study. Respir Res 2024; 25:48. [PMID: 38243237 PMCID: PMC10797938 DOI: 10.1186/s12931-023-02650-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/21/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Neutrophil extracellular traps (NETs) have repeatedly been related to COVID-19 severity and mortality. However, there is no consensus on their quantification, and there are scarce data on their evolution during the disease. We studied circulating NET markers in patients with COVID-19 throughout their hospitalization. METHODS We prospectively included 93 patients (201 blood samples), evaluating the disease severity in 3 evolutionary phases (viral, early, and late inflammation). Of these, 72 had 180 samples in various phases. We also evaluated 55 controls with similar age, sex and comorbidities. We measured 4 NET markers in serum: cfDNA, CitH3, and MPO-DNA and NE-DNA complexes; as well as neutrophil-related cytokines IL-8 and G-CSF. RESULTS The COVID-19 group had higher CitH3 (28.29 vs 20.29 pg/mL, p = 0.022), and cfDNA, MPO-DNA, and NE-DNA (7.87 vs 2.56 ng/mL; 0.80 vs 0.52 and 1.04 vs 0.72, respectively, p < 0.001 for all) than the controls throughout hospitalisation. cfDNA was the only NET marker clearly related to severity, and it remained higher in non-survivors during the 3 phases. Only cfDNA was an independent risk factor for mortality and need for intensive care. Neutrophil count, IL-8, and G-CSF were significantly related to severity. MPO-DNA and NE-DNA showed significant correlations (r: 0.483, p < 0.001), including all 3 phases and across all severity grades, and they only remained significantly higher on days 10-16 of evolution in those who died. Correlations among the other NET markers were lower than expected. CONCLUSIONS The circulating biomarkers of NETs were present in patients with COVID-19 throughout hospitalization. cfDNA was associated with severity and mortality, but the three other markers showed little or no association with these outcomes. Neutrophil activity and neutrophil count were also associated with severity. MPO-DNA and NE-DNA better reflected NET formation. cfDNA appeared to be more associated with overall tissue damage; previous widespread use of this marker could have overestimated the relationship between NETs and severity. Currently, there are limitations to accurate NET markers measurement that make it difficult to assess its true role in COVID-19 pathogenesis.
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Affiliation(s)
- Cristina de Diego
- Department of Pulmonary Medicine, Miguel Servet University Hospital, CIBERES, Instituto de Investigación Sanitaria (ISS) Aragón, Avenida Isabel la Católica 1-9, 50009, Zaragoza, Spain
| | | | - Lucía López-Vergara
- Department of Pulmonary Medicine, Miguel Servet University Hospital, CIBERES, Instituto de Investigación Sanitaria (ISS) Aragón, Avenida Isabel la Católica 1-9, 50009, Zaragoza, Spain
| | - Laura Torralba
- Department of Pulmonary Medicine, Miguel Servet University Hospital, CIBERES, Instituto de Investigación Sanitaria (ISS) Aragón, Avenida Isabel la Católica 1-9, 50009, Zaragoza, Spain
| | | | - Raquel Lahoz
- Department of Biochemistry. Miguel, Servet University Hospital, Zaragoza, Spain
| | - Claudia Abadía
- Department of Biochemistry. Miguel, Servet University Hospital, Zaragoza, Spain
| | - Javier Godino
- Department of Cytometry and Cell Separation, Aragon Institute of Health Sciences (IACS), Zaragoza, Spain
| | - Alberto Cebollada
- Biocomputing Technical Scientific Service, Aragon Institute of Health Sciences (IACS), Zaragoza, Spain
| | - Beatriz Jimeno
- Department of Cytometry and Cell Separation, Aragon Institute of Health Sciences (IACS), Zaragoza, Spain
| | - Carlota Bello
- Department of Radiology, Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | - Antonio Tejada
- Intensive Care Unit, Miguel Servet University Hospital, Zaragoza, Spain
| | - Salvador Bello
- Department of Pulmonary Medicine, Miguel Servet University Hospital, CIBERES, Instituto de Investigación Sanitaria (ISS) Aragón, Avenida Isabel la Católica 1-9, 50009, Zaragoza, Spain.
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Lahoz R, Seshagiri D, Electricwala B, Achouba A, Ding Y, Heo JH, Cristino J, Studer R. Clinical characteristics and treatment patterns in patients with atherosclerotic cardiovascular disease with hypercholesterolemia: a retrospective analysis of a large US real-world database cohort. Curr Med Res Opin 2024; 40:15-25. [PMID: 37941428 DOI: 10.1080/03007995.2023.2270901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/11/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE Guidelines developed by the American College of Cardiology/American Heart Association (ACC/AHA) recommend lipid-lowering therapies (LLTs) to reduce low-density lipoprotein cholesterol (LDL-C) and atherosclerotic cardiovascular disease (ASCVD) risk. This study described LLT utilization patterns and LDL-C goal achievement (to <70 mg/dL) among patients with ASCVD in the United States. METHODS This retrospective study was conducted using Optum's de-identified Clinformatics Data Mart Database (CDM). Patients with their first ASCVD diagnosis (index date) in the CDM database between July 1, 2015, and December 31, 2018, were followed for ≥12 months to assess LLT utilization patterns and change in LDL-C. LLTs included were statins and non-statin LLTs (ezetimibe, fibrates, and proprotein convertase subtilisin/kexin type 9 inhibitors). Adherence was measured as the proportion of days covered (PDC), defined as the number of days with drug on-hand (or number of days exposed to drug) divided by the 12-month follow-up period. Patients with PDC ≥0.8 were considered adherent. RESULTS Among the patients with ASCVD (N = 1,424,893) included in this study, only 621,978 (43.7%) had at least one LDL-C measurement at baseline (6 months prior to and 3 months after the index date). The mean age was 71.5 years, and almost half of the patients were female. Patients were followed for a mean (standard deviation [SD]) duration of 30.6 (11.4) months (median of 29.9 months). During the follow-up, about one-quarter of the patients did not receive any LLT. Among treated patients, 89.5% received statins and 10.5% received non-statin LLT. Less than half (47.6%) of the patients were adherent to the index treatment during the 12-month follow-up. Even in patients receiving combination therapy (statin + non-statin LLT), a sizable proportion (35.8%) showed an increase in LDL-C over the follow-up period. CONCLUSIONS This retrospective study highlighted limited LDL-C monitoring in patients with ASCVD, and unmet need in terms of suboptimal utilization of non-stain LLTs, limited adherence to LLTs, and inadequate lipid control after treatment (among those with LDL-C measurements during the follow-up period) need to be addressed to improve outcomes in this patient cohort.
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Morgan CL, Durand A, McCormack T, Hughes E, Berni TR, Lahoz R. Risk of major adverse cardiovascular events associated with elevated low-density lipoprotein cholesterol in a population with atherosclerotic cardiovascular disease with and without type 2 diabetes: a UK database analysis using the Clinical Practice Research Datalink. BMJ Open 2023; 13:e064541. [PMID: 38030254 PMCID: PMC10689406 DOI: 10.1136/bmjopen-2022-064541] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVES To estimate the 12-month probabilities of major adverse cardiovascular events (MACE) and non-cardiovascular death in patients with atherosclerotic cardiovascular disease (ASCVD) and elevated low-density lipoprotein cholesterol (LDL-C). DESIGN A retrospective database analysis. SETTING UK primary care. PARTICIPANTS Patients were selected from the Clinical Practice Research Datalink (Aurum) linked to Hospital Episode Statistics inpatient and Office of National Statistics mortality datasets. Patients with an ASCVD diagnosis between 01 January 2010 and 31 May 2018 and LDL-C ≥2.6 mmol/L were selected. PRIMARY OUTCOMES Primary outcomes were 12-month risk of (1) MACE (composite of revascularisation, unstable angina, non-fatal myocardial infarction, non-fatal stroke and cardiovascular death) and (2) non-cardiovascular mortality. Kaplan-Meier survival analysis estimated the probability of each outcome. A Cox proportional hazards model explored covariates associated with MACE. RESULTS Of 102 245 study patients, 16 501 (16.1%) had a diagnosis of type 2 diabetes (T2DM). 65.5% of those with and 49.9% of those without T2DM had a lipid-lowering therapy (LLT) 6 months prior to index diagnosis. Twelve-month probability of MACE was 7.9% for non-T2DM and 11.8% for T2DM. LDL-C was significantly associated with risk of MACE (HR=1.19 (95% CI 1.16 to 1.22) per 1 mmol/L). History of acute coronary syndrome, other coronary heart disease, stroke and T2DM significantly increased the risk of MACE. Ezetimibe (0.88 (95% CI 0.79 to 0.99)) and low-intensity statins (0.88 (95% CI 0.79 to 0.97)) were associated with reduced 12-month MACE risk.and low-intensity statins 0.88 (95% CI 0.79 to 0.97) CONCLUSION: We confirmed the association between elevated LDL-C and MACE. Many patients with ASCVD and elevated LDL-C were untreated with LLT. With the increasing demands on general practitioners, initiatives aimed at improving identification and treatment of at-risk patients within primary care should be considered.
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Affiliation(s)
| | | | - Terry McCormack
- Institute of Clinical and Applied Health Research, Hull York Medical School, Hull, UK
| | - Elizabeth Hughes
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, Birmingham, UK
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Bello S, Lasierra AB, López-Vergara L, de Diego C, Torralba L, de Gopegui PR, Lahoz R, Abadía C, Godino J, Cebollada A, Jimeno B, Bello C, Tejada A, Torres A. IL-6 and cfDNA monitoring throughout COVID-19 hospitalization are accurate markers of its outcomes. Respir Res 2023; 24:125. [PMID: 37147677 PMCID: PMC10161166 DOI: 10.1186/s12931-023-02426-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 04/18/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Severe COVID-19 entails a dysregulated immune response, most likely inflammation related to a lack of virus control. A better understanding of immune toxicity, immunosuppression balance, and COVID-19 assessments could help determine whether different clinical presentations are driven by specific types of immune responses. The progression of the immune response and tissular damage could predict outcomes and may help in the management of patients. METHODS We collected 201 serum samples from 93 hospitalised patients classified as moderately, severely, and critically ill. We differentiated the viral, early inflammatory, and late inflammatory phases and included 72 patients with 180 samples in separate stages for longitudinal study and 55 controls. We studied selected cytokines, P-selectin, and the tissue damage markers lactate dehydrogenase (LDH) and cell-free DNA (cfDNA). RESULTS TNF-α, IL-6, IL-8, and G-CSF were associated with severity and mortality, but only IL-6 increased since admission in the critical patients and non-survivors, correlating with damage markers. The lack of a significant decrease in IL-6 levels in the critical patients and non-survivors in the early inflammatory phase (a decreased presence in the other patients) suggests that these patients did not achieve viral control on days 10-16. For all patients, lactate dehydrogenase and cfDNA levels increased with severity, and cfDNA levels increased in the non-survivors from the first sample (p = 0.002) to the late inflammatory phase (p = 0.031). In the multivariate study, cfDNA was an independent risk factor for mortality and ICU admission. CONCLUSIONS The distinct progression of IL-6 levels in the course of the disease, especially on days 10-16, was a good marker of progression to critical status and mortality and could guide the start of IL-6 blockade. cfDNA was an accurate marker of severity and mortality from admission and throughout COVID-19 progression.
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Affiliation(s)
- Salvador Bello
- Department of Pulmonary Medicine, Miguel Servet University Hospital, CIBERES, Instituto de Investigación Sanitaria (ISS) Aragón, Avenida Isabel La Católica 1-9, 50009, Zaragoza, Spain.
| | | | - Lucía López-Vergara
- Department of Pulmonary Medicine, Miguel Servet University Hospital, CIBERES, Instituto de Investigación Sanitaria (ISS) Aragón, Avenida Isabel La Católica 1-9, 50009, Zaragoza, Spain
| | - Cristina de Diego
- Department of Pulmonary Medicine, Miguel Servet University Hospital, CIBERES, Instituto de Investigación Sanitaria (ISS) Aragón, Avenida Isabel La Católica 1-9, 50009, Zaragoza, Spain
| | - Laura Torralba
- Department of Pulmonary Medicine, Miguel Servet University Hospital, CIBERES, Instituto de Investigación Sanitaria (ISS) Aragón, Avenida Isabel La Católica 1-9, 50009, Zaragoza, Spain
| | | | - Raquel Lahoz
- Department of Biochemistry, Miguel Servet University Hospital, Zaragoza, Spain
| | - Claudia Abadía
- Department of Biochemistry, Miguel Servet University Hospital, Zaragoza, Spain
| | - Javier Godino
- Department of Cytometry and Cell Separation, Aragon Institute of Health Sciences (IACS), Zaragoza, Spain
| | - Alberto Cebollada
- Biocomputing Technical Scientific Service, Aragon Institute of Health Sciences (IACS), Zaragoza, Spain
| | - Beatriz Jimeno
- Department of Cytometry and Cell Separation, Aragon Institute of Health Sciences (IACS), Zaragoza, Spain
| | - Carlota Bello
- Department of Radiology, Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | - Antonio Tejada
- Intensive Care Unit, Miguel Servet University Hospital, Zaragoza, Spain
| | - Antoni Torres
- Servei de Pneumologia, Hospital Clinic, Universitat de Barcelona, IDIBAPS, ICREA, CIBERESUCICOVID, Barcelona, Spain
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Seshagiri D, Durand A, Morgan C, Lahoz R. Burden of ASCVD in England. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Klebs S, Lecocq J, Mann C, Zingel R, Seshagiri D, Lahoz R. Characterization of Inclisiran Use in Real World: Prescription Data from Germany. J Clin Lipidol 2022. [DOI: 10.1016/j.jacl.2022.05.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lahoz R, Fagan A, McSharry M, Proudfoot C, Corda S, Studer R. Recurrent heart failure hospitalizations increase the risk of mortality in heart failure patients with atrial fibrillation and type 2 diabetes mellitus in the United Kingdom: a retrospective analysis of Clinical Practice Research Datalink database. BMC Cardiovasc Disord 2022; 22:234. [PMID: 35597922 PMCID: PMC9124377 DOI: 10.1186/s12872-022-02665-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 04/07/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a global illness and is a leading cause of hospitalizations. Recurrent HF hospitalization (HFH) is associated with increased risk of cardiovascular (CV) and all-cause mortality, thereby burdening the health system. Type 2 diabetes mellitus (T2DM) and atrial fibrillation (AF) are two important comorbidities in patients living with HF. This study aims to assess the association between recurrent HFHs with CV and all-cause mortality in patients living with HF and having AF and/or T2DM. METHODS This study was conducted using primary care data from the Clinical Practice Research Datalink database with linkage to hospital data and mortality data. Adults living with HF and with at least 1 HFH were identified from January 2010 to December 2014. Patients were grouped based on the number of recurrent HFHs. During follow-up, all-cause mortality or CV mortality for the HF population with AF and T2DM was recorded. RESULTS Overall, 32.9% of 2344 T2DM patients and 28.2% of 4585 AF patients had at least 1 recurrent HFH. The patients were relatively elderly and were predominantly male. The mean number of all-cause hospitalizations in HF patients having T2DM and AF, with ≥ 1 recurrent HFH were significantly higher than patients without recurrent HFH. The annualized mortality rates in CV mortality as the primary cause and for all-cause mortality and increased with recurrent HFHs, in T2DM and AF patients. The risk of CV mortality as primary cause and all cause morality were 5.39 and 3.19 times higher in T2DM patients with 3 recurrent HFHs versus no recurrent HFH. Similarly, the risk of CV mortality as primary cause and all cause morality was 5.98 and 4.3 times higher in AF patients with 3 recurrent HFHs versus those with no recurrent HFH. CONCLUSIONS Recurrent HFHs are strongly associated with CV mortality and all-cause mortality in HF patients with TD2M or AF. The hospitalization rate highlights the need for treatment and disease management, which will improve the course of the disease and help patients stay out of hospital.
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Affiliation(s)
| | - Ailís Fagan
- Novartis Ireland Limited, 203 Merrion Rd, Dublin, D04 NN12, Ireland
| | - Martin McSharry
- Empower The User, Unit 1B, Trinity Technology & Enterprise Campus, Pearse St, Dublin, D02 KD43, Ireland
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Gouni-Berthold I, Seshagiri D, Studer R, Durand A, Klebs S, Achouba A, Morgan C, Kap E, Lahoz R. Treatment patterns in patients with Familial hypercholesterolemia: evidence from real-world studies in Germany and the UK. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Familial hypercholesterolemia (FH) includes a spectrum of disease as per the number and effect of mutations in specific proteins involved in low-density lipoprotein cholesterol (LDL-C) metabolism, together with other genetic factors. Elevated LDL-C levels have been strongly associated with risk of cardiovascular and coronary heart disease, with up to 10-fold risk in patients (pts) with FH than without FH. The aim of lipid-lowering treatments (LLTs) is to reduce the LDL-C levels, although there is limited research describing treatment patterns and LDL-C outcomes in FH pts in routine care.
Purpose
To characterize the treatment patterns and LDL-C outcomes of FH pts in the real-world setting in Germany (GER) and the UK.
Methods
We conducted two descriptive, non-interventional and retrospective cohort studies. Pts in GER were identified from General Physician (GP) and Cardiology practices available in electronic medical records database Disease Analyzer (January 1992-June 2020). Pts in the UK were identified from the Clinical Practice Research Datalink linked to the Hospital Episode Statistics admitted pts care and Office of National Statistics datasets. Pts were included if they had diagnosis of FH (index date [ID]) and data available within 6-month before and 3-month after the ID. The first diagnosis of FH in the identification period (GER, 1/07/2015–30/06/2019; UK, 01/01/2010–31/05/2018) was considered the ID. Persistence and adherence to the recorded LLT at ID was analyzed for pts with at least 12 months and 24 months of follow-up. Persistence was measured as the duration (in days) with allowed gap of 60 days and adherence as proportion of days covered (PDC).
Results
Analysis included 2,105 FH pts from GER and 9,846 from the UK. Data are presented as GER/UK. The mean (SD) age of pts was 60 (15)/52 (14) years, and 60%/61% were females. Hypertension (53%/27%) and depression (31%/38%) were the common comorbidities. At ID, statin monotherapy (29%/68%) was the most commonly prescribed LLT. The use of ezetimibe, fibrates and PCSK9 inhibitors was very low in both countries (Table 1). Of note, LDL-C measurements at ID (−6m/+3m) were available for 31%/73% of pts. In pts with uncontrolled LDL-C (≥55 mg/dL), 34%/64% were receiving statin monotherapy, whereas there was no use of LLT in 62%/29% of pts. During the 24 months follow-up, the mean (SD) persistence and PDC to statins monotherapy was 471 (264)/489 (289) days and 0.65 (0.36)/0.69 (0.46), respectively, with 50%/70% of pts being adherent (PDC ≥0.80).
Conclusions
In our study, in GER, the rate of LDL-C measurements was low. In both GER and UK, almost all measured patients had LDL-C ≥55mg/dL at ID. Findings indicate low prescriptions of LLTs in GP setting, particularly non-statin LLTs in both countries. The mean adherence (PDC) in GER and the UK was 65% and 69%, respectively within 24 months after ID. Improved LDL-C monitoring and new therapies with potential to lower LDL-C are warranted.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Novartis Pharma AG, Basel, Switzerland
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Affiliation(s)
| | | | - R Studer
- Novartis Pharma AG, Basel, Switzerland
| | - A Durand
- Novartis Pharmaceuticals, London, United Kingdom
| | - S Klebs
- Novartis Pharma GmbH, Nürnberg, Germany
| | - A Achouba
- Novartis Pharma AG, Basel, Switzerland
| | - C Morgan
- Pharmatelligence, Cardiff, United Kingdom
| | - E Kap
- IQVIA, Frankfurt, Germany
| | - R Lahoz
- Novartis Pharma AG, Basel, Switzerland
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Gouni-Berthold I, Seshagiri D, Studer R, Klebs S, Achouba A, Becker EM, Bribian EI, Lahoz R. A real-world assessment of treatment patterns in patients with atherosclerotic cardiovascular disease with hypercholesterolemia: a retrospective database analysis in Germany. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The European Society of Cardiology (ESC) guidelines suggest that greater absolute reduction in low-density lipoprotein cholesterol (LDL-C) leads to greater cardiovascular risk reduction. Several lipid-lowering treatments (LLTs) are available in Germany; however, the research on treatment patterns and LDL-C outcomes among patients (pts) receiving LLTs in real-world setting is limited.
Purpose
To characterize the pts characteristics, treatment patterns and LDL-C outcomes of pts with atherosclerotic cardiovascular disease (ASCVD) with hypercholesterolemia (ASCVD-H) in Germany.
Methods
This is a descriptive, non-interventional, retrospective cohort study of ASCVD-H pts identified from general physician (GP) practices available in the electronic medical record (EMR) database Disease Analyzer (January 1992-June 2020) in Germany. ASCVD-H pts were included if they had a recorded diagnosis, were prescribed LLTs or had LDL-C levels of ≥55 mg/dL anytime within 6 months before and 3 months after the index date (ID), as per the data recorded by the participating physician. The first encounter of ASCVD after hypercholesterolemia during the identification period (1/07/2015–30/06/2019) was considered as the ID. Persistence was measured as the duration (in days) with allowed gap of 60 days and adherence as proportion of days covered (PDC) within 12 and 24 months after ID.
Results
We included 147,905 pts with ASCVD-H (57.2% male; mean age: 70.6 yrs; ≥75 yrs-old: 43.3%; mean BMI: 29.0 kg/m2). Coronary artery disease was the most common index diagnosis (73.2%), followed by cerebrovascular disease (31.7%) and peripheral vascular disease (21.5%). Hypertension (83.5%) and diabetes (27.6%) were the most common comorbidities among these pts. At ID, statin monotherapy (58.6%) was the most commonly prescribed LLT, with simvastatin being the most common drug (36.4%). The use of PCSK9 inhibitors, ezetimibe and fibrates was very limited (<1%; Table 1). Of note, LDL-C measurements (6 months prior and 3 months post index) were available for 50.7% of pts. In pts with uncontrolled LDL-C (≥55 mg/dL), 47.9% were receiving statin monotherapy (28.6% were on simvastatin), whereas there was no LLT prescribed in 48.0% of pts. The mean (SD) persistence and adherence to statins monotherapy within 24 months follow-up was 522 (260) days and 0.721 (0.345), respectively, with 60% of pts being adherent (PDC ≥0.80) to statins monotherapy.
Conclusions
Pts with ASCVD-H in Germany treated by GPs are elderly pts with multiple cardiovascular comorbidities. LDL-C was measured in nearly half of the pts, and almost all had LDL-C ≥55 mg/dL at ID. Findings indicate low prescription of LLTs in GP setting, particularly non-statin LLTs. The mean adherence (PDC) to statin monotherapy was 72% within the 24-month after ID. Data suggest the need for newer therapies with potential to control LDL-C levels.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Novartis Pharma AG, Basel, Switzerland.
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Affiliation(s)
| | | | - R Studer
- Novartis Pharma AG, Basel, Switzerland
| | - S Klebs
- Novartis Pharma GmbH, Nürnberg, Germany
| | - A Achouba
- Novartis Pharma AG, Basel, Switzerland
| | | | | | - R Lahoz
- Novartis Pharma AG, Basel, Switzerland
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Lahoz R, Seshagiri D, Achouba A, Durand A, Morgan C, Berni T, Studer R. Treatment patterns in atherosclerotic cardiovascular disease (ASCVD-H) and ASCVD-risk equivalent (ASCVD-RE-H) patients, both with hypercholesterolemia, a retrospective real-world database analysis in England. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Mahesri M, Chin K, Kumar A, Barve A, Studer R, Lahoz R, Desai RJ. External validation of a claims-based model to predict left ventricular ejection fraction class in patients with heart failure. PLoS One 2021; 16:e0252903. [PMID: 34086825 PMCID: PMC8177622 DOI: 10.1371/journal.pone.0252903] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 05/25/2021] [Indexed: 11/19/2022] Open
Abstract
Background Ejection fraction (EF) is an important prognostic factor in heart failure (HF), but administrative claims databases lack information on EF. We previously developed a model to predict EF class from Medicare claims. Here, we evaluated the performance of this model in an external validation sample of commercial insurance enrollees. Methods Truven MarketScan claims linked to electronic medical records (EMR) data (IBM Explorys) containing EF measurements were used to identify a cohort of US patients with HF between 01-01-2012 and 10-31-2019. By applying the previously developed model, patients were classified into HF with reduced EF (HFrEF) or preserved EF (HFpEF). EF values recorded in EMR data were used to define gold-standard HFpEF (LVEF ≥45%) and HFrEF (LVEF<45%). Model performance was reported in terms of overall accuracy, positive predicted values (PPV), and sensitivity for HFrEF and HFpEF. Results A total of 7,001 HF patients with an average age of 71 years were identified, 1,700 (24.3%) of whom had HFrEF. An overall accuracy of 0.81 (95% CI: 0.80–0.82) was seen in this external validation sample. For HFpEF, the model had sensitivity of 0.96 (95%CI, 0.95–0.97) and PPV of 0.81 (95% CI, 0.81–0.82); while for HFrEF, the sensitivity was 0.32 (95%CI, 0.30–0.34) and PPV was 0.73 (95%CI, 0.69–0.76). These results were consistent with what was previously published in US Medicare claims data. Conclusions The successful validation of the Medicare claims-based model provides evidence that this model may be used to identify patient subgroups with specific EF class in commercial claims databases as well.
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Affiliation(s)
- Mufaddal Mahesri
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, United States of America
| | - Kristyn Chin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, United States of America
| | | | | | | | | | - Rishi J. Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, United States of America
- * E-mail:
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Desai RJ, Mahesri M, Chin K, Levin R, Lahoz R, Studer R, Vaduganathan M, Patorno E. Epidemiologic Characterization of Heart Failure with Reduced or Preserved Ejection Fraction Populations Identified Using Medicare Claims. Am J Med 2021; 134:e241-e251. [PMID: 33127370 DOI: 10.1016/j.amjmed.2020.09.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Administrative claims do not contain ejection fraction information for heart failure patients. We recently developed and validated a claims-based model to predict ejection fraction subtype. METHODS Heart failure patients aged 65 years or above from US Medicare fee-for-service claims were identified using diagnoses recorded after a 6-month baseline period of continuous enrollment, which was used to identify predictors and to apply the claims-based model to distinguish heart failure with reduced or preserved ejection fraction (HFrEF or HFpEF). Patients were followed for the composite outcome of time to first worsening heart failure event (heart failure hospitalization or outpatient intravenous diuretic treatment) or all-cause mortality. RESULTS A total of 3,134,414 heart failure patients with an average age of 79 years were identified, of which 200,950 (6.4%) were classified as HFrEF. Among those classified as HFrEF, men comprised a larger proportion (68% vs 41%) and the average age was lower (76 vs 79 years) compared with HFpEF. History of myocardial infarction was more common in HFrEF (32% vs 13%), while hypertension was more common in HFpEF (71% vs 77%). One-year cumulative incidence of the composite endpoint was 42.6% for HFrEF and 36.9% for HFpEF. One-year all-cause mortality incidence was similar between the groups (27.4% for HFrEF and 26.4% for HFpEF), however, cardiovascular mortality was higher for HFrEF (15.6% vs 11.3%), whereas noncardiovascular mortality was higher for HFpEF (11.8% vs 15.1%). CONCLUSION We replicated well-documented differences in key patient characteristics and cause-specific outcomes between HFrEF and HFpEF in populations identified based on the application of a claims-based model.
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Affiliation(s)
- Rishi J Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, Mass.
| | - Mufaddal Mahesri
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, Mass
| | - Kristyn Chin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, Mass
| | - Raisa Levin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, Mass
| | | | | | - Muthiah Vaduganathan
- Heart and Vascular Center, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, Mass
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Lindmark K, Boman K, Stålhammar J, Olofsson M, Lahoz R, Studer R, Proudfoot C, Corda S, Fonseca AF, Costa-Scharplatz M, Levine A, Törnblom M, Castelo-Branco A, Kopsida E, Wikström G. Recurrent heart failure hospitalizations increase the risk of cardiovascular and all-cause mortality in patients with heart failure in Sweden: a real-world study. ESC Heart Fail 2021; 8:2144-2153. [PMID: 33751806 PMCID: PMC8120394 DOI: 10.1002/ehf2.13296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/23/2021] [Accepted: 02/28/2021] [Indexed: 12/28/2022] Open
Abstract
Aims Heart failure (HF) is a leading cause of hospitalization and is associated with high morbidity and mortality. We examined the impact of recurrent HF hospitalizations (HFHs) on cardiovascular (CV) mortality among patients with HF in Sweden. Methods and results Adults with incident HF were identified from linked national health registers and electronic medical records from 01 January 2005 to 31 December 2013 for Uppsala and until 31 December 2014 for Västerbotten. CV mortality and all‐cause mortality were evaluated. A time‐dependent Cox regression model was used to estimate relative CV mortality rates for recurrent HFHs. Assessment was also done for ejection fraction‐based HF phenotypes and for comorbid atrial fibrillation, diabetes, or chronic renal impairment. Overall, 3878 patients with HF having an index hospitalization were included, providing 9691.9 patient‐years of follow‐up. Patients were relatively old (median age: 80 years) and were more frequently male (55.5%). Compared with patients without recurrent HFHs, the adjusted hazard ratio (HR [95% confidence interval; CI]) for CV mortality and all‐cause mortality were statistically significant for patients with one, two, three, and four or more recurrent HFHs. The risk of CV mortality and all‐cause mortality increased approximately six‐fold in patients with four or more recurrent HFHs vs. those without any HFHs (HR [95% CI]: 6.26 [5.24–7.48] and 5.59 [4.70–6.64], respectively). Similar patterns were observed across the HF phenotypes and patients with comorbidities. Conclusions There is a strong association between recurrent HFHs and CV and all‐cause mortality, with the risk increasing progressively with each recurrent HFH.
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Affiliation(s)
- Krister Lindmark
- Department of Public Health and Clinical Medicine, Heart Centre, Umeå University Hospital, Umeå, Sweden
| | - Kurt Boman
- Research Unit, Medicine-Geriatric, Skellefteå County Hospital, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Jan Stålhammar
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, S-901 87, Sweden
| | - Mona Olofsson
- Research Unit, Medicine-Geriatric, Skellefteå County Hospital, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | | | | | | | | | | | | | | | | | | | - Gerhard Wikström
- Institute of Medical Sciences, Uppsala University, Uppsala, Sweden
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15
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Lahoz R, Proudfoot C, Fonseca AF, Loefroth E, Corda S, Jackson J, Cotton S, Studer R. Caregivers of Patients with Heart Failure: Burden and the Determinants of Health-Related Quality of Life. Patient Prefer Adherence 2021; 15:1153-1164. [PMID: 34079236 PMCID: PMC8165301 DOI: 10.2147/ppa.s297816] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/29/2021] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To assess the burden among caregivers of patients with heart failure (HF) with left ventricular ejection fraction (LVEF) ≤60%. The burden by New York Heart Association (NYHA) functional class was also characterized. PATIENTS AND METHODS A cross-sectional study was conducted in France, Germany, Italy, Spain, and UK from June to November 2019. Patient record forms were completed by 257 cardiologists and 158 general practitioners for consecutive HF patients. Caregivers who accompanied the patient to their consultation completed a caregiver self-completion survey voluntarily, which included the Family Caregiver Quality of Life Questionnaire (FAMQOL) and 5-level 5-dimension EuroQol questionnaire (EQ-5D-5L). RESULTS We analyzed 361 caregivers of patients with HF (NYHA class I, n=41; II, n=212; III IV, n=108). Mean age of caregivers was 58.8 years (NYHA I/II/III-IV: 59.1/60.8/54.6 years; p=0.0029), with majority being females (73.1%). Caregivers spent on average 19.8 hours/week caring for a HF patient, which increased with increase in NYHA class (I/II/III-IV: 11.8/18.1/25.9 hours/week; p=0.0094). Caregivers (24.1%) reported providing emotional support/encouragement to patients as the most troublesome/inconvenient caregiving activity (no significant difference across NYHA class). Nearly one-third of caregivers experienced stress (NYHA I/II/III-IV: 17.1%/28.8%/40.7%; p=0.0111) and anxiety (26.8%/24.1%/39.8%; p=0.0127) due to caregiving burden. The overall FAMQOL mean score decreased significantly (poorer QoL) with increase in NYHA class (I/II/III-IV: 58.1/56.3/52.2; p=0.0069). A trend of decreasing scores with increasing NYHA class was observed across physical, emotional, and social domains (each p≤0.012). CONCLUSION Caregivers of HF patients with LVEF ≤60% experienced a significant burden, which was higher among caregivers of patients with more severe and symptomatic disease.
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Affiliation(s)
- Raquel Lahoz
- Real World Evidence, Cardiovascular, Renal and Metabolism Franchise, Novartis Pharma AG, Basel, Switzerland
- Correspondence: Raquel Lahoz Real World Evidence and Data Science, Cardio-Renal-Metabolic Franchise, Novartis Pharma AG, Asklepios 8-4, Basel, CH-4002, SwitzerlandTel +41 79 535 99 30 Email
| | - Clare Proudfoot
- Health Economics and Outcomes Research, Cardiovascular, Renal and Metabolism Franchise, Novartis Pharma AG, Basel, Switzerland
| | - Ana Filipa Fonseca
- Real World Evidence, Cardiovascular, Renal and Metabolism Franchise, Novartis Pharma AG, Basel, Switzerland
| | - Emil Loefroth
- Real World Evidence, Cardiovascular, Renal and Metabolism Franchise, Novartis Pharma AG, Basel, Switzerland
| | - Stefano Corda
- Global Medical Affairs, Cardiovascular, Renal and Metabolism Franchise, Novartis Pharma AG, Basel, Switzerland
| | - James Jackson
- Real World Research, Adelphi Real World, Bollington, UK
| | - Sarah Cotton
- Real World Research, Adelphi Real World, Bollington, UK
| | - Rachel Studer
- Real World Evidence, Cardiovascular, Renal and Metabolism Franchise, Novartis Pharma AG, Basel, Switzerland
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16
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Fonseca AF, Lahoz R, Proudfoot C, Corda S, Loefroth E, Jackson J, Cotton S, Studer R. Burden and Quality of Life Among Female and Male Patients with Heart Failure in Europe: A Real-World Cross-Sectional Study. Patient Prefer Adherence 2021; 15:1693-1706. [PMID: 34354345 PMCID: PMC8331086 DOI: 10.2147/ppa.s312200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/08/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To characterize symptoms, clinical burden, and health-related quality of life (HRQoL) among women and men with heart failure (HF) with a left ventricular ejection fraction (LVEF) of ≤60% in Europe. PATIENTS AND METHODS A real-world cross-sectional study was conducted in France, Germany, Italy, Spain, and United Kingdom from June to November 2019. Patient record forms were completed by 257 cardiologists and 158 general practitioners for consecutive patients with HF. The same patients were invited to complete a questionnaire comprising patient-reported outcomes: the Minnesota Living with Heart Failure Questionnaire (MLHFQ), five-level five-dimension EuroQol questionnaire (EQ-5D-5L), Visual Analogue Scale (VAS), and Work Productivity and Activity Impairment questionnaire. RESULTS The mean age of 804 patients (men, n=517; women, n=287) was 68.6 years (men, 67.8 years; women, 70.2 years; p=0.0022). The mean LVEF was 44.7% (men, 43.6%; women, 46.8%; p<0.0001). Patients reported dyspnoea when active (overall, 55.7%; men, 56.0%; women, 55.3%), fatigue/weakness/faintness (34.5%; men, 32.9%; women, 37.2%), and oedema (20.3%; men, 18.7%; women, 23.1%) as the most troublesome HF symptoms. Overall, 54.1% of patients reported low mood/depression (men, 50.8%; women, 60.1%). The overall MLHFQ mean score was higher (ie, poorer HRQoL) among women vs men (37.9 vs 34.6; p=0.0481). MLHFQ was consistently higher (ie, poorer HRQoL) for women vs men across the physical (18.6 vs 16.6; p=0.0041) and emotional (9.4 vs 7.9; p=0.0021) scoring domains. Mean EQ-5D utility (0.69 vs 0.75; p=0.0046) and VAS scores (55.4 vs 61.3; p<0.0001) were lower among women compared with men. Overall, 23.4% of patients were hospitalized owing to HF in the previous year (men, 22.7%; women, 24.6%). Patients reported 43.2% activity impairment due to HF (men, 41.6%; women, 46.4%; p=0.01). CONCLUSION HF causes a substantial burden on patients, with a greater burden among women vs men. This gender-related difference is consistent with other HF studies, warranting further research to understand the underlying reasons.
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Affiliation(s)
- Ana Filipa Fonseca
- Novartis Pharma AG, Basel, Switzerland
- Correspondence: Ana Filipa Fonseca Real World Evidence Group, Cardio-Renal-Metabolic Franchise, Novartis Pharma AG, Novartis Campus, Basel, CH-4002, Switzerland Tel: +41 (0) 793489979 Email
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Lahoz R, Heo J, Laguna A, Ding Y, Fonseca A, Amari D, Studer R. Patient characteristics and lipoprotein(A) [LP(A)] values among us patients with established CVD. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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18
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Sienes Bailo P, Lahoz R, Sánchez Marín JP, Izquierdo Álvarez S. Incidence of Huntington disease in a northeastern Spanish region: a 13-year retrospective study at tertiary care centre. BMC Med Genet 2020; 21:233. [PMID: 33228555 PMCID: PMC7684714 DOI: 10.1186/s12881-020-01174-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/12/2020] [Indexed: 11/15/2022]
Abstract
Background Despite the progress in the knowledge of Huntington disease (HD) in recent years, the epidemiology continues uncertain, so the study of incidence becomes relevant. This is important since various factors (type of population, diagnostic criteria, disease-modifying factors, etc.) make these data highly variable. Therefore, the genetic diagnosis of these patients is important, since it unequivocally allows the detection of new cases. Methods Descriptive retrospective study with 179 individuals. Incidence of HD was calculated from the ratio of number of symptomatic cases newly diagnosed per 100,000 inhabitants per year during the period 2007–2019 in Aragon (Spain). Results 50 (27.9%) incident cases of HD (CAG repeat length ≥ 36) were identified from a total of 179 persons studied. The remaining 129/179 (72.1%) were HD negative (CAG repeat length < 36). 29 (58.0%) females and 21 (42.0%) males were confirmed as HD cases. The overall incidence was 0.648 per 100,000 patient-years. 11/50 positive HD cases (22.0%) were identified by performing a predictive test, without clinical symptoms. The minimum number of CAG repeats found was 9 and the most common CAG length among HD negative individuals was 16. Conclusions Our incidence lied within the range reported for other Caucasian populations. Implementation of new techniques has allowed to determine the exact number of CAG repeats, which is especially important in patients with triplet expansions in an HD intermediate and/or incomplete penetrance allele, both in diagnostic, predictive and prenatal tests. Supplementary Information The online version contains supplementary material available at 10.1186/s12881-020-01174-z.
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Affiliation(s)
- Paula Sienes Bailo
- Departamento de Genética. Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet. C/ Padre Arrupe, s/n. Consultas Externas. Planta 3ª. 50009, Zaragoza, Spain
| | - Raquel Lahoz
- Departamento de Genética. Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet. C/ Padre Arrupe, s/n. Consultas Externas. Planta 3ª. 50009, Zaragoza, Spain.
| | - Juan Pelegrín Sánchez Marín
- Departamento de Genética. Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet. C/ Padre Arrupe, s/n. Consultas Externas. Planta 3ª. 50009, Zaragoza, Spain
| | - Silvia Izquierdo Álvarez
- Departamento de Genética. Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet. C/ Padre Arrupe, s/n. Consultas Externas. Planta 3ª. 50009, Zaragoza, Spain
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19
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Desai R, Mahesri M, Chin K, Lahoz R, Studer R, Vaduganathan M, Patorno E. Application of a Medicare claims-based model predicting left ventricular ejection fraction subtype to investigate the epidemiology of heart failure in the US Medicare program. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Administrative claims do not contain ejection fraction (EF) information for heart failure (HF) patients. To address this limitation, we recently developed a claims-based model to classify HF patients into reduced EF (rEF) or preserved EF (pEF) using 35 predictors.
Purpose
To report distribution of key patient characteristics and rates of HF decompensation and mortality in model-identified rEF and pEF patients from nationwide Medicare claims (2012–2016) and compare with estimates from the literature.
Methods
We identified HF patients ≥65 years from US Medicare claims using recorded diagnosis after ≥6 months of continuous enrollment. The date of HF diagnosis was the cohort entry date. The 6-month baseline period prior to the cohort entry date was used to identify predictors and apply the claims-based model to distinguish rEF and pEF. Patients were followed for the composite outcome of time to first HF decompensation (HF hospitalization or outpatient IV diuretic treatment) or all-cause mortality. Descriptive statistics were used to summarize baseline patient characteristics. Cumulative incidence estimates along with 95% confidence intervals (CI) were calculated for the composite endpoint as well as all-cause and cause-specific mortality (derived from National Death Index linkage) using the Kaplan-Meier method.
Results
A total of 3,134,414 HF patients with an average age of 79 years were identified, of which 200,950 (6.4%) were classified as rEF. Among those classified as rEF, men comprised a larger proportion (68% vs 41%), the average age was lower (76 vs 79 years), and history of myocardial infarction was more frequent (32% vs 13%) compared to pEF. One-year cumulative incidence (95% CI) of the composite endpoint was 42.6% (42.4–42.8%) for rEF and 36.9% (36.7–37.0%) for pEF. One-year all-cause mortality incidence was similar between the groups (27.4% [27.2–27.6%] for rEF and 26.4% [26.3–26.4%] for pEF), however, cardiovascular mortality was higher for rEF (16.7% [16.5–16.8%] vs 12.3% [12.2–12.3%]), whereas non-cardiovascular mortality was higher for pEF (12.9% [12.7–13.1%] vs 16.0% (16.0–16.1%) (Figure 1). These results were in line with estimates from other well-established cardiovascular cohorts including the Get With The Guidelines-HF cohort and the Olmstead County HF epidemiology cohort.
Conclusion
We replicated well-documented differences in key patient characteristics and endpoints between rEF and pEF in these populations identified based on application of a claims-based model. Our results support use of this model for identifying cohorts of rEF and pEF to conduct subtype specific investigations of treatment outcomes. However, a notably lower proportion of patients were identified as having rEF compared to previous reports indicating low sensitivity of this approach for rEF and suggesting that model-based classification may not be useful in tracking subtype specific incidence or prevalence of HF using Medicare claims.
Cumulative incidence of outcomes in HF
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Novartis Inc.
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Affiliation(s)
- R.J Desai
- Brigham and Women'S Hospital, Harvard Medical School, Medicine, Boston, United States of America
| | - M Mahesri
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - K Chin
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - R Lahoz
- Novartis Pharma AG, Basel, Switzerland
| | - R Studer
- Novartis Pharma AG, Basel, Switzerland
| | - M Vaduganathan
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - E Patorno
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
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20
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Lahoz R, Corda S, Proudfoot C, Fonseca A, Cotton S, Jackson J, Studer R. Caregiver burden of patients with heart failure with a left-ventricular ejection fraction (LVEF) less than or equal to 60%: a cross-sectional survey in the EU. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and purpose
The majority of patients with heart failure (HF) have difficulties in independently carrying out activities of daily living and hence, require support from caregivers (CGs). This study assessed the quality of life (QoL) of CGs of HF patients with sub-normal LVEF (≤60%).
Methods
A cross-sectional survey of HF patients and their CGs was conducted in France, Germany, Italy, Spain and the UK. Cardiologists and primary care physicians completed patient record forms (PRF) between June and November 2019. Caregivers of the same patients were invited to complete a caregiver self-completion survey, which included the Family Caregiver QoL Scale (FAMQOL) and EQ-5D. Patient demographics were derived from PRFs.
Results
361 CGs (73.1% female, mean age: 58.8 yrs) and HF patients (39.9% female, mean age: 71.2 yrs) were included. 58.2% of the CGs were spouses, 23.4% a child of the patient. On average, CGs devoted 20 hrs/week in the care of HF patients; this CG time increased from 12 to 26 hrs/week with NYHA class I to III/IV of the HF patient. Further, anxiety/stress was experienced overall by 29/31% of CGs which increased from 27/17% for NYHA I to 40/41% for NYHA III/IV of the HF patient (Table 1).
Conclusions
Caregivers of patients with HF and LVEF ≤60% spend a significant amount of time to provide daily support to HF patients. Patients with progressive disease were older, more polymorbid and had a higher disease duration. These factors likely contributed towards increased caregiver burden of HF patients with increased NYHA class.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Novartis Pharma AG
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Affiliation(s)
- R Lahoz
- Novartis Pharma AG, Basel, Switzerland
| | - S Corda
- Novartis Pharma AG, Basel, Switzerland
| | | | | | - S Cotton
- Adelphi Real World, Bollington, United Kingdom
| | - J Jackson
- Adelphi Real World, Bollington, United Kingdom
| | - R Studer
- Adelphi Real World, Bollington, United Kingdom
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21
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Lahoz R, Studer R, Farries G, Proudfoot C, Suminska S, Watkin A, Fagan A, Corda S, Houchen E, Mather P. A real-world assessment of the burden associated with hospitalizations in US patients with heart failure and left ventricular ejection fraction (LVEF) greater than 40%. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background and purpose
Heart failure (HF) is one of the leading causes of hospitalization among older adults and is associated with a large burden of disease for the individual, the patient's family, healthcare systems, and society. This study assessed the burden of hospitalizations in patients with HF with LVEF >40% in the United States (US).
Methods
This retrospective, non-interventional study identified adult patients with incident or prevalent HF in Optum® de-identified Electronic Health Record (EHR) dataset (2007–2018) between 01/01/2013 and 31/12/2017. Optum's longitudinal EHR repository is derived from dozens of healthcare provider organizations in the US, that include more than 700 Hospitals and 7000 Clinics; treating >95 million patients receiving care in the US. Patients were followed for up to 1 year or until last active date whichever occurred first. Comorbidities, all-cause hospitalizations (AcH) and primary cause HF hospitalizations (HFH) were analysed.
Results
120,606 patients with HF and LVEF >40% (54% female) with a mean (SD) age of 71 (13) yrs were included, representing 80,324.74 patient-yrs follow-up (days). Common comorbidities were hypertension (91.8%), ischemic heart disease (IHD, 71.4%), atrial fibrillation (AF, 54.8%), renal disease (54.1%), type 2 diabetes (T2D, 50.7%), obesity (44.6%) and anemia (39%). Comorbidities including IHD (72.9% vs. 68.4%), AF (56.4% vs. 51.6%) and T2D (51.1% vs. 49.9%) were more often recorded in patients with LVEF >40-≤60% than >60% cohort while hypertension (91.6% vs. 92.2%), renal disease (53.8% vs. 54.6%), obesity (43.9% vs. 46.1%) and anemia (38.1% vs. 40.9%) had significantly higher frequency in the LVEF >60% cohort. The annualized AcH rate for patients with LVEF>40% was 1.44 and annualized HFH rate was 0.24 with a median length of stay of 3 and 4 days, respectively. Annualized hospitalization rates were significantly higher for women than men (both AcH and HFH). AcH rates were significantly higher and HFH rates were significantly lower for patients with LVEF>60% compared with LVEF >40-≤60.
Conclusions
This study demonstrates that patients with HF and LVEF >40% experience significant burden from comorbidities and hospitalizations from any-cause and for HF. The hospitalization rates are higher in women (both AcH and HFH) or patients with LVEF >60% (AcH only). Further focus on reduction of hospitalizations and interdisciplinary management of patients with HF should be warranted.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Novartis Pharma AG
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Affiliation(s)
- R Lahoz
- Novartis Pharma AG, Basel, Switzerland
| | - R Studer
- Novartis Pharma AG, Basel, Switzerland
| | - G Farries
- Novartis Ireland Limited, Dublin, Ireland
| | | | - S Suminska
- Novartis Ireland Limited, Dublin, Ireland
| | - A Watkin
- Novartis Ireland Limited, Dublin, Ireland
| | - A Fagan
- Novartis Ireland Limited, Dublin, Ireland
| | - S Corda
- Novartis Pharma AG, Basel, Switzerland
| | - E Houchen
- Novartis Ireland Limited, Dublin, Ireland
| | - P.J Mather
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, United States of America
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22
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Proudfoot C, Fonseca A, Lahoz R, Corda S, Cotton S, Jackson J, Studer R. Patients with heart failure and a LVEF less than 40% present an overall lower health related quality of life than those with LVEF between 40% and 60%: a multinational real-world survey in EU. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0974] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and purpose
Heart Failure (HF) is associated with symptoms such as dyspnoea and fatigue which can impact patients' health related quality of life (HRQoL). This study aimed to characterize and assess the HRQoL of patients with HF and left-ventricular ejection fraction (LVEF) <40% versus those with ≥40%-60%.
Methods
A cross-sectional study of patients with HF was conducted in France, Germany, Italy, Spain and United Kingdom. Patient record forms (PRFs) were completed by 257 cardiologists and 158 general practitioners (GPs) for consecutively consulting patients. The same patients were invited to provide patient-reported outcomes including self-completion questionnaires, Minnesota Living with Heart Failure Questionnaire (MLHFQ) and EQ-5D-5L VAS.
Results
204 HF patients with LVEF <40% (mean age 67.7 years) and 600 patients with LVEF ≥40–60% (mean age 68.9 years) were included. Proportion of males was significantly higher in the lower LVEF group (73.5% vs. 61.2%, p=0.0017). Overall, the patients with lower LVEF more frequently presented with comorbidities than those with LVEF ≥40–60% (p<0.05, Figure 1). NYHA stage III/IV (35.8%/7.4% vs. 15.3%/0.8%) as well as self-reported HF symptoms were more frequently reported in the lower LVEF group (p<0.05, Figure 1). Similarly, patients with LVEF <40% reported statistically significantly worse HRQoL compared to those with LVEF ≥40–60% (Table 1).
Conclusions
The HRQoL of all HF patients with LVEF ≤60% appears impacted, while those with LVEF <40% had significantly worse HRQoL than those with LVEF ≥40–60%. These differences in HRQoL may not only be related to the LVEF but also to the overall characteristics of these patients. Addressing the HRQoL burden for patients should be a key aspect of HF management strategies for all HF patients.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Novartis Pharma AG
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Affiliation(s)
| | | | - R Lahoz
- Novartis Pharma AG, Basel, Switzerland
| | - S Corda
- Novartis Pharma AG, Basel, Switzerland
| | - S Cotton
- Adelphi Real World, Bollington, United Kingdom
| | - J Jackson
- Adelphi Real World, Bollington, United Kingdom
| | - R Studer
- Novartis Pharma AG, Basel, Switzerland
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23
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Fonseca A, Lahoz R, Ferber P, Laguna A, Amari D, Heo J, Ding Y, Studer R. A real-world assessment of the distribution of lipid levels across increasing lipoprotein(a) levels in patients with established cardiovascular disease in the United States. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and purpose
Measurements of lipid levels are frequently used to assess the risk of developing cardiovascular disease (CVD), including future myocardium infarction (MI) and ischemic stroke. Lipoprotein(a) [Lp(a)] has been established as an independent risk factor for developing CVD, however it is not widely measured. This real-world study assessed the distribution of lipid (Total Cholesterol [TC], low-density cholesterol [LDL-C], high-density cholesterol [HDL-C] and Triglycerides [TGs]) levels across different Lp(a) strata of patients with established CVD and at least one Lp(a) assessment.
Methods
This was a descriptive, non-interventional, retrospective cohort study of patients with established CVD and at least one Lp(a) assessment in the Optum® de-identified Electronic Health Record dataset (2007–2019). The index date was defined as the date of the first established CVD (MI, ischemic stroke or peripheral artery disease diagnosis) in the identification period (1/1/2008–30/6/2018) following one-year continuous enrollment. Patients were followed for up to one year, until death or transfer out of the dataset, whichever occurred first.
Results
5,434 patients (55.5% males) with established CVD and at least one Lp(a) assessment having a mean (SD) age of 62.5 (12.6) years were evaluated. During the 12 months pre-index period, 49.9%, 46.1%, 48.1% and 49.8% of these patients had a measurement of TC, LDL-C, HDL-C and TGs, respectively. Overall, the mean (SD) TC, LDL-C, HDL-C and TGs levels were 182.1 (47.0) mg/dL [n=2,712], 102.6 (40.1) mg/dL [n=2,503], 52.7 (16.7) mg/dL [n=2,614], and 140.3 (108.8) mg/dL [n=2,707], respectively. More than half of these patients were treated with at least one lipid lowering drug (includes statins, ezetimibe, fibrates, niacin or PCSK9is) during the pre-index period. The mean (SD) levels of TC, LDL-C, HDL-C and TG in patients with Lp(a) <30 mg/dL, 30–50] mg/dL, 50–70 mg/dL, 70–90 mg/dL and ≥90 mg/dL are presented in Figure 1.
Conclusions
Overall, no trends in the levels of total cholesterol, LDL-C, HDL-C or triglycerides were observed across increasing levels of lipoprotein(a). These findings suggest the measurement of lipoprotein(a) is required to ensure a complete characterization of a patient lipid profile.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Novartis Pharma AG
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Affiliation(s)
| | - R Lahoz
- Novartis Pharma AG, Basel, Switzerland
| | - P Ferber
- Novartis Pharma AG, Basel, Switzerland
| | - A Laguna
- Novartis Pharma AG, Basel, Switzerland
| | - D.T Amari
- Novartis Pharmaceuticals Corporation, East Hanover, United States of America
| | - J.H Heo
- Novartis Pharmaceuticals Corporation, East Hanover, United States of America
| | - Y Ding
- Novartis Pharmaceuticals Corporation, East Hanover, United States of America
| | - R Studer
- Novartis Pharma AG, Basel, Switzerland
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24
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Laguna A, Lahoz R, Fonseca A, Amari D, Ferber P, Heo J, Ding Y, Studer R. Characteristics of patients with at least one lipoprotein(a) [Lp(a)] assessment and those with Lp(a) levels equal to or greater than 70 mg/dL: a real-world study in the US. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and purpose
Elevated lipoprotein(a) [Lp(a)] has been associated with increased risk of cardiovascular disease (CVD). The objective of this real-world study was to characterize the patients in the United States (US) that have an Lp(a) assessment and those with Lp(a) levels ≥70 mg/dL.
Methods
This is a descriptive, non-interventional, retrospective cohort study of patients with at least one Lp(a) assessment and one-year continuous enrollment prior to index date (first Lp(a) assessment in the identification period i.e. 1/1/2008–30/6/2019) using the Optum® de-identified Electronic Health Record (EHR) dataset (2007–2019) in the US. Optum's longitudinal EHR repository include more than 700 Hospitals and 7000 Clinics; treating more than 95 million patients receiving care in the US.
Results
26,997 patients (50.8% females) with ≥1 Lp(a) assessment having a mean (SD) age of 52.6 (14.1) years were evaluated. Patient distribution across Lp(a) levels ≥30, ≥50, ≥70, and ≥90 mg/dL were 32.4%, 20.2%, 12.3%, and 6.6%, respectively. Patients with Lp(a) ≥70 mg/dL (N=3,314) had a mean (SD) age of 54.7 (13.2) years and 55.2% were female. The overall population that gets tested for Lp(a) and the subgroup of patients with Lp(a) ≥70 mg/dL had prior myocardial infarction (4.8% and 6.2%), prior ischemic stroke (2.2% and 2.5%), peripheral artery disease (6.7% and 8.4%), dyslipidaemia (72.6% and 80.9%), hypertension (53.0% and 60.9%), diabetes mellitus (23.5% and 26.8%) and chronic ischemic heart disease (19.6% and 24.6%) at index. The use of baseline medications included statins (37.3% and 49.1%), ACEi/ARBs (28.2% and 34.0%) and beta-blockers (19.0% and 23.6%) for the overall population and those patients with Lp(a) ≥70 mg/dL, respectively.
The mean (SD) low-density lipoprotein cholesterol, triglycerides and total cholesterol levels were 109.8 (39.8) mg/dL [n=7,371], 138.3 (119.3) mg/dL [n=8,179] and 190.5 (46.8) mg/dL [n=8,181], respectively for overall population and 114.8 (41.5) mg/dL [n=980], 129.6 (80.5) mg/dL [n=1,063] and 195.9 (47.6) mg/dL [n=1,056] for patients with Lp(a) ≥70 mg/dL.
Conclusions
Of patients with an Lp(a) assessment in the US, more than 10% had Lp(a) levels ≥70 mg/dL. These patients were frequently diagnosed with dyslipidaemia and when reported showed elevated LDL-C and total cholesterol values. Further analyses are required to better understand any differences in patient characteristics and treatment of patients across Lp(a) levels.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Novartis Pharma AG
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Affiliation(s)
- A Laguna
- Novartis Pharma AG, Basel, Switzerland
| | - R Lahoz
- Novartis Pharma AG, Basel, Switzerland
| | | | - D.T Amari
- Novartis Pharmaceuticals Corporation, East Hanover, United States of America
| | - P Ferber
- Novartis Pharma AG, Basel, Switzerland
| | - J.H Heo
- Novartis Pharmaceuticals Corporation, East Hanover, United States of America
| | - Y Ding
- Novartis Pharmaceuticals Corporation, East Hanover, United States of America
| | - R Studer
- Novartis Pharma AG, Basel, Switzerland
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25
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Lahoz R, Fagan A, McSharry M, Proudfoot C, Corda S, Studer R. Recurrent heart failure hospitalizations are associated with increased cardiovascular mortality in patients with heart failure in Clinical Practice Research Datalink. ESC Heart Fail 2020; 7:1688-1699. [PMID: 32383551 PMCID: PMC7373936 DOI: 10.1002/ehf2.12727] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/12/2020] [Accepted: 04/03/2020] [Indexed: 12/28/2022] Open
Abstract
Aims Heart failure (HF) is a leading cause of hospitalization and is associated with high morbidity and mortality post‐diagnosis. Here, we examined the impact of recurrent HF hospitalization (HFH) on cardiovascular (CV) and all‐cause mortality among HF patients. Methods and Results Adult HF patients identified in the Clinical Practice Research Datalink with a first (index) hospitalization due to HF recorded in the Hospital Episode Statistics data set from January 2010 to December 2014 were included. Patients were followed up until death or end of study (December 2017). CV mortality as primary and as any reported cause and all‐cause mortality were evaluated. An extended Cox regression model was used for reporting adjusted relative CV mortality rates for time‐dependent recurrent HFHs. Overall, 8603 HF patients with an index hospitalization were included, providing 15 964 patient‐years of follow‐up. Patients were relatively old (median age: 80 years) and were mostly male (54.6%), with main co‐morbidities being hypertension and atrial fibrillation. Recurrent HFHs occurred one, two, three, and more than four times in 1561 (18.2%), 518 (6.02%), 206 (2.4%), and 153 (1.8%) patients, respectively. The median time to mortality was 215 (38–664) days for 50.8% of patients who died for any cause during the study period and 139 (27–531) days for 31.3% who died with CV reasons as primary cause. Compared with those of patients without recurrent HFHs, the adjusted hazard ratios (95% CI) for CV mortality as primary cause were 2.65 (2.35–2.99), 3.69 (3.06–4.43), 5.82 (4.48–7.58), and 5.95 (4.40–8.05) for those with one, two, three, and more than four recurrent HFHs. Conclusions There is a strong association between recurrent HFH and CV mortality, with the risk increasing progressively with each recurrent HFH.
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26
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Ziemssen T, Tolley C, Bennett B, Kilgariff S, Jones E, Pike J, Tomic D, Piani-Meier D, Lahoz R. A mixed methods approach towards understanding key disease characteristics associated with the progression from RRMS to SPMS: Physicians' and patients' views. Mult Scler Relat Disord 2019; 38:101861. [PMID: 31865132 DOI: 10.1016/j.msard.2019.101861] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 10/16/2019] [Accepted: 11/16/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The transition from relapsing-remitting multiple sclerosis (RRMS) to secondary progressive multiple sclerosis (SPMS) evolves over time and it can be challenging for physicians to identify progression early. Typically, SPMS is diagnosed retrospectively with a significant delay, based on a history of gradual worsening, independent of relapses, following an initial relapsing-remitting disease course. As such, SPMS is often associated with a considerable period of diagnostic uncertainty. This study aimed to explore and characterize key symptoms and impacts associated with transitioning from RRMS to SPMS and inform the content for a tool to support evaluation of early subtle signs suggestive of progressive disease. METHODS The qualitative study involved 60-min, face-to-face, concept elicitation (CE) interviews with 32 patients with MS (US = 16 and Germany = 16); and 30-min, telephone, CE interviews with 16 neurologists (US = 8 and Germany = 8). Multivariate analysis on data from a real-world observational study of 3294 MS patients assessed the differences between early-RRMS and early-SPMS, and identified factors that were significant drivers of this difference. These studies informed selection of the key variables to be included in a pilot tool. Sixteen physicians used the pilot tool, presented as a paper questionnaire, with a sample of patients whom they suspected were progressing to SPMS (n ≥ 5). Following this, the physicians participated in a 30-min cognitive debriefing (CD) interview to evaluate the relevance and usefulness of the tool. Qualitative analysis of all anonymized, verbatim transcripts was performed using thematic analysis. RESULTS Patients and physicians reported signs that indicated progression to SPMS including gradual worsening of symptoms, lack of clear recovery, increased severity and presence of new symptoms. No specific symptoms definitively indicated progression to SPMS, however a number of potential symptoms associated with progression were identified by SPMS patients and physicians, including worsening ambulation, cognition, balance, muscle weakness, visual symptoms, bladder symptoms and fatigue. Quality of life domains reported to be more severely impacted in SPMS than MS in general included: physical activity, work, daily activities, emotional and social functioning. Multivariate analysis of the observational study data identified several variables strongly associated with progression to SPMS including, requirement of assistance in daily living, presence of motor symptoms, presence of ataxia/coordination symptoms, and unemployment. Physicians reported that items included in the tool were easy to understand and relevant. Physicians also reported that there is an unmet need for a tool to help identify signs of SPMS progression and so the tool would be useful in clinical practice. CONCLUSIONS This was the first stage of development of a novel, validated, physician-completed tool to support physician-patient interactions in evaluating signs indicative of disease progression to SPMS. Qualitative and quantitative methods (involving physician and patients) were used to determine tool content. The usefulness and unmet need for such a tool in clinical practice was confirmed via CD interviews with physicians. Further work is now warranted to develop a scoring algorithm and validate the tool so that it can be reliably implemented in clinical practice.
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Affiliation(s)
- Tjalf Ziemssen
- Center of Clinical Neuroscience, MS Center, University Clinic Carl Gustav Carus, TU Dresden, Germany.
| | - Chloe Tolley
- Adelphi Values Ltd, Bollington, Cheshire, United Kingdom
| | - Bryan Bennett
- Adelphi Values Ltd, Bollington, Cheshire, United Kingdom
| | | | - Eddie Jones
- Adelphi Real World, Bollington, Cheshire, United Kingdom
| | - James Pike
- Adelphi Real World, Bollington, Cheshire, United Kingdom
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27
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Lahoz R, Fagan A, McSharry M, Proudfoot C, Corda S, Studer R. 3267Impact of recurrent heart failure hospitalizations on cardiovascular mortality in subpopulations with atrial fibrillation and Type 2 diabetes mellitus in a UK database. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Previous studies have suggested that recurrent heart failure hospitalizations (HFh) are a predictor of cardiovascular (CV) and all-cause mortality. Patients with atrial fibrillation (AF) or type 2 diabetes mellitus (T2DM) may be at increased risk.
Purpose
This real-world study examined the impact of recurrent HFh on CV mortality in subgroups of patients with (i) AF or (ii) T2DM in the UK.
Methods
Adult HF patients identified in the CPRD database with a first (index) hospitalization due to HF recorded in the HES dataset from 01/01/2010 to 31/12/2014 and with a claim for AF or T2DM (not mutually exclusive) within the year prior to the index hospitalization were included. Patients were followed until death, transfer out or end of study period (31/12/2017). CV death as primary cause and death due to any cause were evaluated. An extended Cox regression model was used for reporting adjusted relative CV mortality rates for time dependent recurrent HFh.
Results
4585 (53.30%) HF patients with AF and 2344 (27.25%) HF patients with T2DM were included, providing 7846 and 4269 patient-years follow-up, respectively. Patients were relatively old (median [IQR] age of 81 [74–87] and 78 [70–84]) and majority were male (54.2% and 59.1%, respectively). All-cause and CV mortality rates are provided in the table. Compared with those without recurrent HFh, the adjusted hazard ratios (95% CI) for CV death for the AF group were 2.6 (2.3–3.1), 3.2 (2.5–4.1), 5.8 (4.1–8.1) and 6.9 (4.6–10.5) for 1, 2, 3 and ≥4 recurrent HFh, and for the T2DM group were 2.2 (1.7–2.8), 3.3 (2.3–4.7), 5.1 (3.3–8.1) and 3.9 (2.3–6.6), respectively.
All-cause and CV mortality rates 0 Recurrent HFh 1 Recurrent HFh 2 Recurrent HFh 3 Recurrent HFh 4+ Recurrent HFh All patients AF n=3294 (71.8%) n=817 (17.8%) n=282 (6.2%) n=116 (2.5%) n=76 (1.2%) n=4585 (100.0%) Follow-up time (days) from respective recurrent HF hospitalization (median [IQR]) 345 [57–906] 118 [27–522] 80 [19–367] 54 [19–240] 126 [50–379] 254 [42–793] All-cause death (n (%)) 1755 (53.3%) 483 (59.1%) 159 (56.4%) 80 (69.0%) 46 (60.5%) 2523 (55.0%) CV death- primary cause (n (%)) 1059 (32.2%) 325 (39.8%) 109 (38.7%) 56 (48.3%) 34 (44.7%) 1583 (34.5%) T2DM n=1573 (67.1%) n=456 (19.5%) n=170 (7.3%) n=85 (3.6%) n=60 (2.6%) n=2344 (100.0%) Follow-up time (days) from respective recurrent HF hospitalization (median [IQR]) 360 [63–933] 198 [43–545] 68 [17–292] 106 [26–251] 160 [68–389] 267 [49–771] All-cause death (n (%)) 824 (52.4%) 248 (54.4%) 99 (58.2%) 51 (60.0%) 40 (66.7%) 1262 (53.8%) CV death – primary cause (n (%)) 501 (31.9%) 159 (34.9%) 69 (40.6%) 36 (42.4%) 26 (43.3%) 791 (33.8%)
Conclusion
Recurrent HFh are a strong predictor of CV death in the HF population with AF or with T2DM. The risk of CV and all-cause death increases with recurrent HFh in these subpopulations, highlighting the relevance of reducing hospitalizations in the management of HF patients with such comorbid conditions.
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Affiliation(s)
- R Lahoz
- Novartis Pharma AG, Basel, Switzerland
| | - A Fagan
- Novartis Ireland Limited, Dublin, Ireland
| | - M McSharry
- Novartis Ireland Limited, Dublin, Ireland
| | | | - S Corda
- Novartis Pharma AG, Basel, Switzerland
| | - R Studer
- Novartis Pharma AG, Basel, Switzerland
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28
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Wang X, Lahoz R, Jawla S, Przybysz R, Kahler KH, Burdukova L, Venkata SK, Nassim M, Jalapu A, Justo N. Identification and mapping of worldwide sources of generic real-world data. Pharmacoepidemiol Drug Saf 2019; 28:899-905. [PMID: 31062446 DOI: 10.1002/pds.4782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 11/10/2022]
Abstract
PURPOSE The demand for real-world data as supportive evidence to traditional clinical studies has increased in the past few years. The present study aimed to identify worldwide generic sources of real-world data and to assess completeness and suitability of selected real-world evidence (RWE) data sources to conduct prespecified research. METHODS A systematic literature review was conducted to identify generic (non-disease specific) sources of real-world data in Medline and Embase from January 1, 2010 to September 8, 2015. Data sources used in observational studies were identified and summarized based on their geographical distribution and the type of data. In the next step, the selected data sources were critically evaluated for their completeness. RESULTS A total of 10,069 identified publications were screened, leading to 2635 unique data sources across 102 countries. Europe had the maximum number of data sources (n = 1163) followed by United States (n = 578), and Asia, Middle East, and African Countries (n = 374). The most common type of identified data sources across all countries was structured data sources, ie, administrative databases and registries. Of the identified data sources, 300 were selected for further investigation. From the selected databases, ~50% had confirmed information on over 60% of the investigated variables, ~61% were suitable for epidemiological research, and 60% had possibility of linkage. CONCLUSIONS The present study applied a systematic literature review approach and identified available generic sources of real-world data worldwide, in addition to the United States and Europe, which are suitable for conducting pre-defined researches and support future RWE studies.
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Affiliation(s)
- Xuan Wang
- Commercialisation & Outcomes, ICON plc, Stockholm, Sweden
| | - Raquel Lahoz
- Real World Evidence & Digital, Novartis Pharma AG, Basel, Switzerland
| | - Shantanu Jawla
- Patient Access Services, Novartis Healthcare Private Limited, Hyderabad, Telangana, India
| | - Raymond Przybysz
- Real World Evidence & Digital, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Kristijan H Kahler
- Real World Evidence & Digital, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Lisa Burdukova
- Commercialisation & Outcomes, ICON plc, Stockholm, Sweden
| | - Shiva Kumar Venkata
- Patient Access Services, Novartis Healthcare Private Limited, Hyderabad, Telangana, India
| | - Maria Nassim
- Commercialisation & Outcomes, ICON plc, Stockholm, Sweden
| | - Anil Jalapu
- Patient Access Services, Novartis Healthcare Private Limited, Hyderabad, Telangana, India
| | - Nahila Justo
- Commercialisation & Outcomes, ICON plc, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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Jackson JD, Cotton SE, Bruce Wirta S, Proenca CC, Zhang M, Lahoz R, Balas B, Calado FJ. Care pathways and treatment patterns for patients with heart failure in China: results from a cross-sectional survey. Drug Des Devel Ther 2018; 12:2311-2321. [PMID: 30100706 PMCID: PMC6067623 DOI: 10.2147/dddt.s166277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Purpose The objective of this study was to describe the clinical care pathways, management and treatment patterns, and hospitalizations for patients with heart failure (HF) in China. Subjects and methods A cross-sectional survey of cardiologists and their patients with HF was conducted. Patient record forms were completed by 150 cardiologists for 10 consecutive patients. Patients for whom a patient record form was completed were invited to complete a patient self-completion questionnaire. Results Most of the 1,500 patients (mean [SD] age 66 [10] years; 55% male) included in the study received care in tier-2 and -3 hospitals in large cities. Cardiologists were responsible for initial consultation, diagnosis, and treatment of patients with HF. The use of guideline-recommended diagnostics was high. However, guideline-recommended double- and triple-combination therapy was received by only 51% and 18% of patients, respectively. In total, 20% of patients with HF reported that they were not consulted on the choice of therapy. Concordance was high (≥80%) between matched cardiologist and patient pairs for the occurrence of side effects, while cardiologists more often under- than overreported the occurrence of side effects of treatment reported by patients. Conclusion The management of HF was predominantly overseen by cardiologists. The use of diagnostic tests was high, but the use of guideline-recommended treatment was low in this population. Improved communication between patients and cardiologists is essential to optimize treatment decision making and to increase awareness of treatment side effects.
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Affiliation(s)
| | - Sarah E Cotton
- Real World Research, Adelphi Real World, Bollington, UK,
| | - Sara Bruce Wirta
- Real World Evidence, Cardio-Metabolic Franchise, Novartis Sweden AB, Stockholm, Sweden
| | | | - Milun Zhang
- Health Economics and Outcomes Research, Novartis Pharma China, Beijing, China
| | - Raquel Lahoz
- Medical Affairs, Cardio-Metabolic Franchise, Novartis Pharma AG, Basel, Switzerland
| | - Bogdan Balas
- Medical Affairs, Cardio-Metabolic Franchise, Novartis Pharma AG, Basel, Switzerland
| | - Frederico J Calado
- Medical Affairs, Cardio-Metabolic Franchise, Novartis Pharma AG, Basel, Switzerland
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Jackson JDS, Cotton SE, Bruce Wirta S, Proenca CC, Zhang M, Lahoz R, Calado FJ. Burden of heart failure on patients from China: results from a cross-sectional survey. Drug Des Devel Ther 2018; 12:1659-1668. [PMID: 29922040 PMCID: PMC5996854 DOI: 10.2147/dddt.s148949] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Little evidence exists on the burden that chronic heart failure (HF) poses specifically to patients in China. The objective of this study, therefore, was to describe the burden of HF on patients in China. MATERIALS AND METHODS A cross-sectional survey of cardiologists and their patients with HF was conducted. Patient record forms were completed by 150 cardiologists for 10 consecutive patients. Patients for whom a patient record form was completed were invited to complete a patient questionnaire. RESULTS Most of the 933 patients (mean [SD] age 65.8 [10.2] years; 55% male; 80% retired) included in the study received care in tier 2 and 3 hospitals in large cities. Patients gave a median score of 4 on a scale from 1 (no disruption) to 10 (severe disruption) to describe how much HF disrupts their everyday life. Patients in paid employment (8%) missed 10% of work time and experienced 29% impairment in their ability to work due to HF in the previous week. All aspects of patients' health-related quality of life (QoL) were negatively affected by their condition. Mean ± SD utility calculated by the 3-level 5-dimension EuroQol questionnaire was 0.8±0.2, and patients rated their health at 70.3 (11.5) on a 100 mm visual analog scale. Patients incurred costs associated with HF treatment, travel, and professional caregiving services. CONCLUSION HF is associated with poor health-related QoL and considerable disruption in patients' lives. Novel and improved therapies are needed to reduce the burden of HF on patients and the health care system.
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Affiliation(s)
| | | | - Sara Bruce Wirta
- Real World Evidence, Cardio-Metabolics Franchise, Novartis Sweden AB, Stockholm, Sweden
| | | | - Milun Zhang
- Health Economics and Outcomes Research and Access Strategy, Novartis Pharma China, Beijing, China
| | - Raquel Lahoz
- Real World Evidence, Cardio-Metabolics Franchise, Novartis Pharma AG, Basel, Switzerland
| | - Frederico J Calado
- Real World Evidence, Cardio-Metabolics Franchise, Novartis Pharma AG, Basel, Switzerland
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Jackson JDS, Cotton SE, Bruce Wirta S, Proenca CC, Zhang M, Lahoz R, Calado FJ. Burden of heart failure on caregivers in China: results from a cross-sectional survey. Drug Des Devel Ther 2018; 12:1669-1678. [PMID: 29922041 PMCID: PMC5996855 DOI: 10.2147/dddt.s148970] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Family and friends play a pivotal role in caring for patients with heart failure (HF); however, evidence of the impact of caregiving is limited. The objectives of this study were to describe the burden of caregiving on informal caregivers of patients with chronic HF in China. MATERIALS AND METHODS A cross-sectional survey of cardiologists, their patients with HF, and those patients' caregivers was conducted. Patient record forms were completed by 150 cardiologists for 10 consecutive patients. Caregivers of these patients were invited to complete a questionnaire. RESULTS Overall, 458 caregivers completed a questionnaire (mean ± standard deviation age 60.1±10.6 years; 60% female; 77% spouses; 74% retired). Caregivers spent a mean of 24.5 (16.9) hours caregiving per week, and a third reported a reduction in their social activity, time for themselves, or time for family. Caregivers in employment took several days off work in the past 3 months owing to caregiving, sometimes resulting in reduced income. Up to 79% of caregivers reported an impact on their physical or emotional well-being, and 57% reported deterioration in their objective health status. Inconsistencies stemming from differences in the three-level five-dimension EuroQol questionnaire and HF Caregiver Questionnaire were observed for the impact of caregiving on caregivers' health-related quality of life. CONCLUSION Assisting patients with HF is associated with caregiver burden. Addressing the needs of caregivers may help to promote their continued support and improve patient outcomes.
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Affiliation(s)
- James DS Jackson
- Real World Research, Adelphi Real World, Bollington, Cheshire, UK
| | - Sarah E Cotton
- Real World Research, Adelphi Real World, Bollington, Cheshire, UK
| | - Sara Bruce Wirta
- Real World Evidence Center of Excellence, Novartis Sweden AB, Stockholm, Sweden
| | | | - Milun Zhang
- Health Economics and Outcomes Research & Access Strategy, Novartis Pharma China, Beijing, China
| | - Raquel Lahoz
- Real World Evidence Center of Excellence, Novartis Pharma AG, Basel, Switzerland
| | - Frederico J Calado
- Real World Evidence Center of Excellence, Novartis Pharma AG, Basel, Switzerland
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Calmarza P, Lapresta C, Martínez M, Lahoz R, Povar J. Utility of myeloperoxidase in the differential diagnosis of acute coronary syndrome. Arch Cardiol Mex 2017; 88:391-396. [PMID: 29233491 DOI: 10.1016/j.acmx.2017.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/31/2017] [Accepted: 11/06/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES To determine the usefulness of myeloperoxidase in discriminating between patients with acute coronary syndrome and patients with chest pain by other causes. METHODS The study included all patients over 18 years of age who come consecutively to the emergency department from September 2015 to December 2015 with chest pain of non-traumatic origin. The initial patient evaluation was performed according to the study protocol for patients with suspected acute coronary syndrome (ACS) in our Emergency Department. This included the serial measurement of troponin, and in this case myeloperoxidase, with serialization on admission and at 6h. For the determination of myeloperoxidase (MPO), a single step sandwich enzyme immunoassay by Siemens, automated on a Dimension analyser, was used. RESULTS Statistically significant differences were observed in the concentration of myeloperoxidase at time 0 among patients diagnosed with ACS: 505 (413)pmol/L, and non-ACS patients: 388 (195)pmol/L (p<.001), as well as at 6h (p<.001). An area under the curve ROC of 0.824 was obtained at 6h for ACS patients, with a confidence interval of 95% from 0.715 to 0.933 and a level of significance of p<.001. Statistically significant differences were also found in the concentration of myeloperoxidase at time 0 and at 6h among patients with ACS and patients with heart disease other than coronary artery disease. CONCLUSIONS The concentration of MPO helps to differentiate between ACS and non-ACS patients, as well as between ACS patients and patients with heart diseases other than coronary artery disease.
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Affiliation(s)
- Pilar Calmarza
- Department of Clinical Biochemistry, Universitary Hospital Miguel Servet, Zaragoza, Spain.
| | - Carlos Lapresta
- Department of Preventive Medicine, Barbastro Hospital, Huesca, Spain
| | - María Martínez
- Department of Endocrinology, University Hospital Miguel Servet, Zaragoza, Spain
| | - Raquel Lahoz
- Department of Clinical Biochemistry, Universitary Hospital Miguel Servet, Zaragoza, Spain
| | - Javier Povar
- Department of Urgences, University Hospital Miguel Servet, Zaragoza, Spain
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Störk S, Handrock R, Jacob J, Walker J, Calado F, Lahoz R, Hupfer S, Klebs S. Epidemiology of heart failure in Germany: a retrospective database study. Clin Res Cardiol 2017; 106:913-922. [PMID: 28748265 PMCID: PMC5655572 DOI: 10.1007/s00392-017-1137-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/17/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chronic heart failure (HF) is associated with significant healthcare expenditure, morbidity, and mortality. This study investigated the epidemiology of HF in Germany. METHODS This retrospective study used anonymous healthcare claims data from the German Health Risk Institute on individuals with statutory health insurance. Patients with uninterrupted data from 1 January 2009 to 31 December 2013 or death (whichever occurred first), and ≥2 recorded HF-related diagnoses in 2011, were included. Patients with newly diagnosed HF were identified. Patients were followed up for 2 years from first diagnosis. RESULTS Of 3,132,337 eligible patients, 123,925 (55.0% women; mean age 76.2 years) had HF: a prevalence of 3.96%. Of these, 26,368 had newly diagnosed HF: an incidence of 655/100,000 persons at risk. Incidence increased with age and was similar regardless of sex. During follow-up, there were 48,159 hospital admissions among newly diagnosed patients (1.8 hospitalizations/patient/2 years); HF accounted for 6% of these. Additionally, 20,148 patients (16.3%) overall and 5983 newly diagnosed patients (22.7%) died. Most new cases of HF were diagnosed by office-based physicians (63.2%); new cases among hospital inpatients were predominantly diagnosed by internal medicine specialists (70.7%). Overall, 94.0% received their initial prescription for HF treatment from a family practitioner. CONCLUSIONS The high prevalence and incidence observed in this representative sample emphasize the burden of HF in Germany. Substantial hospitalization rates and mortality highlight the need for early diagnosis and appropriate treatment, and for close cooperation between physician specialties and healthcare sectors.
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Affiliation(s)
- Stefan Störk
- Comprehensive Heart Failure Centre Würzburg and Department of Internal Medicine I, University and University Hospital Würzburg, Würzburg, Germany. .,Deutsches Zentrum für Herzinsuffizienz Würzburg, Am Schwarzenberg 15, 97078, Würzburg, Germany.
| | | | - Josephine Jacob
- Elsevier Health Analytics, Berlin, Germany.,Health Risk Institute, Berlin, Germany
| | - Jochen Walker
- Elsevier Health Analytics, Berlin, Germany.,Health Risk Institute, Berlin, Germany
| | | | | | | | - Sven Klebs
- Novartis Pharma GmbH, Nuremberg, Germany
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Rico VJ, Lahoz R, Rey-García F, Yubero F, Espinós JP, de la Fuente GF, González-Elipe AR. Laser Treatment of Nanoparticulated Metal Thin Films for Ceramic Tile Decoration. ACS Appl Mater Interfaces 2016; 8:24880-24886. [PMID: 27556592 DOI: 10.1021/acsami.6b07469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This paper presents a new method for the fabrication of metal-like decorative layers on glazed ceramic tiles. It consists of the laser treatment of Cu thin films prepared by electron-beam evaporation at glancing angles. A thin film of discontinuous Cu nanoparticles was electron-beam-evaporated in an oblique angle configuration onto ceramic tiles and an ample palette of colors obtained by laser treatment both in air and in vacuum. Scanning electron microscopy along with UV-vis-near-IR spectroscopy and time-of-flight secondary ion mass spectrometry analysis were used to characterize the differently colored layers. On the basis of these analyses, color development has been accounted for by a simple model considering surface melting phenomena and different microstructural and chemical transformations of the outmost surface layers of the samples.
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Affiliation(s)
- V J Rico
- Instituto de Ciencia de Materiales de Sevilla, CSIC-Universidad Sevilla , Avenida Américo Vespucio 49, 41092 Sevilla, Spain
| | | | - F Rey-García
- Departamento de Física & I3N, Universidade de Aveiro , 3810-193 Aveiro, Portugal
| | - F Yubero
- Instituto de Ciencia de Materiales de Sevilla, CSIC-Universidad Sevilla , Avenida Américo Vespucio 49, 41092 Sevilla, Spain
| | - J P Espinós
- Instituto de Ciencia de Materiales de Sevilla, CSIC-Universidad Sevilla , Avenida Américo Vespucio 49, 41092 Sevilla, Spain
| | | | - A R González-Elipe
- Instituto de Ciencia de Materiales de Sevilla, CSIC-Universidad Sevilla , Avenida Américo Vespucio 49, 41092 Sevilla, Spain
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Vekeman F, Gauthier-Loiselle M, Faust E, Lefebvre P, Lahoz R, Duh MS, Sacco P. Patient and Caregiver Burden Associated With Fragile X Syndrome in the United States. Am J Intellect Dev Disabil 2015; 120:444-459. [PMID: 26322391 DOI: 10.1352/1944-7558-120.5.444] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study evaluated the incremental healthcare costs associated with Fragile X syndrome (FXS) for patients and their caregivers. Using administrative healthcare claims data (1999-2012), subjects with ≥ 1 FXS diagnosis (ICD-9-CM: 759.83) were matched 1:5 with non-FXS controls using high-dimensional propensity scores. Costs and resource utilization were examined. Among employees, payment for disability leave and absenteeism were also examined. We identified 590 FXS and 2,950 non-FXS individuals along with 647 and 2,611 caregivers, respectively. FXS patients and their caregivers experienced higher all-cause direct costs compared to control cohorts (total[SD]: $14,677[46,752] vs. $6,103[26,081]; $5,259[19,360] vs. $2,120[6,425], respectively, p < 0.05). Employed FXS patients and caregivers had higher indirect costs compared to their controls (total[SD]: $4,477[5,161] vs. $1,751[2,556]; $2,641[4,238] vs. $1,211[1,936], respectively, p < 0.05).
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Capkun G, Lahoz R, Verdun E, Song X, Chen W, Korn JR, Dahlke F, Freitas R, Fraeman K, Simeone J, Johnson BH, Nordstrom B. Expanding the use of administrative claims databases in conducting clinical real-world evidence studies in multiple sclerosis. Curr Med Res Opin 2015; 31:1029-39. [PMID: 25661016 DOI: 10.1185/03007995.2015.1014029] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Administrative claims databases provide a wealth of data for assessing the effect of treatments in clinical practice. Our aim was to propose methodology for real-world studies in multiple sclerosis (MS) using these databases. RESEARCH DESIGN AND METHODS In three large US administrative claims databases: MarketScan, PharMetrics Plus and Department of Defense (DoD), patients with MS were selected using an algorithm identified in the published literature and refined for accuracy. Algorithms for detecting newly diagnosed ('incident') MS cases were also refined and tested. Methodology based on resource and treatment use was developed to differentiate between relapses with and without hospitalization. RESULTS When various patient selection criteria were applied to the MarketScan database, an algorithm requiring two MS diagnoses at least 30 days apart was identified as the preferred method of selecting patient cohorts. Attempts to detect incident MS cases were confounded by the limited continuous enrollment of patients in these databases. Relapse detection algorithms identified similar proportions of patients in the MarketScan and PharMetrics Plus databases experiencing relapses with (2% in both databases) and without (15-20%) hospitalization in the 1 year follow-up period, providing findings in the range of those in the published literature. LIMITATION Additional validation of the algorithms proposed here would increase their credibility. CONCLUSIONS The methods suggested in this study offer a good foundation for performing real-world research in MS using administrative claims databases, potentially allowing evidence from different studies to be compared and combined more systematically than in current research practice.
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Hallikainen I, Martikainen J, Lin PJ, Cohen JT, Lahoz R, Välimäki T, Hongisto K, Väätäinen S, Vanhanen M, Neumann PJ, Hänninen T, Koivisto AM. The Progression of Alzheimer's Disease Can Be Assessed with a Short Version of the CERAD Neuropsychological Battery: The Kuopio ALSOVA Study. Dement Geriatr Cogn Dis Extra 2014; 4:494-508. [PMID: 25685140 PMCID: PMC4296232 DOI: 10.1159/000369159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background/Aims Measuring and predicting Alzheimer's disease (AD) progression is important in order to adjust treatment and allocate care resources. We aimed to identify a combination of subtests from the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Battery (CERAD-NB) that best correlated with AD progression in follow-up as well as to predict AD progression. Method A total of 236 participants with very mild [Clinical Dementia Rating (CDR) = 0.5] or mild AD (CDR = 1.0) at baseline were followed up for 3 years. The CERAD-NB and Mini-Mental State Examination (MMSE) were used to assess cognition, and the CDR scale sum of boxes (CDR-sb) was employed to evaluate AD progression. Generalized estimating equations were used to develop models to predict and follow up disease progression. Results Performance declined on all CERAD-NB subtests. The ability of the separate subtests to distinguish between groups (baseline CDR = 0.5 or 1.0) diminished during follow-up. The best combination of subtests that explained 62% of CDR-sb variance in follow-up included verbal fluency, constructional praxis, the clock drawing test, and the MMSE. Baseline values of the same combination predicted 37% of the CDR-sb change. Conclusion A short version of the CERAD-NB subtests provides a promising and time-efficient alternative for measuring cognitive deterioration during AD follow-up. Although the initial signs of AD include memory difficulties, it may be useful to assess non-memory tasks in follow-up.
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Affiliation(s)
- Ilona Hallikainen
- School of Educational Sciences and Psychology, Kuopio, Finland ; Neurology, Institute of Clinical Medicine, Kuopio, Finland
| | - Janne Martikainen
- Pharmacoeconomics and Outcomes Research Unit, School of Pharmacy, Kuopio, Finland
| | - Pei-Jung Lin
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Mass., USA
| | - Joshua T Cohen
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Mass., USA
| | | | - Tarja Välimäki
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland ; Development, Clinical Education and Research Unit of Nursing, Kuopio, Finland
| | | | - Saku Väätäinen
- Pharmacoeconomics and Outcomes Research Unit, School of Pharmacy, Kuopio, Finland
| | | | - 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, Mass., USA
| | - Tuomo Hänninen
- Neurology, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Anne Maria Koivisto
- Neurology, Institute of Clinical Medicine, Kuopio, Finland ; Neurology, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
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Lahoz R, Bergvall N, Nazareth T, Korn JR. Persistence in Open and Closed Data Sources: A Study of Fingolimod Verse Interferons/Glatiramer Acetate in Patients with Multiple Sclerosis. Value Health 2014; 17:A401. [PMID: 27200959 DOI: 10.1016/j.jval.2014.08.913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- R Lahoz
- Novartis Pharma AG, Basel, Switzerland
| | | | - T Nazareth
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Bergvall N, Lahoz R, Nazareth T, Korn JR. Persistence with Fingolimod Versus Dimethyl Fumarate in Patients with Multiple Sclerosis: Retrospective Analysis of us Open-Source Pharmacy Data. Value Health 2014; 17:A400-A401. [PMID: 27200952 DOI: 10.1016/j.jval.2014.08.912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - R Lahoz
- Novartis Pharma AG, Basel, Switzerland
| | - T Nazareth
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Bergvall N, Petrilla AA, Karkare SU, Lahoz R, Agashivala N, Pradhan A, Capkun G, Makin C, McGuiness CB, Korn JR. Persistence with and adherence to fingolimod compared with other disease-modifying therapies for the treatment of multiple sclerosis: a retrospective US claims database analysis. J Med Econ 2014; 17:696-707. [PMID: 25019581 DOI: 10.3111/13696998.2014.940422] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Achieving therapeutic goals in multiple sclerosis (MS) requires strict adherence to treatment schedules. This retrospective study analyzed persistence with, and adherence to, fingolimod compared with injectable/infusible disease-modifying therapies (DMTs) in patients with MS. METHODS Patients in the PharMetrics Plus™ US administrative claims database with at least one prescription for, or administration of, fingolimod, glatiramer acetate (GA), interferon (IFN), or natalizumab (index DMT) between October 1, 2010 and September 30, 2011 were included. Patients were naïve to index DMT (no claim in the previous 360 days) and had an MS diagnosis code within 360 days of the first index DMT prescription. Outcomes were persistence, risk of discontinuing index DMT (evaluated by a Cox proportional hazards model), adherence (measured using the medication possession ratio [MPR] and proportion of days covered [PDC] in patients with at least two index DMT prescriptions), and the risk of being non-adherent (MPR <80% and PDC <80%, assessed using a logistic regression model). RESULTS The study included 3750 patients (fingolimod, n = 889; GA, n = 1233; any IFN, n = 1341; natalizumab, n = 287). Discontinuation rates (fingolimod, 27.9%; GA, 39.5%; IFN, 43.7%; natalizumab, 39.5%; all p < 0.001) and risk of discontinuation were significantly higher (hazard ratios vs fingolimod [95% confidence interval]: GA, 1.75 [1.49-2.07]; IFN, 2.01 [1.71-2.37]; natalizumab, 1.53 [1.22-1.91]) for patients receiving other DMTs compared with fingolimod. The risk of being non-adherent was also lower for patients in the fingolimod cohort than the other treatment cohorts, irrespective of whether non-adherence was defined as MPR <80% (p < 0.05 for all) or PDC <80% (p < 0.05 for GA and IFN). LIMITATIONS As with all studies assessing real-world treatment patterns it is unclear if medications were used as prescribed. CONCLUSIONS In a real-world setting, persistence with, and adherence to, oral fingolimod was higher than for injectable and infusible DMTs.
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Bergvall N, Lahoz R, Reynolds T, Korn JR. Healthcare resource use and relapses with fingolimod versus natalizumab for treating multiple sclerosis: a retrospective US claims database analysis. Curr Med Res Opin 2014; 30:1461-71. [PMID: 24754349 DOI: 10.1185/03007995.2014.915802] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Healthcare resource utilization in patients with multiple sclerosis (MS) is linked to relapses and disease progression. This retrospective cohort database analysis compared healthcare resource use and proxy measures of relapse outcomes in patients with active disease who switched to fingolimod or natalizumab. METHODS Using administrative claims data from the US PharMetrics Plus database, we identified patients with an MS diagnosis and a claim for fingolimod or natalizumab between 1 October 2010 and 30 June 2012 (index period) who had experienced a relapse (identified using a claims-based algorithm) and used other disease-modifying therapies (DMTs) in the previous year. Patients in the fingolimod and natalizumab cohorts were propensity score matched (1:1). MS-related inpatient stays, corticosteroid use and the proportion of patients experiencing claims-based relapses were assessed in the pre-index and post-index persistence periods. Time to first claims-based relapse in the post-index persistence period was assessed using a Kaplan-Meier curve. RESULTS The study included 623 unmatched patients (299 and 324 patients in the fingolimod and natalizumab cohorts, respectively) and 370 matched patients (185 in each cohort). In the matched analysis, MS-related inpatient stays and corticosteroid use were similar in the fingolimod and natalizumab cohorts during the post-index persistence period, and were significantly reduced versus the pre-index period (p < 0.01). A similar proportion of patients in the fingolimod and natalizumab cohorts were free from claims-based relapses in the persistence period (68.1% and 68.6%, respectively). There was no significant difference in the likelihood of experiencing a claims-based relapse (p = 0.8696). LIMITATION Identification of relapses is based on database claims rather than on clinical assessment. CONCLUSIONS In analyses of patients with MS with a history of relapse and DMT use, fingolimod and natalizumab reduce healthcare resource utilization and have similar effectiveness in a real-world setting.
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González-Clemente JM, Font B, Lahoz R, Llauradó G, Gambús G. Inercia clínica en pacientes con diabetes mellitus tipo 2 no insulinizados en tratamiento con hipoglucemiantes orales. Estudio INERCIA. Med Clin (Barc) 2014; 142:478-84. [DOI: 10.1016/j.medcli.2013.02.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 02/19/2013] [Accepted: 02/21/2013] [Indexed: 11/26/2022]
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Ruiz de la Cruz A, Lahoz R, Siegel J, de la Fuente GF, Solis J. High speed inscription of uniform, large-area laser-induced periodic surface structures in Cr films using a high repetition rate fs laser. Opt Lett 2014; 39:2491-2494. [PMID: 24979026 DOI: 10.1364/ol.39.002491] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We report on the fabrication of laser-induced periodic surface structures in Cr films upon high repetition rate fs laser irradiation (up to 1 MHz, 500 fs, 1030 nm), employing beam scanning. Highly regular large-area (9 cm2) gratings with a relative diffraction efficiency of 42% can be produced within less than 6 min. The ripple period at moderate and high fluences is 0.9 μm, with a small period of 0.5 μm appearing at lower energies. The role of the irradiation parameters on the characteristics of the laser-induced periodic surface structures (LIPSS) is studied and discussed in the frame of the models presently used. We have identified the polarization vector orientation with respect to the scan direction as a key parameter for the fabrication of high-quality, large-area LIPSS, which, for perpendicular orientation, allows the coherent extension of the sub-wavelength structure over macroscopic distances. The processing strategy is robust in terms of broad parameter windows and applicable to other materials featuring LIPSS.
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Bergvall N, Makin C, Lahoz R, Agashivala N, Pradhan A, Capkun G, Petrilla AA, Karkare SU, McGuiness CB, Korn JR. Relapse rates in patients with multiple sclerosis switching from interferon to fingolimod or glatiramer acetate: a US claims database study. PLoS One 2014; 9:e88472. [PMID: 24516663 PMCID: PMC3916439 DOI: 10.1371/journal.pone.0088472] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 01/04/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Approximately one-third of patients with multiple sclerosis (MS) are unresponsive to, or intolerant of, interferon (IFN) therapy, prompting a switch to other disease-modifying therapies. Clinical outcomes of switching therapy are unknown. This retrospective study assessed differences in relapse rates among patients with MS switching from IFN to fingolimod or glatiramer acetate (GA) in a real-world setting. METHODS US administrative claims data from the PharMetrics Plus™ database were used to identify patients with MS who switched from IFN to fingolimod or GA between October 1, 2010 and March 31, 2012. Patients were matched 1∶1 using propensity scores within strata (number of pre-index relapses) on demographic (e.g. age and gender) and disease (e.g. timing of pre-index relapse, comorbidities and symptoms) characteristics. A claims-based algorithm was used to identify relapses while patients were persistent with therapy over 360 days post-switch. Differences in both the probability of experiencing a relapse and the annualized relapse rate (ARR) while persistent with therapy were assessed. RESULTS The matched sample population contained 264 patients (n = 132 in each cohort). Before switching, 33.3% of patients in both cohorts had experienced at least one relapse. During the post-index persistence period, the proportion of patients with at least one relapse was lower in the fingolimod cohort (12.9%) than in the GA cohort (25.0%), and ARRs were lower with fingolimod (0.19) than with GA (0.51). Patients treated with fingolimod had a 59% lower probability of relapse (odds ratio, 0.41; 95% confidence interval [CI], 0.21-0.80; p = 0.0091) and 62% fewer relapses per year (rate ratio, 0.38; 95% CI, 0.21-0.68; p = 0.0013) compared with those treated with GA. CONCLUSIONS In a real-world setting, patients with MS who switched from IFNs to fingolimod were significantly less likely to experience relapses than those who switched to GA.
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Affiliation(s)
| | - Charles Makin
- IMS Health, Plymouth Meeting, Pennsylvania, United States of America
| | | | - Neetu Agashivala
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, United States of America
| | - Ashish Pradhan
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, United States of America
| | | | | | - Swapna U. Karkare
- IMS Health, Plymouth Meeting, Pennsylvania, United States of America
| | | | - Jonathan R. Korn
- IMS Health, Plymouth Meeting, Pennsylvania, United States of America
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Bergvall N, Makin C, Lahoz R, Agashivala N, Pradhan A, Capkun G, Petrilla A, Karkare SU, Balderston McGuiness C, Korn JR. Comparative effectiveness of fingolimod versus interferons or glatiramer acetate for relapse rates in multiple sclerosis: a retrospective US claims database analysis. Curr Med Res Opin 2013; 29:1647-56. [PMID: 24059944 DOI: 10.1185/03007995.2013.847411] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [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] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Disease-modifying therapies, such as fingolimod, interferon (IFN) and glatiramer acetate (GA), have differing effects on relapse rates in patients with multiple sclerosis (MS), but little is known about the real-world differences in relapse rates with these treatments. This retrospective study assessed relapse rates in patients with active MS initiating fingolimod, IFN or GA therapy in a real-world setting. METHODS Using administrative claims data from the US PharMetrics Plus database, we identified previously treated and untreated patients with MS who initiated fingolimod, IFN or GA treatment between 1 October 2010 and 31 March 2011 and had experienced a relapse in the previous year. A claims-based algorithm was used to identify relapses over the persistence period in patients with 540 days of post-index continuous enrolment. A logistic regression model assessed the probability of having at least one relapse and a generalized linear model estimated differences in annualized relapse rates (ARRs). RESULTS The study enrolled 525 patients (fingolimod, n = 128; combined IFN/GA cohort, n = 397) of the 31,041 initially identified. Similar findings for fingolimod and IFN/GA were observed for the unadjusted proportion of patients experiencing relapses (31.3% vs. 34.0%, respectively; p = 0.5653) and ARRs (0.50 vs. 0.55, respectively) while persistent to treatment. After adjusting for baseline differences, fingolimod was associated with a 52% reduction in the probability of having a relapse (odds ratio, 0.48; 95% confidence interval [CI], 0.28-0.84; p = 0.0097) and a 50% reduction in ARR (rate ratio, 0.50; 95% CI, 0.34-0.75; p = 0.0006) compared with IFN/GA. LIMITATIONS Identification of relapses is based on the claims in the database rather than on a clinical assessment. CONCLUSIONS In a real-world setting, fingolimod was shown to be associated with significantly lower relapse rates than IFN/GA in patients with MS who had a history of relapses.
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Miravitlles M, Sicras A, Crespo C, Cuesta M, Brosa M, Galera J, Lahoz R, Lleonart M, Riera MI. Costs of chronic obstructive pulmonary disease in relation to compliance with guidelines: a study in the primary care setting. Ther Adv Respir Dis 2013; 7:139-50. [PMID: 23653458 DOI: 10.1177/1753465813484080] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The aim of this study was to analyse the economic impact of nonadherence to the Global Initiative for Obstructive Lung Disease (GOLD) guidelines in patients with chronic obstructive pulmonary disease (COPD). METHODS A retrospective analysis was carried out on a claim database. Patients aged at least 40 years with a diagnosis of COPD were eligible for this analysis. Demographics, medical data and use of resources were collected and direct and indirect costs were analysed (from January 2008 to June 2009). A probabilistic multivariate sensitivity analysis of avoided costs was carried out. All results are presented in annualized form and costs are expressed in Euros (2009). RESULTS A total of 1365 patients were included, 79.5% were men. The mean age (±standard deviation) was 71.4 (±10.3) years, the mean forced expiratory volume in 1 s (FEV1) was 65.3% and they had a COPD history of 5.5 (±2.9) years. Patients were divided into an adherent group and a nonadherent group depending on whether therapeutic recommendations according to severity defined in the GOLD guidelines (2007) were followed. Patients in both groups were also classified as having stage II (FEV1 < 80% and < 50%) or stage III disease (FEV1 < 50% and ≥ 30%). The total annual drug cost per patient in the nonadherent group was €771.5 while it was only €426.4 for the adherent group. The average direct cost per patient per year in the nonadherent stage II group was €1465 (±971) and it rose to €2942 (±1918) for patients in the nonadherent group with stage III disease. The potential saving from the implementation of the GOLD guidelines in stage II COPD amounted to €758 per patient per year (68% saving on drug cost). In contrast, the cost for patients with stage III disease was higher in the adherent group versus the nonadherent group (€2468). CONCLUSIONS The cost of COPD may vary according to compliance with the GOLD guidelines. The cost observed for patients with stage II disease is higher than expected in patients who adhere to treatment, but patients with stage III disease treated according to the GOLD guidelines had significantly higher treatment costs.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, Pg. vall d'Hebron 119-129, 08035 Barcelona, Spain.
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Lizán L, Paz S, Dilla T, Rodríguez JM, Lahoz R, Reig-Ferrer A. [Concept and tools]. Aten Primaria 2009; 41:275-80. [PMID: 19403202 DOI: 10.1016/j.aprim.2008.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Accepted: 06/11/2008] [Indexed: 10/20/2022] Open
Affiliation(s)
- Luis Lizán
- Unidad Docente de Medicina de Familia y Universidad Jaime I, Castellón, España.
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Badia X, Díez-Pérez A, Lahoz R, Lizán L, Nogués X, Iborra J. The ECOS-16 questionnaire for the evaluation of health related quality of life in post-menopausal women with osteoporosis. Health Qual Life Outcomes 2004; 2:41. [PMID: 15291959 PMCID: PMC514569 DOI: 10.1186/1477-7525-2-41] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2003] [Accepted: 08/03/2004] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The aim of this study is to validate the questionnaire ECOS-16 (Assessment of health related quality of life in osteoporosis) for the evaluation of health related quality of life (HRQoL) in post-menopausal women with osteoporosis. METHODS An observational, prospective and multi-centre study was carried out among post-menopausal women with osteoporosis in primary care centres and hospital outpatient clinics. All patients attended 2 visits: at baseline and at 6 months. In addition, the subgroup of outpatients attended another visit a month after the baseline to assess the test-retest reliability. The psychometric properties of the questionnaire were evaluated in terms of feasibility, validity (content validity and construct validity) and internal consistency in baseline, and in terms of test-retest reliability and responsiveness to change in visit at month and visit at 6 months, respectively. In all visits, ECOS-16, EUROQoL-5D (EQ-5D) and four 7-point items about health status (general health status, back pain, limitation in daily activities and emotional status) were administered, whereas only outpatients were given MINI-OQLQ (Mini Osteoporosis Quality of Life Questionnaire), besides all clinical variables; and sociodemographic variables at baseline. RESULTS 316 women were consecutively included, 212 from primary care centres and 104 from hospital outpatient clinics. Feasibility: 94.3% of patients answered all items of the questionnaire. The mean administration time was 12.3 minutes. VALIDITY factor analysis suggested that the questionnaire was unidimensional. In the multivariate analysis, patients with vertebral fractures, co-morbidity and a lower education level showed to have worse HRQoL. Moderate to high correlations were found between the ECOS-16 score and the other health status questionnaires (0.47-0.82). Reliability: internal consistency (Cronbach's alpha) was 0.92 and test-retest reliability (ICC) was 0.80. Responsiveness to change: ECOS-16 scores increased according to change perceived by the patient, as well as the effect size (ranges between 1.35 to 0.43), the greater the perception of change in patients' general health status, the greater the changes in patients' scores. The Minimal Clinically Important Difference (MCID) suggested a change of 0.5 points in the ECOS-16 score, representing the least improvement in general health status due to their osteoporosis: "slightly better". CONCLUSION ECOS-16 has been proven preliminarily to have good psychometric properties, so that it can be potentially a useful tool to evaluate HRQoL of post-menopausal women with osteoporosis in research and routine clinical practice.
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Affiliation(s)
- Xavier Badia
- Health Outcomes Research (HOR) Europe, Plató 6, 1° 5, 08021 Barcelona, Spain
- Departament d'Epidemiologia I Salut Pública de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Adolfo Díez-Pérez
- Servei de Medicina Interna, Hospital Ntra. Sra. del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Raquel Lahoz
- Health Outcomes Research (HOR) Europe, Plató 6, 1° 5, 08021 Barcelona, Spain
| | - Luis Lizán
- Health Outcomes Research (HOR) Europe, Plató 6, 1° 5, 08021 Barcelona, Spain
- Unidad Docente de Medicina de Familia, Castellón, Spain
| | - Xavier Nogués
- Servei de Medicina Interna, Hospital Ntra. Sra. del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
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Roca-Cusachs A, Badia X, Dalfó A, Gascón G, Abellán J, Lahoz R, Varela C, Velasco O. [Relationship between clinical and therapeutic variables and health-related quality of life in patients with hypertension. MINICHAL Study]. Med Clin (Barc) 2003; 121:12-7. [PMID: 12812703 DOI: 10.1016/s0025-7753(03)74112-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Our objective was to evaluate, through the health related quality of life (HRQoL) questionnaire MINICHAL, the influence of socio-demographic, clinical and therapeutic variables on health related quality of life of hypertensive patients. PATIENTS AND METHOD An observational, prospective and multi-center study was carried out in hypertensive patients who were either starting or undergoing a modification of antihypertensive treatment. A total of three visits was done: a baseline visit and two follow-up visits at one and six months. At all three visits, several socio-demographic, clinical and therapeutic variables were recorded and HRQoL was measured using the MINICHAL questionnaire, the Spanish version of the Psychological General Well-Being Index, and a single question about the change in general health status. The objective was to evaluate the impact of these variables on HRQoL. RESULTS 736 patients with hypertension were evaluated. In the multivariate analysis, gender, number of concomitant diseases, degree of hypertension, organ damage and educational level were all variables displaying a relation with HRQoL. After 6 months of treatment intensification, an improvement of HRQoL was observed. Moreover, a positive correlation was observed between the degree of reduction of blood pressure (BP) and heart rate and HRQoL improvement, especially in the State of mind dimension. CONCLUSIONS In hypertension, a better BP control has a positive influence on HRQoL. As several clinical variables are negatively correlated with HRQoL, specific interventions are needed to correct modifiable factors.
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Affiliation(s)
- Alex Roca-Cusachs
- Unidad de Hipertensión. Servicio de Medicina Interna. Hospital de la Santa Creu i Sant Pau. Barcelona. Spain.
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