141 results on '"Roalfe, Andrea K"'
Search Results
2. Body mass index and survival in people with heart failure
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Jones, Nicholas R, primary, Ordóñez-Mena, José M, additional, Roalfe, Andrea K, additional, Taylor, Kathryn S, additional, Goyder, Clare R, additional, Hobbs, FD Richard, additional, and Taylor, Clare J, additional
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- 2023
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3. MICE or NICE? An economic evaluation of clinical decision rules in the diagnosis of heart failure in primary care
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Monahan, Mark, Barton, Pelham, Taylor, Clare J, Roalfe, Andrea K, Hobbs, F.D. Richard, Cowie, Martin, Davis, Russell, Deeks, Jon, Mant, Jonathan, McCahon, Deborah, McDonagh, Theresa, Sutton, George, and Tait, Lynda
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- 2017
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4. Diagnostic accuracy of natriuretic peptide screening for left ventricular systolic dysfunction in the community: systematic review and meta‐analysis
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Goyder, Clare R., primary, Roalfe, Andrea K., additional, Jones, Nicholas R., additional, Taylor, Kathy S., additional, Plumptre, Charles D., additional, James, Olivia, additional, Fanshawe, Thomas R., additional, Hobbs, F D Richard, additional, and Taylor, Clare J., additional
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- 2023
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5. Survival of patients with chronic heart failure in the community: a systematic review and meta-analysis protocol
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Jones, Nicholas R., Roalfe, Andrea K., Adoki, Ibiye, Richard Hobbs, F. D., and Taylor, Clare J.
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- 2018
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6. Natriuretic peptide testing and heart failure diagnosis in primary care: diagnostic accuracy study
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Taylor, Clare J, primary, Ordóñez-Mena, José M, additional, Lay-Flurrie, Sarah L, additional, Goyder, Clare R, additional, Taylor, Kathryn S, additional, Jones, Nicholas R, additional, Roalfe, Andrea K, additional, and Hobbs, FD Richard, additional
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- 2022
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7. Long term changes in health‐related quality of life for people with heart failure: the ECHOES study
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Roalfe, Andrea K., primary, Taylor, Clare J., additional, and Hobbs, F.D. Richard, additional
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- 2022
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8. An occupational therapy intervention for residents with stroke related disabilities in UK care homes (OTCH) : cluster randomised controlled trial
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Sackley, Catherine M, Walker, Marion F, Burton, Christopher R, Watkins, Caroline L, Mant, Jonathan, Roalfe, Andrea K, Wheatley, Keith, Sheehan, Bart, Sharp, Leslie, Stant, Katie E, Fletcher-Smith, Joanna, Steel, Kerry, Wilde, Kate, Irvine, Lisa, and Peryer, Guy
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- 2015
9. Estimated stroke risk, yield, and number needed to screen for atrial fibrillation detected through single time screening: a multicountry patient-level meta-analysis of 141,220 screened individuals
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Lowres, Nicole, Olivier, Jake, Chao, Tze-Fan, Chen, Shih-Ann, Chen, Yi, Diederichsen, Axel, Fitzmaurice, David A., Gomez-Doblas, Juan Jose, Harbison, Joseph, Healey, Jeff S., Hobbs, F. D. Richard, Kaasenbrood, Femke, Keen, William, Lee, Vivian W., Lindholt, Jes S., Lip, Gregory Y. H., Mairesse, Georges H., Mant, Jonathan, Martin, Julie W., Martín-Rioboó, Enrique, McManus, David D., Muñiz, Javier, Münzel, Thomas, Nakamya, Juliet, Neubeck, Lis, Orchard, Jessica J., Pérula de Torres, Luis Ángel, Proietti, Marco, Quinn, F. Russell, Roalfe, Andrea K., Sandhu, Roopinder K., Schnabel, Renate B., Smyth, Breda, Soni, Apurv, Tieleman, Robert, Wang, Jiguang, Wild, Philipp S., Yan, Bryan P., and Freedman, Ben
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Atrial fibrillation -- Diagnosis ,Anticoagulants -- Usage ,Stroke -- Risk factors ,Budgets ,Medical economics ,Fibrillation ,Biological sciences - Abstract
Background The precise age distribution and calculated stroke risk of screen-detected atrial fibrillation (AF) is not known. Therefore, it is not possible to determine the number needed to screen (NNS) to identify one treatable new AF case (NNS-Rx) (i.e., Class-1 oral anticoagulation [OAC] treatment recommendation) in each age stratum. If the NNS-Rx is known for each age stratum, precise cost-effectiveness and sensitivity simulations can be performed based on the age distribution of the population/region to be screened. Such calculations are required by national authorities and organisations responsible for health system budgets to determine the best age cutoffs for screening programs and decide whether programs of screening should be funded. Therefore, we aimed to determine the exact yield and calculated stroke-risk profile of screen-detected AF and NNS-Rx in 5-year age strata. Methods and findings A systematic review of Medline, Pubmed, and Embase was performed (January 2007 to February 2018), and AF-SCREEN international collaboration members were contacted to identify additional studies. Twenty-four eligible studies were identified that performed a single time point screen for AF in a general ambulant population, including people [greater than or equal to]65 years. Authors from eligible studies were invited to collaborate and share patient-level data. Statistical analysis was performed using random effects logistic regression for AF detection rate, and Poisson regression modelling for CHA.sub.2 DS.sub.2 -VASc scores. Nineteen studies (14 countries from a mix of low- to middle- and high-income countries) collaborated, with 141,220 participants screened and 1,539 new AF cases. Pooled yield of screening was greater in males across all age strata. The age/sex-adjusted detection rate for screen-detected AF in [greater than or equal to]65-year-olds was 1.44% (95% CI, 1.13%-1.82%) and 0.41% (95% CI, 0.31%-0.53%) for Conclusions People with screen-detected AF are at elevated calculated stroke risk: above age 65, the majority have a Class-1 OAC recommendation for stroke prevention, and >70% have [greater than or equal to]1 additional stroke risk factor other than age/sex. Our data, based on the largest number of screen-detected AF collected to date, show the precise relationship between yield and estimated stroke risk profile with age, and strong dependence for NNS-RX on the age distribution of the population to be screened: essential information for precise cost-effectiveness calculations., Author(s): Nicole Lowres 1,*, Jake Olivier 2, Tze-Fan Chao 3,4, Shih-Ann Chen 3,4, Yi Chen 5,6, Axel Diederichsen 7, David A. Fitzmaurice 6,8, Juan Jose Gomez-Doblas 9,10, Joseph Harbison 11,12, [...]
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- 2019
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10. Long term changes in health‐related quality of life for people with heart failure: the ECHOES study.
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Roalfe, Andrea K., Taylor, Clare J., and Hobbs, F.D. Richard
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HEART failure ,QUALITY of life ,INDEPENDENT variables ,PHYSICAL mobility ,VENTRICULAR ejection fraction - Abstract
Aims: Heart failure (HF) impairs all aspects of health‐related quality of life (HRQoL), but little is known about the effect of developing HF on HRQoL over time. We aimed to report changes in HRQoL over a 13‐year period. Methods and results: HRQoL was measured in the Echocardiographic Heart of England Screening (ECHOES) study and the ECHOES‐X follow‐up study (N = 1618) using the SF‐36 questionnaire (Version 1). Mixed modelling compared changes in HRQoL across diagnostic groups, adjusting for potential predictors and design variables. Patients who had developed HF with reduced ejection fraction (HFrEF) or HF with preserved ejection fraction (HFpEF) at rescreening had significantly greater reduction in physical functioning (PF) and role physical (RP) scores compared with those without HF; adjusted mean difference in PF: HFrEF −16.1, [95% confidence interval (CI) −22.2 to −10.1]; HFpEF −14.6, (95% CI −21.2 to −8.1); in RP: HFrEF −20.7, (95% CI −31.8 to −9.7); HFpEF −19.3, (95% CI −31.0 to −7.6). Changes in HRQoL of those with a HF diagnosis at baseline and rescreen, with exception of role emotion, were similar to those without HF but started from a much lower baseline score. Conclusions: People with a new diagnosis of HF at rescreening had a significant reduction in HRQoL. Conversely, for those with HF detected on initial screening, little change was observed in HRQoL scores on rescreening. Further research is required to understand the development of HF over time and to test interventions designed to prevent decline in HRQoL, potentially through earlier diagnosis and treatment optimization. [ABSTRACT FROM AUTHOR]
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- 2023
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11. Natriuretic peptide testing and heart failure diagnosis in primary care: diagnostic accuracy study.
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Taylor, Clare J, Ordóñez-Mena, José M, Lay-Flurrie, Sarah L, Goyder, Clare R, Taylor, Kathryn S, Jones, Nicholas R, Roalfe, Andrea K, and Hobbs, FD Richard
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HEART failure ,PEPTIDES ,PRIMARY care ,SECONDARY care (Medicine) ,ALDOSTERONE antagonists ,DIAGNOSIS ,BRAIN natriuretic factor - Abstract
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). Method: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of NP testing for HF diagnosis was assessed. Results: In total, 229 580 patients had an NP test and 21 102 (9.2%) were diagnosed with HF within 6 months. The ESC NT-proBNP threshold ≥125 pg/mL had a sensitivity of 94.6% (95% confidence interval [CI] = 94.2 to 95.0) and specificity of 50.0% (95% CI = 49.7 to 50.3), compared with sensitivity of 81.7% (95% CI = 81.0 to 82.3) and specificity of 80.3% (95% CI = 80.0 to 80.5) for the NICE NT-proBNP ≥400 pg/mL threshold. PPVs for an NT-proBNP test were 16.4% (95% CI = 16.1 to 16.6) and 30.0% (95% CI = 29.6 to 30.5) for ESC and NICE thresholds, respectively. For both guidelines, nearly all patients with an NT-proBNP level below the threshold did not have HF (NPV: ESC 98.9%, 95% CI = 98.8 to 99.0 and NICE 97.7%, 95% CI = 97.6 to 97.8). Conclusion: At the higher NICE chronic HF guideline NP thresholds, one in five cases are initially missed in primary care but the lower ESC thresholds require more diagnostic assessments. NP is a reliable 'rule-out' test at both cut-points. The optimal NP threshold will depend on the priorities and capacity of the healthcare system. [ABSTRACT FROM AUTHOR]
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- 2023
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12. Long term trends in natriuretic peptide testing for heart failure in UK primary care: a cohort study
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Roalfe, Andrea K, primary, Lay-Flurrie, Sarah L, additional, Ordóñez-Mena, José M, additional, Goyder, Clare R, additional, Jones, Nicholas R, additional, Hobbs, F D Richard, additional, and Taylor, Clare J, additional
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- 2021
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13. Natriuretic peptide level at heart failure diagnosis and risk of hospitalisation and death in England 2004–2018
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Taylor, Clare J, primary, Lay-Flurrie, Sarah L, additional, Ordóñez-Mena, José M, additional, Goyder, Clare R, additional, Jones, Nicholas R, additional, Roalfe, Andrea K, additional, and Hobbs, FD Richard, additional
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- 2021
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14. Survival of people with valvular heart disease in a large, English community-based cohort study
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Taylor, Clare J, primary, Ordóñez-Mena, José M, additional, Jones, Nicholas R, additional, Roalfe, Andrea K, additional, Myerson, Saul G, additional, Prendergast, Bernard D, additional, and Hobbs, FD Richard, additional
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- 2021
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15. Diagnosing heart failure in primary care: individual patient data meta‐analysis of two European prospective studies
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Roalfe, Andrea K., primary, Taylor, Clare J., additional, Kelder, Johannes C., additional, Hoes, Arno W., additional, and Hobbs, F.D. Richard, additional
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- 2021
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16. Natriuretic peptide level at heart failure diagnosis and risk of hospitalisation and death in England 2004-2018.
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Taylor, Clare J., Lay-Flurrie, Sarah L., Ordóñez-Mena, José M., Goyder, Clare R., Jones, Nicholas R., Roalfe, Andrea K., Richard Hobbs, F. D., and Hobbs, Fd Richard
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HEART failure ,PEPTIDES ,MORTALITY ,NURSE practitioners ,MUSCULOSKELETAL system diseases ,DIGESTIVE system diseases ,DIAGNOSIS - Abstract
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.Methods: Population-based cohort study of 40 007 patients in the Clinical Practice Research Datalink in England with a new HF diagnosis (48% men, mean age 78.5 years). We used linked primary and secondary care data between 1 January 2004 and 31 December 2018 to report one-year hospitalisation and 1-year, 5-year and 10-year mortality by NP level.Results: 22 085 (55%) participants were hospitalised in the year following diagnosis. Adjusted odds of HF-related hospitalisation in those with a high NP (NT-proBNP >2000 pg/mL) were twofold greater (OR 2.26 95% CI 1.98 to 2.59) than a moderate NP (NT-proBNP 400-2000 pg/mL). All-cause mortality rates in the high NP group were 27%, 62% and 82% at 1, 5 and 10 years, compared with 19%, 50% and 77%, respectively, in the moderate NP group and, in a competing risks model, risk of HF-related death was 50% higher at each timepoint. Median time between NP test and HF diagnosis was 101 days (IQR 19-581).Conclusions: High baseline NP is associated with increased HF-related hospitalisation and poor survival. While healthcare systems remain under pressure from the impact of COVID-19, research to test novel strategies to prevent hospitalisation and improve outcomes-such as a mandatory two-week HF diagnosis pathway-is urgently needed. [ABSTRACT FROM AUTHOR]- Published
- 2022
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17. Long term trends in natriuretic peptide testing for heart failure in UK primary care: a cohort study.
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Roalfe, Andrea K, Lay-Flurrie, Sarah L, Ordóñez-Mena, José M, Goyder, Clare R, Jones, Nicholas R, Hobbs, F D Richard, and Taylor, Clare J
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HEART failure ,NATRIURETIC peptides ,PATIENTS ,HOSPITAL care ,SOCIOECONOMICS - Abstract
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. Methods and results Cohort study using linked primary and secondary care data of adult (≥45 years) patients in England 2004–18 (n = 7 212 013, 48% male) to report trends in NP testing (over time, by age, sex, ethnicity, and socioeconomic status) and HF diagnosis rates. NP test rates increased from 0.25 per 1000 person-years [95% confidence interval (CI) 0.23–0.26] in 2004 to 16.88 per 1000 person-years (95% CI 16.73–17.03) in 2018, with a significant upward trend in 2010 following publication of national HF guidance. Women and different ethnic groups had similar test rates, and there was more NP testing in older and more socially deprived groups as expected. The HF detection rate was constant over the study period (around 10%) and the proportion of patients without NP testing prior to diagnosis remained high [99.6% (n = 13 484) in 2004 vs. 76.7% (n = 12 978) in 2017]. Conclusion NP testing in primary care has increased over time, with no evidence of significant inequalities, but most patients with HF still do not have an NP test recorded prior to diagnosis. More NP testing in primary care may be needed to prevent hospitalization and facilitate HF diagnosis at an earlier, more treatable stage. [ABSTRACT FROM AUTHOR]
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- 2022
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18. A Randomised Controlled Trial of Extended Anticoagulation Treatment Versus Standard Treatment for the Prevention of Recurrent VTE and Post-thrombotic Syndrome in Patients Being Treated for a First Episode of Unprovoked VTE (The ExACT Study)
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Bradbury, Charlotte A, Fletcher, Kate, Sun, Yongzhong, Heneghan, Carl, Gardiner, Chris, Roalfe, Andrea K, Hardy, Pollyanna, Mccahon, Deborah, Heritage, Gail, Shackleford, Helen, Hobbs, Richard, and Fitzmaurice, David A
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warfarin ,post‐thrombotic syndrome ,thrombosis (venous) ,anticoagulation ,D‐dimer - Abstract
Venous thromboembolism (VTE) is prevalent and impactful, with a risk of death, morbidity and recurrence. Post thrombotic syndrome (PTS) is a common consequence and associated with impaired quality of life (QoL). The ExACT study was a non-blinded, prospective, multi-centred RCT comparing extended versus limited duration anticoagulation following a first unprovoked VTE (Proximal DVT or PE). Adults were eligible if they had completed ≥3 months anticoagulation (remaining anticoagulated). The primary outcome was time to first recurrent VTE from randomisation. The secondary outcomes included PTS severity, bleeding, QoL and D-dimers. 281 patients were recruited, randomised and followed up for 24 months (mean age 63, Male:Female 2:1). There was a significant reduction in recurrent VTE for patients receiving extended anticoagulation (2.75 vs 13.54 events/100 patient years, aHR 0.20(95%CI:0.09 to 0.46, p
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- 2019
19. National trends in heart failure mortality in men and women,United Kingdom, 2000–2017
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Taylor, Clare J., primary, Ordóñez‐Mena, José M., additional, Jones, Nicholas R., additional, Roalfe, Andrea K., additional, Lay‐Flurrie, Sarah, additional, Marshall, Tom, additional, and Hobbs, F.D. Richard, additional
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- 2020
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20. Prevalence of atrial fibrillation in the general population and in high-risk groups: the ECHOES study
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Davis, Russell C., Hobbs, F.D. Richard, Kenkre, Joyce E., Roalfe, Andrea K., Iles, Rachel, Lip, Gregory Y.H., and Davies, Michael K.
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- 2012
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21. A cross-sectional study of quality of life in an elderly population (75 years and over) with atrial fibrillation: secondary analysis of data from the Birmingham Atrial Fibrillation Treatment of the Aged study
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Roalfe, Andrea K., Bryant, Toni L., Davies, Matthew H., Hackett, Thomas G., Saba, Samiramis, Fletcher, Kate, Lip, Gregory Y. H., Hobbs, F.D. Richard, and Mant, Jonathan
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- 2012
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22. Development and initial validation of a simple clinical decision tool to predict the presence of heart failure in primary care: the MICE (Male, Infarction, Crepitations, Edema, MICE) rule
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Roalfe, Andrea K., Mant, Jonathan, Doust, Jenny A., Barton, Pelham, Cowie, Martin R., Glasziou, Paul, Mant, David, McManus, Richard J., Holder, Roger, Deeks, Jonathan J., Doughty, Robert N., Hoes, Arno W., Fletcher, Kate, and Hobbs, F.D. Richard
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- 2012
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23. Ten-year prognosis of heart failure in the community: follow-up data from the Echocardiographic Heart of England Screening (ECHOES) study
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Taylor, Clare J., Roalfe, Andrea K., Iles, Rachel, and Hobbs, F.D. Richard
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- 2012
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24. Survival rates in elderly patients with heart failure: reply
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Jones, Nicholas R., primary, Roalfe, Andrea K., additional, Adoki, Ibiye, additional, Taylor, Clare J., additional, and Hobbs, F.D. Richard, additional
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- 2020
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25. Survival of patients with chronic heart failure in the community: a systematic review and meta‐analysis
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Jones, Nicholas R., primary, Roalfe, Andrea K., additional, Adoki, Ibiye, additional, Hobbs, F.D. Richard, additional, and Taylor, Clare J., additional
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- 2019
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26. Prognosis of all-cause heart failure and borderline left ventricular systolic dysfunction: 5 year mortality follow-up of the Echocardiographic Heart of England Screening Study (ECHOES)
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Hobbs, F.D. Richard, Roalfe, Andrea K., Davis, Russell C., Davies, Michael K., and Hare, Rachel
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- 2007
27. Prevalence of Subclinical Thyroid Dysfunction and Its Relation to Socioeconomic Deprivation in the Elderly: A Community-Based Cross-Sectional Survey
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Wilson, Sue, Parle, James V., Roberts, Lesley M., Roalfe, Andrea K., Hobbs, F D. Richard, Clark, Penny, Sheppard, Michael C., Gammage, Michael D., Pattison, Helen M., and Franklyn, Jayne A.
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- 2006
28. The REFER (REFer for EchocaRdiogram) protocol: a prospective validation of a clinical decision rule, NT-proBNP, or their combination, in the diagnosis of heart failure in primary care. Rationale and design
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Tait Lynda, Roalfe Andrea K, Mant Jonathan, Cowie Martin R, Deeks Jonathan J, Iles Rachel, Barton Pelham M, Taylor Clare J, Derit Marites, and Hobbs FD
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Heart failure ,Clinical decision rule ,Diagnosis ,Echocardiogram ,NT-proBNP ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Heart failure is a major cause of mortality and morbidity. As mortality rates are high, it is important that patients seen by general practitioners with symptoms suggestive of heart failure are identified quickly and treated appropriately. Identifying patients with heart failure or deciding which patients need further tests is a challenge. All patients with suspected heart failure should be diagnosed using objective tests such as echocardiography, but it is expensive, often delayed, and limited by the significant skill shortage of trained echocardiographers. Alternative approaches for diagnosing heart failure are currently limited. Clinical decision tools that combine clinical signs, symptoms or patient characteristics are designed to be used to support clinical decision-making and validated according to strict methodological procedures. The REFER Study aims to determine the accuracy and cost-effectiveness of our previously derived novel, simple clinical decision rule, a natriuretic peptide assay, or their combination, in the triage for referral for echocardiography of symptomatic adult patients who present in general practice with symptoms suggestive of heart failure. Methods/design This is a prospective, Phase II observational, diagnostic validation study of a clinical decision rule, natriuretic peptides or their combination, for diagnosing heart failure in primary care. Consecutive adult primary care patients 55 years of age or over presenting to their general practitioner with a chief complaint of recent new onset shortness of breath, lethargy or peripheral ankle oedema of over 48 hours duration, with no obvious recurrent, acute or self-limiting cause will be enrolled. Our reference standard is based upon a three step expert specialist consensus using echocardiography and clinical variables and tests. Discussion Our clinical decision rule offers a potential solution to the diagnostic challenge of providing a timely and accurate diagnosis of heart failure in primary care. Study results will provide an evidence-base from which to develop heart failure care pathway recommendations and may be useful in standardising care. If demonstrated to be effective, the clinical decision rule will be of interest to researchers, policy makers and general practitioners worldwide. Trial registration ISRCTN17635379
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- 2012
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29. A cluster randomised controlled trial of an occupational therapy intervention for residents with stroke living in UK care homes (OTCH): study protocol
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Sackley Cath M, Burton Chris R, Herron-Marx Sandy, Lett Karen, Mant Jonathan, Roalfe Andrea K, Sharp Leslie J, Sheehan Bart, Stant Katie E, Walker Marion F, Watkins Caroline L, Wheatley Keith, Williams Jane, Yao Guiqing L, and Feltham Max G
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Stroke ,Occupational therapy ,Care homes ,Cluster randomised controlled trial ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Abstract Background The occupational therapy (OT) in care homes study (OTCH) aims to investigate the effect of a targeted course of individual OT (with task training, provision of adaptive equipment, minor environmental adaptations and staff education) for stroke survivors living in care homes, compared to usual care. Methods/Design A cluster randomised controlled trial of United Kingdom (UK) care homes (n = 90) with residents (n = 900) who have suffered a stroke or transient ischaemic attack (TIA), and who are not receiving end-of-life care. Homes will be stratified by centre and by type of care provided and randomised (50:50) using computer generated blocked randomisation within strata to receive either the OT intervention (3 months intervention from an occupational therapist) or control (usual care). Staff training on facilitating independence and mobility and the use of adaptive equipment, will be delivered to every home, with control homes receiving this after the 12 month follow-up. Allocation will be concealed from the independent assessors, but the treating therapists, and residents will not be masked to the intervention. Measurements are taken at baseline prior to randomisation and at 3, 6 and 12 months post randomisation. The primary outcome measure is independence in self-care activities of daily living (Barthel Activities of Daily Living Index). Secondary outcome measures are mobility (Rivermead Mobility Index), mood (Geriatric Depression Scale), preference based quality of life measured from EQ-5D and costs associated with each intervention group. Quality adjusted life years (QALYs) will be derived based on the EQ-5D scores. Cost effectiveness analysis will be estimated and measured by incremental cost effectiveness ratio. Adverse events will be recorded. Discussion This study will be the largest cluster randomised controlled trial of OT in care homes to date and will clarify the currently inconclusive literature on the efficacy of OT for stroke and TIA survivors residing in care homes. Trial registration ISRCTN00757750
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- 2012
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30. The effectiveness of exercise as a treatment for postnatal depression: study protocol
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Daley Amanda J, Jolly Kate, Sharp Debbie J, Turner Katrina M, Blamey Ruth V, Coleman Sarah, McGuinness Mary, Roalfe Andrea K, Jones Ian, and MacArthur Christine
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Exercise ,Postnatal depression ,Gynecology and obstetrics ,RG1-991 - Abstract
Abstract Background Postnatal depression can have a substantial impact on the woman, the child and family as a whole. Thus, there is a need to examine different ways of helping women experiencing postnatal depression; encouraging them to exercise may be one way. A meta analysis found some support for exercise as an adjunctive treatment for postnatal depression but the methodological inadequacy of the few small studies included means that it is uncertain whether exercise reduces symptoms of postnatal depression. We aim to determine whether a pragmatic exercise intervention that involves one-to-one personalised exercise consultations and telephone support plus usual care in women with postnatal depression, is superior to usual care only, in reducing symptoms of postnatal depression. Methods We aim to recruit 208 women with postnatal depression in the West Midlands. Recently delivered women who meet the ICD-10 diagnosis for depression will be randomised to usual care plus exercise or usual care only. The exercise intervention will be delivered over 6 months. The primary outcome measure is difference in mean Edinburgh Postnatal Depression Scale score between the groups at six month follow-up. Outcome measures will be assessed at baseline and at six and 12 month post randomisation. Discussion Findings from the research will inform future clinical guidance on antenatal and postnatal mental health, as well as inform practitioners working with postnatal depression. Trial registration number ISRCTN84245563
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- 2012
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31. MICE or NICE? An economic evaluation of clinical decision rules in the diagnosis of heart failure in primary care
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Monahan, Mark, Barton, Pelham, Taylor, Clare J, Roalfe, Andrea K, Hobbs, FD Richard, REFER Investigators, Cowie, Martin, Davis, Russell, Deeks, Jon, Mant, Jonathan, McCahon, Deborah, McDonagh, Theresa, Sutton, George, Tait, Lynda, Mant, Jonathan [0000-0002-9531-0268], and Apollo - University of Cambridge Repository
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Heart Failure ,Male ,Primary Health Care ,Cost-Benefit Analysis ,Clinical Decision-Making ,Myocardial Infarction ,State Medicine ,England ,Cost benefit analysis ,Practice Guidelines as Topic ,Medical economics ,Economic model ,Edema ,Humans ,Female ,Prospective Studies ,General practice ,Natriuretic peptide ,Aged ,Follow-Up Studies - Abstract
BACKGROUND: Detection and treatment of heart failure (HF) can improve quality of life and reduce premature mortality. However, symptoms such as breathlessness are common in primary care, have a variety of causes and not all patients require cardiac imaging. In systems where healthcare resources are limited, ensuring those patients who are likely to have HF undergo appropriate and timely investigation is vital. DESIGN: A decision tree was developed to assess the cost-effectiveness of using the MICE (Male, Infarction, Crepitations, Edema) decision rule compared to other diagnostic strategies to identify HF patients presenting to primary care. METHODS: Data from REFER (REFer for EchocaRdiogram), a HF diagnostic accuracy study, was used to determine which patients received the correct diagnosis decision. The model adopted a UK National Health Service (NHS) perspective. RESULTS: The current recommended National Institute for Health and Care Excellence (NICE) guidelines for identifying patients with HF was the most cost-effective option with a cost of £4400 per quality adjusted life year (QALY) gained compared to a "do nothing" strategy. That is, patients presenting with symptoms suggestive of HF should be referred straight for echocardiography if they had a history of myocardial infarction or if their NT-proBNP level was ≥400pg/ml. The MICE rule was more expensive and less effective than the other comparators. Base-case results were robust to sensitivity analyses. CONCLUSIONS: This represents the first cost-utility analysis comparing HF diagnostic strategies for symptomatic patients. Current guidelines in England were the most cost-effective option for identifying patients for confirmatory HF diagnosis. The low number of HF with Reduced Ejection Fraction patients (12%) in the REFER patient population limited the benefits of early detection.
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- 2018
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32. An Occupational Therapy intervention for residents with stroke-related disabilities in UK Care Homes (OTCH): cluster randomised controlled trial with economic evaluation
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Sackley, Catherine M, Walker, Marion F, Burton, Christopher R, Watkins, Caroline L, Mant, Jonathan, Roalfe, Andrea K, Wheatley, Keith, Sheehan, Bart, Sharp, Leslie, Stant, Katie E, Fletcher-Smith, Joanna, Steel, Kerry, Barton, Garry R, Irvine, Lisa, Peryer, Guy, OTCH Investigators, Mant, Jonathan [0000-0002-9531-0268], and Apollo - University of Cambridge Repository
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Aged, 80 and over ,Male ,Stroke ,Technology Assessment, Biomedical ,Occupational Therapy ,Ischemic Attack, Transient ,Cost-Benefit Analysis ,Surveys and Questionnaires ,Activities of Daily Living ,Humans ,Female ,Quality-Adjusted Life Years ,United Kingdom - Abstract
BACKGROUND: Care home residents with stroke-related disabilities have significant activity limitations. Phase II trial results suggested a potential benefit of occupational therapy (OT) in maintaining residents' capacity to engage in functional activity. OBJECTIVE: To evaluate the clinical effectiveness and cost-effectiveness of a targeted course of OT in maintaining functional activity and reducing further health risks from inactivity for UK care home residents living with stroke-related disabilities. DESIGN: Pragmatic, parallel-group, cluster randomised controlled trial with economic evaluation. Cluster randomisation occurred at the care-home level. Homes were stratified according to trial administrative centre and type of care provided (nursing or residential), and they were randomised 1 : 1 to either the intervention or the control arm. SETTING: The setting was 228 care homes which were local to 11 trial administrative centres across England and Wales. PARTICIPANTS: Care home residents with a history of stroke or transient ischaemic attack, including residents with communication and cognitive impairments, not receiving end-of-life care. INTERVENTION: Personalised 3-month course of OT delivered by qualified therapists. Care workers participated in training workshops to support personal activities of daily living. The control condition consisted of usual care for residents. MAIN OUTCOME MEASURES: Outcome data were collected by a blinded assessor. The primary outcome at the participant level was the Barthel Index of Activities of Daily Living (BI) score at 3 months. The secondary outcomes included BI scores at 6 and 12 months post randomisation, and the Rivermead Mobility Index, Geriatric Depression Scale-15 and European Quality of Life-5 Dimensions, three levels, questionnaire scores at all time points. Economic evaluation examined the incremental cost per quality-adjusted life-year (QALY) gain. Costs were estimated from the perspective of the NHS and Personal Social Services. RESULTS: Overall, 568 residents from 114 care homes were allocated to the intervention arm and 474 residents from another 114 care homes were allocated to the control arm, giving a total of 1042 participants. Randomisation occurred between May 2010 and March 2012. The mean age of participants was 82.9 years, and 665 (64%) were female. No adverse events attributable to the intervention were recorded. Of the 1042 participants, 870 (83%) were included in the analysis of the primary outcome (intervention, n = 479; control, n = 391). The primary outcome showed no significant differences between groups. The adjusted mean difference in the BI score between groups was 0.19 points higher in the intervention arm [95% confidence interval (CI) -0.33 to 0.70, p = 0.48; adjusted intracluster correlation coefficient 0.09]. Secondary outcome measures showed no significant differences at all time points. Mean incremental cost of the Occupational Therapy intervention for residents with stroke living in UK Care Homes intervention was £438.78 (95% CI -£3360.89 to £1238.46) and the incremental QALY gain was 0.009 (95% CI -0.030 to 0.048). LIMITATIONS: A large proportion of participants with very severe activity-based limitations and cognitive impairment may have limited capacity to engage in therapy. CONCLUSION: A 3-month individualised course of OT showed no benefit in maintaining functional activity in an older care home population with stroke-related disabilities. FUTURE WORK: There is an urgent need to reduce health-related complications caused by inactivity and to provide an enabling built environment within care homes. TRIAL REGISTRATION: Current Controlled Trials ISRCTN00757750. FUNDING: This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 15. See the Health Technology Assessment programme website for further project information.
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- 2018
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33. Additional file 1: of Survival of patients with chronic heart failure in the community: a systematic review and meta-analysis protocol
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Jones, Nicholas, Roalfe, Andrea K., Ibiye Adoki, F. Richard Hobbs, and Taylor, Clare
- Abstract
PRISMA-P 2015 Checklist. (DOCX 32 kb)
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- 2018
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34. Trends in survival after a diagnosis of heart failure in the United Kingdom 2000-2017: population based cohort study
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Taylor, Clare J, primary, Ordóñez-Mena, José M, additional, Roalfe, Andrea K, additional, Lay-Flurrie, Sarah, additional, Jones, Nicholas R, additional, Marshall, Tom, additional, and Hobbs, F D Richard, additional
- Published
- 2019
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35. National trends in heart failure mortality in men and women, United Kingdom, 2000–2017.
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Taylor, Clare J., Ordóñez‐Mena, José M., Jones, Nicholas R., Roalfe, Andrea K., Lay‐Flurrie, Sarah, Marshall, Tom, and Hobbs, F.D. Richard
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WOMEN'S mortality ,GENDER ,DEATH rate ,OLDER men ,HEART failure ,HOSPITAL statistics - Abstract
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. During the study period 15 084 women and 15 822 men with heart failure died. Women were on average 5 years older at diagnosis (79.6 vs. 74.8 years). Median survival was lower in women compared to men (3.99 vs. 4.47 years), but women had a 14% age‐adjusted lower risk of all‐cause mortality [hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.84–0.88]. Heart failure was equally likely to be cause of death in women and men (HR 1.03, 95% CI 0.96–1.12). There were modest improvements in survival for both genders, but these were greater in men. The reduction in mortality risk in women was greatest for those diagnosed in the community (HR 0.83, 95% CI 0.80–0.85). Conclusions: Women are diagnosed with heart failure older than men but have a better age‐adjusted prognosis. Survival gains were less in women over the last two decades. Addressing gender differences in heart failure diagnostic and treatment pathways should be a clinical and research priority. [ABSTRACT FROM AUTHOR]
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- 2021
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36. Standardisation of rates using logistic regression: a comparison with the direct method
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Wilson Sue, Holder Roger L, and Roalfe Andrea K
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Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Standardisation of rates in health services research is generally undertaken using the direct and indirect arithmetic methods. These methods can produce unreliable estimates when the calculations are based on small numbers. Regression based methods are available but are rarely applied in practice. This study demonstrates the advantages of using logistic regression to obtain smoothed standardised estimates of the prevalence of rare disease in the presence of covariates. Methods Step by step worked examples of the logistic and direct methods are presented utilising data from BETS, an observational study designed to estimate the prevalence of subclinical thyroid disease in the elderly. Rates calculated by the direct method were standardised by sex and age categories, whereas rates by the logistic method were standardised by sex and age as a continuous variable. Results The two methods produce estimates of similar magnitude when standardising by age and sex. The standard errors produced by the logistic method were lower than the conventional direct method. Conclusion Regression based standardisation is a practical alternative to the direct method. It produces more reliable estimates than the direct or indirect method when the calculations are based on small numbers. It has greater flexibility in factor selection and allows standardisation by both continuous and categorical variables. It therefore allows standardisation to be performed in situations where the direct method would give unreliable results.
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- 2008
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37. Evaluation of the Birmingham IBS symptom questionnaire
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Wilson Sue, Roberts Lesley M, and Roalfe Andrea K
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Abstract Background Irritable Bowel Syndrome (IBS) is a chronic/common condition that causes a significant effect on the individual (reduced quality of life), society (time lost off work) and health services. Comparison of studies evaluating the management of IBS has been hindered by the lack of a widely adopted validated symptom score. The aim of this study was to develop and validate a disease specific score to measure the symptoms of patients with IBS. Methods A self-administered 14-item symptom questionnaire (based on Rome II criteria) was mailed to 533 persons included in a prevalence study of IBS. The reliability of each underlying dimension identified was measured by Cronbach's α. Validity was assessed by comparing symptom scores with concurrent IBS specific quality of life (QoL) scores. Reproducibility was measured by the test-retest method and responsiveness measured by effect size. Results 379 (71%) questionnaires were returned. The underlying dimensions identified were pain, diarrhoea and constipation. Cronbach's α was 0.74 for pain, 0.90 for diarrhoea and 0.79 for constipation. Pain and diarrhoea dimensions had good external validity (r = -0.3 to -0.6), constipation dimension had moderate external validity (r = -0.2 to -0.3). All dimensions were reproducible (ICCs 0.75 to 0.81). Effect sizes of 0.27 to 0.53 were calculated for those with a reported improvement in symptoms. Conclusion The Birmingham IBS Symptom Questionnaire has been developed and tested. It has been shown to be suitable for self-completion and acceptable to patients. The questionnaire has 3 internal dimensions which have good reliability, external validity and are responsive to a change in health status.
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- 2008
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38. Aerobic exercise for vasomotor menopausal symptoms: A cost-utility analysis based on the Active Women trial
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Goranitis, Ilias, primary, Bellanca, Leana, additional, Daley, Amanda J., additional, Thomas, Adele, additional, Stokes-Lampard, Helen, additional, Roalfe, Andrea K., additional, and Jowett, Sue, additional
- Published
- 2017
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39. The REFER (REFer for EchocaRdiogram) study: a prospective validation and health economic analysis of a clinical decision rule, NT-proBNP or their combination in the diagnosis of heart failure in primary care
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Taylor, Clare J, primary, Monahan, Mark, additional, Roalfe, Andrea K, additional, Barton, Pelham, additional, Iles, Rachel, additional, and Hobbs, FD Richard, additional
- Published
- 2017
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40. Prevalencia de la fibrilación auricular en la población general y en grupos de alto riesgo: estudio ECHOES
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Davis, Russell C., Hobbs, F.D. Richard, Kenkre, Joyce E., Roalfe, Andrea K., Iles, Rachel, Lip, Gregory Y.H., and Davies, Michael K.
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FACTORES DE RIESGO ,ATRIAL FIBRILLATION ,MORTALITY ,RISK FACTORS ,PREVALENCIA ,MORTALIDAD ,FIBRILACIóN AURICULAR ,PREVALENCE - Abstract
Resumen Objetivos: establecer la prevalencia de la fibrilación auricular (FA) en la población general en el Reino Unido y en los individuos con factores de riesgo. Método y resultados: se estableció la prevalencia de la FA electrocardiográfica en grupos seleccionados de forma prospectiva; se seleccionaron aleatoriamente 3.960 individuos de la población, mayores de 45 años; 782 tenían diagnóstico previo de insuficiencia cardíaca y 1.062 con antecedente de infarto de miocardio, hipertensión, angina de pecho o diabetes. Los pacientes también fueron evaluados clínicamente y mediante ecocardiografía. Se hizo un seguimiento de la mortalidad durante ocho años. Se encontró FA en 78 de la muestra aleatoria de la población (2,0%). La prevalencia fue de 1,6% en las mujeres y de 2,4% en los hombres, aumentando con la edad, yendo desde 0,2% en los sujetos de entre 45 y 54 años, hasta 8,0% en los de 75 años o mayores. La mitad de todos los casos eran en pacientes de 75 años o mayores. Solo 23 de los 78 (29,5%) con diagnóstico de FA estaban recibiendo warfarina. De los 782 pacientes, 175 (22,4%) con diagnóstico de insuficiencia cardíaca presentaban FA, y 95 (54,3%) de ellos tenían una función ventricular izquierda normal. Se constató FA en 14 de los 244 (5,7%) pacientes con antecedentes de infarto de miocardio; en 15 de los 388 (3,9%) pacientes con hipertensión; en 15 de los 321 (4,7%) pacientes con angina, y en 11 de los 208 (5,3%) pacientes diabéticos. Ajustando por edad y sexo, la mortalidad fue 1,57 veces mayor en quienes presentaban FA. Conclusión: la FA es frecuente en ancianos y en personas con factores de riesgo clínico. Un tamizaje de estos grupos permitiría identificar a muchos individuos con FA. El uso de anticoagulación era bajo en la época en que se hizo la evaluación inicial, a fines de los años 90, pero la práctica puede haber cambiado en los últimos tiempos. Summary Aim: To establish the prevalence of atrial fibrillation (AF) in the general population in the UK, and in those with risk factors. Methods and results: The prevalence of AF on electrocardiography was established in prospectively selected groups: 3960 randomly selected from the population, aged 45+; 782 with a previous diagnosis of heart failure; and 1062 with a record of myocardial infarction, hypertension, angina, or diabetes. Patients were also assessed clinically and with echocardiography. Mortality was tracked for 8 years. Atrial fibrillation was found in 78 of the random population sample (2.0%). Prevalence was 1.6% in women and 2.4% in men, rising with age from 0.2% in those aged 45-54 to 8.0% in those aged 75 and older. Half of all cases were in patients aged 75 and older. Only 23 of the 78 (29.5%) of those in AF took warfarin. Of the 782 patients, 175 (22.4%) with a diagnosis of heart failure were in AF, with normal left ventricular function in 95 (54.3%) of these. Atrial fibrillation was found in 14 of the 244 (5.7%) of those with a history of myocardial infarction, 15 of the 388 (3.9%) of those with hypertension, 15 of the 321 (4.7%) of those with angina, and 11 of the 208 (5.3%) of diabetics. Adjusting for age and sex, mortality was 1.57 times higher for those in AF. Conclusion: Atrial fibrillation is common in the elderly and those with clinical risk factors. Screening these groups would identify many with AF. Use of anticoagulation was low at the time of the initial assessments in the late 1990s; practice may have changed recently
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- 2013
41. Primary care REFerral for EchocaRdiogram (REFER) in heart failure: a diagnostic accuracy study.
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Taylor, Clare J., Roalfe, Andrea K., Iles, Rachel, Hobbs, F.D. Richard, Hobbs, Fd Richard, REFER investigators, Barton, P, Deeks, J, McCahon, D, Cowie, M R, Sutton, G, Davis, R C, Mant, J, McDonagh, T, and Tait, L
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PRIMARY care ,ECHOCARDIOGRAPHY ,HEART failure ,MEDICAL decision making ,FAMILY medicine ,NATRIURETIC peptides ,DIAGNOSIS ,COMPARATIVE studies ,DYSPNEA ,ELECTROCARDIOGRAPHY ,EXPERIMENTAL design ,FATIGUE (Physiology) ,LONGITUDINAL method ,RESEARCH methodology ,MEDICAL cooperation ,MEDICAL protocols ,MEDICAL referrals ,PEPTIDE hormones ,PEPTIDES ,PRIMARY health care ,RESEARCH ,RESEARCH funding ,EVALUATION research ,RECEIVER operating characteristic curves - Abstract
Background: Symptoms of breathlessness, fatigue, and ankle swelling are common in general practice but deciding which patients are likely to have heart failure is challenging.Aim: To evaluate the performance of a clinical decision rule (CDR), with or without N-Terminal pro-B type natriuretic peptide (NT-proBNP) assay, for identifying heart failure.Design and Setting: Prospective, observational, diagnostic validation study of patients aged >55 years, presenting with shortness of breath, lethargy, or ankle oedema, from 28 general practices in England.Method: The outcome was test performance of the CDR and natriuretic peptide test in determining a diagnosis of heart failure. The reference standard was an expert consensus panel of three cardiologists.Results: Three hundred and four participants were recruited, with 104 (34.2%; 95% confidence interval [CI] = 28.9 to 39.8) having a confirmed diagnosis of heart failure. The CDR+NT-proBNP had a sensitivity of 90.4% (95% CI = 83.0 to 95.3) and specificity 45.5% (95% CI = 38.5 to 52.7). NT-proBNP level alone with a cut-off <400 pg/ml had sensitivity 76.9% (95% CI = 67.6 to 84.6) and specificity 91.5% (95% CI = 86.7 to 95.0). At the lower cut-off of NT-proBNP <125 pg/ml, sensitivity was 94.2% (95% CI = 87.9 to 97.9) and specificity 49.0% (95% CI = 41.9 to 56.1).Conclusion: At the low threshold of NT-proBNP <125 pg/ml, natriuretic peptide testing alone was better than a validated CDR+NT-proBNP in determining which patients presenting with symptoms went on to have a diagnosis of heart failure. The higher NT-proBNP threshold of 400 pg/ml may mean more than one in five patients with heart failure are not appropriately referred. Guideline natriuretic peptide thresholds may need to be revised. [ABSTRACT FROM AUTHOR]- Published
- 2017
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42. Do members of the British public know how to contact emergency medical services when abroad?
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Hudson, Kate R., primary, Jawad, Maryam, additional, Kingdon, Samantha, additional, Thomas, Elin H., additional, Roalfe, Andrea K., additional, and Daley, Amanda J., additional
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- 2013
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43. Influenza vaccination of future healthcare workers: A cross-sectional study of uptake, knowledge and attitudes
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Blank, Debra L., primary, Bodansky, David M.S., additional, Forbes, Anna, additional, Garde, Emma, additional, Story, Fleur, additional, Roalfe, Andrea K., additional, and Tait, Lynda, additional
- Published
- 2010
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44. Standardisation of rates using logistic regression: a comparison with the direct method
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Roalfe, Andrea K, primary, Holder, Roger L, additional, and Wilson, Sue, additional
- Published
- 2008
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45. Evaluation of the Birmingham IBS symptom questionnaire
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Roalfe, Andrea K, primary, Roberts, Lesley M, additional, and Wilson, Sue, additional
- Published
- 2008
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46. Observational longitudinal cohort study to determine progression to heart failure in a screened community population: the Echocardiographic Heart of England Screening Extension (ECHOES-X) study.
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Taylor, Clare J., Roalfe, Andrea K., Tait, Lynda, Davis, Russell C., Iles, Rachel, Derit, Marites, and Hobbs, F. D. Richard
- Abstract
Objectives: Rescreen a large community cohort to examine the progression to heart failure over time and the role of natriuretic peptide testing in screening. Design: Observational longitudinal cohort study. Setting: 16 socioeconomically diverse practices in central England. Participants: Participants from the original Echocardiographic Heart of England Screening (ECHOES) study were invited to attend for rescreening. Outcome measures: Prevalence of heart failure at rescreening overall and for each original ECHOES subgroup. Test performance of N Terminal pro-B-type Natriuretic Peptide (NT-proBNP) levels at different thresholds for screening. Results: 1618 of 3408 participants underwent screening which represented 47% of survivors and 26% of the original ECHOES cohort. A total of 176 (11%, 95% CI 9.4% to 12.5%) participants were classified as having heart failure at rescreening; 103 had heart failure with reduced ejection fraction (HFREF) and 73 had heart failure with preserved ejection fraction (HFPEF). Sixty-eight out of 1232 (5.5%, 95% CI 4.3% to 6.9%) participants who were recruited from the general population over the age of 45 and did not have heart failure in the original study, had heart failure on rescreening. An NT-proBNP cut-off of 400 pg/mL had sensitivity for a diagnosis of heart failure of 79.5% (95% CI 72.4% to 85.5%) and specificity of 87% (95% CI 85.1% to 88.8%). Conclusions: Rescreening identified new cases of HFREF and HFPEF. Progression to heart failure poses a significant threat over time. The natriuretic peptide cut-off level for ruling out heart failure must be low enough to ensure cases are not missed at screening. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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47. Development and initial validation of a simple clinical decision tool to predict the presence of heart failure in primary care: the MICE (Male, Infarction, Crepitations, Edema) rule.
- Author
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Roalfe AK, Mant J, Doust JA, Barton P, Cowie MR, Glasziou P, Mant D, McManus RJ, Holder R, Deeks JJ, Doughty RN, Hoes AW, Fletcher K, Hobbs FD, Roalfe, Andrea K, Mant, Jonathan, Doust, Jenny A, Barton, Pelham, Cowie, Martin R, and Glasziou, Paul
- Abstract
Aims: Diagnosis of heart failure in primary care is often inaccurate, and access to and use of echocardiography is suboptimal. This study aimed to develop and provisionally validate a clinical prediction rule to optimize referral for echocardiography of people identified in primary care with suspected heart failure.Methods and Results: A systematic review identified studies of diagnosis of heart failure set in primary care. The individual patient data for five of these studies were obtained. Logistic regression models to predict heart failure were developed on one of the data sets and validated on the others using area under the receiver operating characteristic curve (AUROC), and goodness-of-fit calibration plots. A model based upon four simple clinical features (Male, history of myocardial Infarction, Crepitations, Edema: MICE) and natriuretic peptide had good validity when applied to other data sets, with AUROCs between 0.84 and 0.93, and reasonable calibration. The rule performed well across the data sets, with sensitivity between 81% and 96% and specificity between 57% and 74%.Conclusions: A simple clinical rule based upon gender, history of myocardial infarction, presence of ankle oedema, and presence of basal lung crepitations can discriminate between people with suspected heart failure who should be referred straight for echocardiography and people for whom referral should depend upon the result of a natriuretic peptide test. Prospective validation and an implementation evaluation of the rule is now warranted. [ABSTRACT FROM AUTHOR]- Published
- 2012
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48. Estimated stroke risk, yield, and number needed to screen for atrial fibrillation detected through single time screening: a multicountry patient-level meta-analysis of 141,220 screened individuals
- Author
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Lowres, Nicole, Olivier, Jake, Chao, Tze-Fan, Chen, Shih-Ann, Chen, Yi, Diederichsen, Axel, Fitzmaurice, David A, Gomez-Doblas, Juan Jose, Harbison, Joseph, Healey, Jeff S, Hobbs, FD Richard, Kaasenbrood, Femke, Keen, William, Lee, Vivian W, Lindholt, Jes S, Lip, Gregory YH, Mairesse, Georges H, Mant, Jonathan, Martin, Julie W, Martín-Rioboó, Enrique, McManus, David D, Muñiz, Javier, Münzel, Thomas, Nakamya, Juliet, Neubeck, Lis, Orchard, Jessica J, Pérula De Torres, Luis Ángel, Proietti, Marco, Quinn, F Russell, Roalfe, Andrea K, Sandhu, Roopinder K, Schnabel, Renate B, Smyth, Breda, Soni, Apurv, Tieleman, Robert, Wang, Jiguang, Wild, Philipp S, Yan, Bryan P, and Freedman, Ben
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Adult ,Aged, 80 and over ,Male ,Age Factors ,Middle Aged ,Prognosis ,Risk Assessment ,3. Good health ,Stroke ,Electrocardiography ,Young Adult ,Sex Factors ,Predictive Value of Tests ,Risk Factors ,Atrial Fibrillation ,Humans ,Mass Screening ,Female ,Aged - Abstract
BACKGROUND: The precise age distribution and calculated stroke risk of screen-detected atrial fibrillation (AF) is not known. Therefore, it is not possible to determine the number needed to screen (NNS) to identify one treatable new AF case (NNS-Rx) (i.e., Class-1 oral anticoagulation [OAC] treatment recommendation) in each age stratum. If the NNS-Rx is known for each age stratum, precise cost-effectiveness and sensitivity simulations can be performed based on the age distribution of the population/region to be screened. Such calculations are required by national authorities and organisations responsible for health system budgets to determine the best age cutoffs for screening programs and decide whether programs of screening should be funded. Therefore, we aimed to determine the exact yield and calculated stroke-risk profile of screen-detected AF and NNS-Rx in 5-year age strata. METHODS AND FINDINGS: A systematic review of Medline, Pubmed, and Embase was performed (January 2007 to February 2018), and AF-SCREEN international collaboration members were contacted to identify additional studies. Twenty-four eligible studies were identified that performed a single time point screen for AF in a general ambulant population, including people ≥65 years. Authors from eligible studies were invited to collaborate and share patient-level data. Statistical analysis was performed using random effects logistic regression for AF detection rate, and Poisson regression modelling for CHA2DS2-VASc scores. Nineteen studies (14 countries from a mix of low- to middle- and high-income countries) collaborated, with 141,220 participants screened and 1,539 new AF cases. Pooled yield of screening was greater in males across all age strata. The age/sex-adjusted detection rate for screen-detected AF in ≥65-year-olds was 1.44% (95% CI, 1.13%-1.82%) and 0.41% (95% CI, 0.31%-0.53%) for 70% have ≥1 additional stroke risk factor other than age/sex. Our data, based on the largest number of screen-detected AF collected to date, show the precise relationship between yield and estimated stroke risk profile with age, and strong dependence for NNS-RX on the age distribution of the population to be screened: essential information for precise cost-effectiveness calculations.
49. Trends in survival after a diagnosis of heart failure in the United Kingdom 2000-2017 : population based cohort study
- Author
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Taylor, Clare J, Ordóñez-Mena, José M, Roalfe, Andrea K, Lay-Flurrie, Sarah, Jones, Nicholas R, Marshall, Tom, and Hobbs, F D Richard
50. Estimated stroke risk, yield, and number needed to screen for atrial fibrillation detected through single time screening: a multicountry patient-level meta-analysis of 141,220 screened individuals
- Author
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F. Russell Quinn, Vivian W Y Lee, Philipp S. Wild, David Fitzmaurice, William Keen, Yi Chen, Georges H. Mairesse, Julie W. Martin, Juan José Gómez-Doblas, Jake Olivier, Thomas Münzel, Juliet Nakamya, FD Richard Hobbs, Nicole Lowres, Joseph Harbison, Ben Freedman, Jeff S. Healey, Breda Smyth, Gregory Y.H. Lip, Andrea K Roalfe, Shih Ann Chen, Roopinder K. Sandhu, Luis Ángel Pérula de Torres, Tze Fan Chao, Jonathan Mant, Axel Cosmus Pyndt Diederichsen, Bryan P. Yan, Femke Kaasenbrood, Lis Neubeck, Marco Proietti, Ji-Guang Wang, David D. McManus, Jessica Orchard, Renate B. Schnabel, Enrique Martín-Rioboó, Jes S. Lindholt, Javier Muñiz, Robert G. Tieleman, Apurv Soni, Lowres, Nicole [0000-0001-9061-3406], Olivier, Jake [0000-0002-3144-4507], Diederichsen, Axel [0000-0002-1285-4826], Gomez-Doblas, Juan Jose [0000-0002-9020-639X], Harbison, Joseph [0000-0003-3680-5751], Hobbs, FD Richard [0000-0001-7976-7172], Kaasenbrood, Femke [0000-0003-4404-3646], Lindholt, Jes S [0000-0001-9536-4488], Lip, Gregory YH [0000-0002-7566-1626], Mairesse, Georges H [0000-0002-2255-4181], Mant, Jonathan [0000-0002-9531-0268], Muñiz, Javier [0000-0002-3087-2067], Münzel, Thomas [0000-0001-5503-4150], Neubeck, Lis [0000-0001-5852-1034], Orchard, Jessica J [0000-0002-5702-7277], Pérula de Torres, Luis Ángel [0000-0002-8784-4905], Proietti, Marco [0000-0003-1452-2478], Roalfe, Andrea K [0000-0003-1622-2639], Wild, Philipp S [0000-0003-4413-9752], Freedman, Ben [0000-0002-3809-2911], and Apollo - University of Cambridge Repository
- Subjects
Male ,Health Screening ,Economics ,Social Sciences ,030204 cardiovascular system & hematology ,Vascular Medicine ,Screening programme ,Electrocardiography ,0302 clinical medicine ,Risk Factors ,Health care ,Atrial Fibrillation ,Medicine and Health Sciences ,Mass Screening ,Public and Occupational Health ,030212 general & internal medicine ,media_common ,Aged, 80 and over ,Age Factors ,General Medicine ,Middle Aged ,University hospital ,Prognosis ,3. Good health ,Stroke ,Bioassays and Physiological Analysis ,Neurology ,Health ,Medicine ,Female ,Training program ,Arrhythmia ,Research Article ,Adult ,Cerebrovascular Diseases ,Cost-Effectiveness Analysis ,Cardiology ,Library science ,Research and Analysis Methods ,Risk Assessment ,Stroke risk ,03 medical and health sciences ,Young Adult ,Age Distribution ,Sex Factors ,Population Metrics ,Predictive Value of Tests ,Political science ,media_common.cataloged_instance ,Humans ,Early career ,European union ,Ischemic Stroke ,Aged ,Health Care Policy ,Population Biology ,business.industry ,Electrophysiological Techniques ,Biology and Life Sciences ,Number needed to screen ,Economic Analysis ,Health Care ,Age Groups ,People and Places ,eHealth ,Population Groupings ,Cardiac Electrophysiology ,business ,Screening Guidelines - Abstract
Background The precise age distribution and calculated stroke risk of screen-detected atrial fibrillation (AF) is not known. Therefore, it is not possible to determine the number needed to screen (NNS) to identify one treatable new AF case (NNS-Rx) (i.e., Class-1 oral anticoagulation [OAC] treatment recommendation) in each age stratum. If the NNS-Rx is known for each age stratum, precise cost-effectiveness and sensitivity simulations can be performed based on the age distribution of the population/region to be screened. Such calculations are required by national authorities and organisations responsible for health system budgets to determine the best age cutoffs for screening programs and decide whether programs of screening should be funded. Therefore, we aimed to determine the exact yield and calculated stroke-risk profile of screen-detected AF and NNS-Rx in 5-year age strata. Methods and findings A systematic review of Medline, Pubmed, and Embase was performed (January 2007 to February 2018), and AF-SCREEN international collaboration members were contacted to identify additional studies. Twenty-four eligible studies were identified that performed a single time point screen for AF in a general ambulant population, including people ≥65 years. Authors from eligible studies were invited to collaborate and share patient-level data. Statistical analysis was performed using random effects logistic regression for AF detection rate, and Poisson regression modelling for CHA2DS2-VASc scores. Nineteen studies (14 countries from a mix of low- to middle- and high-income countries) collaborated, with 141,220 participants screened and 1,539 new AF cases. Pooled yield of screening was greater in males across all age strata. The age/sex-adjusted detection rate for screen-detected AF in ≥65-year-olds was 1.44% (95% CI, 1.13%–1.82%) and 0.41% (95% CI, 0.31%–0.53%) for 70% have ≥1 additional stroke risk factor other than age/sex. Our data, based on the largest number of screen-detected AF collected to date, show the precise relationship between yield and estimated stroke risk profile with age, and strong dependence for NNS-RX on the age distribution of the population to be screened: essential information for precise cost-effectiveness calculations., Nicole Lowres and colleagues report on stroke risk in people with atrial fibrillation detected by screening., Author summary Why was this study done? Atrial fibrillation is a common heart rhythm problem that often has no symptoms, so people are unaware they have this condition. People with atrial fibrillation can have a very high stroke risk if they are not appropriately treated with anticoagulant medications, and this risk increases with age. Screening for atrial fibrillation is recommended in many guidelines, although the precise age distribution and calculated stroke risk of atrial fibrillation detected by screening is not known. Accurate age-specific data are required for cost-effectiveness analysis, to inform the most appropriate age cutoff for screening based on the age distribution of the population to be screened. What did the researchers do and find? Investigators from 19 atrial fibrillation screening studies across the world agreed to collaborate and share patient-level data, providing a combined database of 141,220 people screened and 1,539 screen-detected cases of atrial fibrillation. Our study was able to quantify the yield and stroke risk for atrial fibrillation in 5-year age brackets, showing the exact relationship of how the yield of screening and stroke risk of screen-detected atrial fibrillation increases with age. The yield of screening was not influenced by the screening method used or the recruitment setting, indicating that screening programs can be established based on available resources. To our knowledge, this is the first study to demonstrate the precise relationship of the number that need to be screened to identify one new atrial fibrillation case, or one new atrial fibrillation case in whom anticoagulant treatment is guideline recommended, in 5-year age brackets. What do these findings mean? This study demonstrates the high calculated stroke risk of screen-detected AF and the high proportion with at least one additional stroke risk factor other than age or sex. These data allow for accurate simulations of cost-effectiveness of screening, including sensitivity analyses, based on the age distribution of the population to be screened. Ultimately, these data may be used to assist development of health policy around the development of atrial fibrillation screening programs, tailored to the specific health system and resources available.
- Published
- 2019
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