BackgroundTo date, there has been no comprehensive study on the association between atrial fibrillation (AF) and multimorbidity. The present study investigated the epidemiology of AF and the association between multimorbidity and the onset of AF. In addition, the correlation between multimorbidity and the use of anticoagulants and the risk of cerebrovascular events considering multimorbidity was explored in AF patients.MethodsIntego is a primary care registry network in Belgium. A case–control study was performed using Intego data from a 10-year time interval (2002 to 2011). All patients aged 60 years and older in 2002 who had developed new AF between 2002 and 2011 were selected, as well as a group of matched control patients. In addition, the prescription of anticoagulants and incident cerebrovascular events were recorded in patients with AF.ResultsAF showed a prevalence of 5.3 % in 2002, and an upward trend was observed between 2002 and 2011. In all, 1830 patients with AF and 6622 control patients were included. AF patients had significantly more comorbidities (mCCI (modified Charlson Comorbidity Index) 5 ± 2 vs 4 ± 2, P < 0.001). In addition, 9.7 % of patients with AF developed a cerebrovascular event (mean follow-up time of 2.7 ± 2.5 years). Both the under- and overuse of anticoagulants was observed. Of the 49 % of patients with AF who were considered at high risk (CHADS2 ≥ 2), 50 % received anticoagulants in the first six months after diagnosis, whereas 49 % of patients who were at low risk (CHADS2 = 0) did not.ConclusionsAF is highly prevalent in older primary care patients and is significantly associated with multimorbidity. A discrepancy between the guidelines and clinical practice of anticoagulant use was observed. As multimorbidity seems to play a role in this, further qualitative research to study the perception and motives of the general practitioner is needed.

ObjectivesTo examine the relation between static and dynamic blood pressure (BP) measurements and the evolution of kidney function in older people, adjusted for the presence of multimorbidity.DesignRetrospective cohort study during a 10-year time interval (2002–2012) in three age strata of patients aged 60 and older.SettingPrimary care registration network with 97 general practitioners working in 55 practices regularly submitting collected patient data.ParticipantsAll patients with at least one BP measurement in 2002 and at least four serum creatine measurements after 2002 (n=8636). A modified Charlson Comorbidity Index (mCCI) at baseline was registered. Change in systolic and diastolic BP (DBP) and pulse pressure (PP) from 2002 onwards was calculated. The relation between kidney function evolution and baseline BP and change in BP was examined using linear and logistic regression analysis.Main outcome measuresThe slope of the estimated glomerular filtration rate (eGFR, MDRD, Modification of Diet in Renal Disease equation) was calculated by the ordinal least square method. A rapid annual decline of kidney function was defined as ≥3 mL/min/1.73 m2/year.ResultsRapid annual decline of kidney function occurred in 1130 patients (13.1%). High baseline systolic BP (SBP) and PP predicted kidney function decline in participants aged 60–79 years. No correlation between baseline BP and kidney function decline was found in participants aged 80 years and older. An annual decline of ≥1 mm Hg in SBP and PP was a strong risk factor for a rapid annual kidney function decline in all age strata, independent of baseline BP and mCCI. A decline in DBP as also a strong independent predictor in participants aged 60–79 years.ConclusionsThe present study identified a decline in BP over time as a strong risk factor for kidney function decline in all age strata, adjusted for mCCI and baseline kidney function and BP.

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BackgroundThe number of newly diagnosed gonorrhoea and syphilis cases has increased in Flanders in recent years. Our aim was to investigate, to which extent these diagnoses were registered by general practitioners (GPs), and to examine opportunities and limits of the Intego database in this regard.MethodsData from a retrospective cohort study based on the Flemish Intego general practice database was analyzed for the years 2009–2013. Case definitions were applied. Due to small case numbers obtained, cases were pooled and averaged over the observation period. Frequencies were compared with those calculated from figures of mandatory notification.ResultsA total of 91 gonorrhoea and 23 syphilis cases were registered. The average Intego annual frequency of gonorrhoea cases obtained was 11.9 (95% Poisson confidence interval (CI) 9.6; 14.7) per 100,000 population, and for syphilis 3.0 (CI 1.9; 4.5), respectively, while mandatory notification was calculated at 14.0 (CI: 13.6, 14.4) and 7.0 (CI: 6.7, 7.3), respectively.ConclusionIn spite of limitations such as small numbers and different case definitions, comparison with mandatory notification suggests that the GP was involved in the large majority of gonorrhoea cases, while the majority of new syphilis cases did not come to the knowledge of the GP.

Background General practitioners (GPs) as a group have been identified as playing an important role in gonorrhoea management in Flanders. Belgian guidelines recommended ceftriaxone or alternatively spectinomycin from 2008 onwards and azithromycin combination therapy since 2012. Objectives This study investigates to which extent contemporary gonorrhoea treatment guidelines were followed. Methods A retrospective cohort study (2009–2013) of antibiotic prescriptions for gonorrhoea cases registered in the Flemish Intego general practice database was carried out. The database is based on electronic health record routine registration by over 90 GPs using the software programme Medidoc. Results Ninety-one gonorrhoea cases with ten chlamydia and one genital trichomonas coinfections in 90 patients were registered between 2009 and 2013. The proportion of cases with ceftriaxone and/or spectinomycin prescriptions rose from 13% (two of 15 cases) in 2009 to 56% (nine of 16 cases) in 2013. Combination therapy of ceftriaxone and/or spectinomycin together with azithromycin rose from 0 of 15 cases (0%) in 2009 to 7 of 16 cases (44%) in 2013. Conclusion Although numbers are small, the results suggest that gonorrhoea therapy guideline adherence improved between 2009 and 2013.