Multi-vessel disease (MVD) is a severe heart condition where a blockage builds up inside more than one blood vessel in the heart. These vessels carry oxygen-rich blood to the heart. The blockage is called a plaque and is made up of fat, cholesterol, calcium, and other substances found in the blood. MVD is often associated with a higher risk of major adverse cardiovascular (MACE) events such as stroke, heart attack and death.
Although MVD is mostly associated with build-up of plaque inside blood vessels, there is still difficulty in predicting which patient groups are at a higher risk of MACE and who in turn should be targeted for intervention.
This study aims to understand which MVD patient groups are at a higher chance of getting MACE by looking at the effect of different factors on the occurrence of MACE. We shall also be able to profile patients with MACE and look at how much resources they consume in the health system.
With this study, we should be able to provide an in-depth look into MVD in England, which will allow changes in health policy and treatment patterns, especially targeting patients at risk factor of MACE and those who consume a lot of resources in the NHS.
The presence of multi-vessel disease (MVD) is defined by the presence of ? 50 percent stenosis of two or more epicardial coronary arteries. With current advancements in drug research, there is hope that MVD can be managed by management of cholesterol, treating high-risk patients following an acute myocardial infarction (MI) which would in turn reduce the morbidity, mortality and health care costs associated with them. However, there is limited understanding of the most at-risk patients which would affect the impact of targeted treatments if they are to be made available on the NHS. There is also a limited availability of knowledge on the prevalence of MVD and the incidence of Major Adverse Cardiovascular Events (MACE) in this group.
This study aims to ascertain the prevalence of MACE in patients diagnosed with MVD. This will be done by creating a cohort of patients with MVD using an algorithm based on codes. Three sub cohorts will be created out of the main cohort based on co-morbidity with diabetes and availability of at least one risk factor or availability of two or more risk factors (prior MI, Peripheral Artery Disease (PAD) or aged 65 or over).
We shall describe demographic characteristics, prevalence of MACE, cardiovascular treatment prescribed and mortality. Health care resource usage will also be calculated and reported for inpatient admissions, cost, length of stay and destination on discharge. Outcomes will be described as total, means, medians, percentage or rates as appropriate.
Unadjusted odds ratios and mean incidence along with 95% confidence intervals will be calculated for all MACE, MI, non-fatal stroke and cardiovascular death at 90 days and 1,2,3 and 4 years on comparing each cohort matched controls. We shall adjust for age, sex and any other risk factors that we may identify as having an effect on the dependent variables.
Prevalence of MVD; Demographics (Mean and median age on inclusion, age distribution by decade, sex distribution, deprivation, Charlson co-morbidity score distribution, mean and median follow-up, total and mean admitted time), prevalence of Myocardial infarction, non-fatal stroke, pulmonary embolism, cardiovascular death within the cohort; Healthcare resource outcomes (prescriptions issued in primary care, number of inpatient admissions, inpatient length of stay, inpatient HRG tariffs); Clinical outcomes (mortality, destination after discharge)
Adrian Paul J. Rabe - Chief Investigator - Health iQ Ltd ( UK ) t/a CorEvitas
Adrian Paul J. Rabe - Corresponding Applicant - Health iQ Ltd ( UK ) t/a CorEvitas
Gulsah Akin Unal - Collaborator - Health iQ Ltd ( UK ) t/a CorEvitas
Gulum Alamgir - Collaborator - Health iQ Ltd ( UK ) t/a CorEvitas
James Tilbury - Collaborator - Health iQ Ltd ( UK ) t/a CorEvitas
Jay Were - Collaborator - Health iQ Ltd ( UK ) t/a CorEvitas
Gulsah Akin Unal - Collaborator - Health iQ Ltd ( UK ) t/a CorEvitas
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation