Publications by authors named "Sarah Lay-Flurrie"
Background: Heart failure (HF) is a risk factor for stroke among people with atrial fibrillation (AF). Prognosis following an HF diagnosis is often poor, but this is not accounted for in existing stroke risk scores.
Aim: To examine stroke incidence in people with HF and AF compared with AF alone, considering the competing risk of death.
Article Synopsis
- Heart failure (HF) increases the risk of major bleeding in patients with atrial fibrillation (AF), suggesting it should be considered in bleeding risk assessments.
- A study of over 2 million patients found that those with both HF and AF experienced a higher rate of major hemorrhages compared to those with AF alone, despite lower anticoagulant prescription rates.
- While patients with HF and AF are at a greater risk for major bleeding, they also have a higher mortality rate than bleeding incidence, indicating the need for individualized prognostic evaluations when assessing bleeding risk.
Objectives: To generate real-world evidence on all-cause mortality and economic burden of Clostridioides difficile infections (CDIs) and recurrences (rCDIs) in England.
Methods: We conducted a cohort study using retrospective data from Clinical Practice Research Datalink linked to Hospital Episode Statistics. Patients diagnosed with CDI in hospital and community settings during 2015-2018 were included and followed for ≥1 year.
Objective: To estimate the epidemiological and clinical burden of Clostridioides difficile infections (CDIs) and recurrences (rCDIs) in England.
Methods: This retrospective study included adult patients diagnosed with CDI (community or hospital settings) over 2015-2019 from Clinical Practice Research Datalink and Hospital Episode Statistics databases. Incidences of CDI and rCDI were determined annually.
Background: Antihypertensives reduce the risk of cardiovascular disease but are also associated with harms including acute kidney injury (AKI). Few data exist to guide clinical decision making regarding these risks.
Aim: To develop a prediction model estimating the risk of AKI in people potentially indicated for antihypertensive treatment.
Article Synopsis
- Antihypertensive medications are effective for reducing cardiovascular disease risk, but their impact on serious adverse events in frail older adults isn't well understood.
- A study analyzed data from over 3.8 million patients aged 40 and older in England between 1998 and 2018 to investigate if starting antihypertensive treatment was linked to an increase in various serious health issues.
- Findings showed that patients prescribed antihypertensives had higher risks for complications like hospitalizations from falls, hypotension, syncope, acute kidney injury, and other electrolyte-related issues.
Background: Natriuretic peptide (NP) testing is recommended for patients presenting to primary care with symptoms of chronic heart failure (HF) to prioritise referral for diagnosis.
Aim: To report NP test performance at European Society of Cardiology (ESC) and National Institute for Health and Care Excellence (NICE) guideline referral thresholds.
Design And Setting: Diagnostic accuracy study using linked primary and secondary care data (2004 to 2018).
Objective: To develop and externally validate the STRAtifying Treatments In the multi-morbid Frail elderlY (STRATIFY)-Falls clinical prediction model to identify the risk of hospital admission or death from a fall in patients with an indication for antihypertensive treatment.
Design: Retrospective cohort study.
Setting: Primary care data from electronic health records contained within the UK Clinical Practice Research Datalink (CPRD).
Purpose: Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) may be treated with surgical mesh devices; evidence of their long-term complications is lacking.
Patients And Methods: Rates of diagnoses of depression, anxiety or self-harm (composite measure) and sexual dysfunction, and rates of prescriptions for antibiotics and opioids were estimated in women with and without mesh surgery, with a diagnostic SUI/POP code, registered in the Clinical Practice Research Datalink (CPRD) gold database.
Results: There were 220,544 women eligible for inclusion; 74% (n = 162,687) had SUI, 37% (n = 82,123) had POP, and 11% (n = 24,266) had both.
Background: It remains unclear to what extent reductions in urgent referrals for suspected cancer during the COVID-19 pandemic were the result of fewer patients attending primary care compared to GPs referring fewer patients.
Methods: Cohort study including electronic health records data from 8,192,069 patients from 663 English practices. Weekly consultation rates, cumulative consultations and referrals were calculated for 28 clinical features from the NICE suspected cancer guidelines.
Aims: Heart failure (HF) is a malignant condition with poor outcomes and is often diagnosed on emergency hospital admission. Natriuretic peptide (NP) testing in primary care is recommended in international guidelines to facilitate timely diagnosis. We aimed to report contemporary trends in NP testing and subsequent HF diagnosis rates over time.
View Article and Find Full Text PDFObjective: To assess the associations between statins and adverse events in primary prevention of cardiovascular disease and to examine how the associations vary by type and dosage of statins.
Design: Systematic review and meta-analysis.
Data Sources: Studies were identified from previous systematic reviews and searched in Medline, Embase, and the Cochrane Central Register of Controlled Trials, up to August 2020.
Objective: Heart failure (HF) is a malignant condition requiring urgent treatment. Guidelines recommend natriuretic peptide (NP) testing in primary care to prioritise referral for specialist diagnostic assessment. We aimed to assess association of baseline NP with hospitalisation and mortality in people with newly diagnosed HF.
View Article and Find Full Text PDFBackground: The complexity of general practice consultations may be increasing and varies in different settings. A measure of complexity is required to test these hypotheses.
Aim: To develop a valid measure of general practice consultation complexity applicable to routine medical records.
Background: Patients with myeloma experience substantial delays in their diagnosis, which can adversely affect their prognosis.
Aim: To generate a clinical prediction rule to identify primary care patients who are at highest risk of myeloma.
Design And Setting: Retrospective open cohort study using electronic health records data from the UK's Clinical Practice Research Datalink (CPRD) between 1 January 2000 and 1 January 2014.
Background: In 2011, National Institute for Health and Care Excellence (NICE) guidelines recommended the routine use of out-of-office blood pressure (BP) monitoring for the diagnosis of hypertension. These changes were predicted to reduce unnecessary treatment costs and workload associated with misdiagnosis.
Aim: To assess the impact of guideline change on rates of hypertension-related consultation in general practice.
Objective: To examine the association between antihypertensive treatment and specific adverse events.
Design: Systematic review and meta-analysis.
Eligibility Criteria: Randomised controlled trials of adults receiving antihypertensives compared with placebo or no treatment, more antihypertensive drugs compared with fewer antihypertensive drugs, or higher blood pressure targets compared with lower targets.
Objective: To understand the current prevalence of, and attitudes to, self-monitoring of blood pressure (BP) during pregnancy.
Methods: Five thousand, five hundred and fifty-five pregnant women from antenatal clinics in 16 hospitals in England were invited to complete a survey.
Main Outcome Measures: The primary outcome was the proportion of women currently BP self-monitoring.
Hypertension has been identified as a risk factor for coronavirus disease 2019 (COVID-19) and associated adverse outcomes. This study examined the association between preinfection blood pressure (BP) control and COVID-19 outcomes using data from 460 general practices in England. Eligible patients were adults with hypertension who were tested or diagnosed with COVID-19.
View Article and Find Full Text PDFNational trends in heart failure mortality in men and women, United Kingdom, 2000-2017.
Eur J Heart Fail
January 2021
Aims: To understand gender differences in the prognosis of women and men with heart failure, we compared mortality, cause of death and survival trends over time.
Methods And Results: We analysed UK primary care data for 26 725 women and 29 234 men over age 45 years with a new diagnosis of heart failure between 1 January 2000 and 31 December 2017 using the Clinical Practice Research Datalink, inpatient Hospital Episode Statistics and the Office for National Statistics death registry. Age-specific overall survival and cause-specific mortality rates were calculated by gender and year.
Objective: To examine the relationship between pregnancy outcomes and BP level and variability.
Design: Secondary analysis of CHIPS trial data (Control of Hypertension In Pregnancy Study, NCT01192412).
Setting: International.
Article Synopsis
- In recent years, guidelines have encouraged out-of-office blood pressure monitoring for diagnosing hypertension, despite concerns about potential increases in cardiovascular health issues.
- A study involving nearly 4 million adults showed that the incidence of hypertension decreased overall, but the 2011 guideline changes didn't immediately affect the rate but rather stabilized it over time.
- The use of ambulatory monitoring significantly increased post-guideline changes, but the rate of cardiovascular events remained unchanged, supporting the recommendation for continued out-of-office monitoring in hypertension diagnosis.
Background: Blood pressure (BP) measurement is increasingly carried out through home or ambulatory monitoring, yet existing cardiovascular risk scores were developed for use with measurements obtained in clinics.
Aim: To describe differences in cardiovascular risk estimates obtained using ambulatory or home BP measurements instead of clinic readings.
Design And Setting: Secondary analysis of data from adults aged 25-84 years in the UK and the Netherlands without prior history of cardiovascular disease (CVD) in two BP monitoring studies: the Blood Pressure in different Ethnic groups (BP-Eth) study and the Home versus Office blood pressure MEasurements: Reduction of Unnecessary treatment Study (HOMERUS).
Background: Primary care workload is high and increasing in the United Kingdom. We sought to examine the association between rates of primary care consultation and outcomes in England.
Methods: Cross sectional observational study of routine electronic health care records in 283 practices from the Clinical Practice Research Datalink from April 2013 to March 2014.
Objectives: To report reliable estimates of short term and long term survival rates for people with a diagnosis of heart failure and to assess trends over time by year of diagnosis, hospital admission, and socioeconomic group.
Design: Population based cohort study.
Setting: Primary care, United Kingdom.