Cardiovascular disease (CVD) is a class of illness involving the heart or blood vessels. In the past, studies have tended to look at either the development of new CVD in healthy people or the progression of CVD in patients who already had the disease. Studies that examine both CVD development and progression are rare, but allow researchers to compare the risk of death in healthy people and patients with different types of CVD. This comparison may help identify patients at particular risk of death, for example in men compared to women, ethnic groups, and across different age groups. It will also allow researchers to study whether patients at greater risk of death differ from low-risk patients in terms of the care they received and what their risk factors are. The results may allow researchers to identify how doctors can ensure the best care for all patients. We therefore use data available for patients admitted to hospital with CVD in England linked to general practice and death certificate data to investigate what people then go on and die from in healthy people and CVD patients.
Epidemiological research in cardiovascular disease (CVD) is traditionally divided into incidence and prognostic studies investigating respectively the period up to and the periods after the occurrence of CVD events. Investigations are rare that combine these two periods among healthy individuals and survivors of CVD within the same study population. Such studies allow researchers to compare patients from primary and hospital care with regard to mortality risk using the period up to CVD events as baseline risk period. This cohort study therefore jointly examines data from the general population (CPRD) and CVD patients (HES) in relation to disease-free survival and post-CVD prognosis (ONS). Healthy individuals enter the cohort in primary care and are followed up for mortality up to and after the initial presentation of 11 CVD phenotypes. Cox proportional hazard models will be used to estimate the effect of intercurrent non-fatal CVD events on CVD, non-CVD, and all-cause mortality. With this unified approach we will assess whether initial presentation of different CVD phenotypes has heterogeneous effects on the subsequent prognosis and possible explanations for such heterogeneities by differences in primary and/or secondary prevention. The study results may enable researchers to identify best practices and missed opportunities in current healthcare services.
Spiros Denaxas - Chief Investigator - University College London ( UCL )
Christof Prugger - Corresponding Applicant - Charite - University Of Medicine Berlin
Christof Prugger - Collaborator - Charite - University Of Medicine Berlin
Harry Hemingway - Collaborator - University College London ( UCL )
Jean-Philippe Empana - Collaborator - Inserm-transfert
Kenan Direk - Collaborator - University College London ( UCL )
Marie-Cecile Perier - Collaborator - Inserm-transfert
Muriel Tafflet - Collaborator - Inserm-transfert
Tobias Kurth - Collaborator - Charite - University Of Medicine Berlin
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation