Temporal variation in the diagnosis of resolved atrial fibrillation and the influence of performance targets on clinical coding: cohort study

Adderley, Nicola J; Nirantharakumar, Krishnarajah; Marshall, Tom

doi:10.1136/bmjopen-2019-030454

Cited by 4 publications

(2 citation statements)

References 18 publications

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“…Approval for this analysis was obtained from the Scientific Review Committee (for the use of IMRD data) in March 2020 (SRC reference No: 20SRC019). 13…”

Section: Ethicsmentioning

confidence: 99%

“…12 At the time of being coded as resolved AF, most were not receiving anticoagulants (82.6%; 95% CI = 81.9% to 83.3%) and most had never been prescribed anticoagulants (62.3%; 95% CI = 61.4 to 63.2). 13 Their removal from the register therefore increased the proportion on the register prescribed anticoagulants. This suggests introduction of a financial incentive led to an increase in coding of AF as resolved (that is, a diagnosis of resolved AF).…”

Section: Introductionmentioning

confidence: 99%

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An interrupted time-series analysis of the effects of withdrawal of financial incentives on diagnosis of atrial fibrillation as resolved. Does withdrawal of an incentive reverse its unintended effects?

et al. 2022

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BackgroundThe UK introduced financial incentives for management of atrial fibrillation (AF) in 2006, after which there was an increase in the proportion of AF patients diagnosed as resolved. Removal of incentives in Scotland provides a natural experiment to investigate the effects of withdrawal of an incentive on diagnosis of resolved AF.AimInvestigate effects of introduction and withdrawal of financial incentives on the diagnosis of resolved AF.Design & settingCohort study in a large database of UK primary care records, before and after introduction of incentives in April 2006 in Scotland, England and Northern Ireland, and their withdrawal in April 2016 in Scotland.MethodInterrupted time-series analysis of monthly rates of resolved AF. from January 2000 to September 2019.ResultsWe included 251,526 adult patients with AF, of whom 14,674 were diagnosed as resolved AF. In April 2006 there were similar shift-changes in rates of resolved AF per 1,000 in England 1.55 (95% CI: 1.11–2.00) and Northern Ireland 1.54 (95% CI: 0.91–2.18) and a smaller increase in Scotland 0.79 (95% CI: 0.04–1.53). There were modest downward post-introduction trends in all countries. After Scotland’s withdrawal of the incentive in April 2016 there was a small, statistically non-significant, downward shift in rate of resolved AF per 1000–0.39 (95% CI: −3.21–2.42) and no change in post-removal trend.ConclusionsIntroduction of a financial incentive coincided with an increase in resolved AF but we found no evidence its withdrawal led to a reduction.

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“…Approval for this analysis was obtained from the Scientific Review Committee (for the use of IMRD data) in March 2020 (SRC reference No: 20SRC019). 13…”

Section: Ethicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An interrupted time-series analysis of the effects of withdrawal of financial incentives on diagnosis of atrial fibrillation as resolved. Does withdrawal of an incentive reverse its unintended effects?

et al. 2022

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Interactions Between Atrial Fibrillation and Natriuretic Peptide in Predicting Heart Failure Hospitalization or Cardiovascular Death

Brady

Chua

Nehaj

et al. 2022

JAHA

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Background Natriuretic peptides are routinely quantified to diagnose heart failure (HF). Their concentrations are also elevated in atrial fibrillation (AF). To clarify their value in predicting future cardiovascular events, we measured natriuretic peptides in unselected patients with cardiovascular conditions and related their concentrations to AF and HF status and outcomes. Methods and Results Consecutive patients with cardiovascular conditions presenting to a large teaching hospital underwent clinical assessment, 7‐day ECG monitoring, and echocardiography to diagnose AF and HF. NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) was centrally quantified. Based on a literature review, four NT‐proBNP groups were defined (<300, 300–999, 1000–1999, and ≥2000 pg/mL). Clinical characteristics and NT‐proBNP concentrations were related to HF hospitalization or cardiovascular death. Follow‐up data were available in 1616 of 1621 patients (99.7%) and analysis performed at 2.5 years (median age, 70 [interquartile range, 60–78] years; 40% women). HF hospitalization or cardiovascular death increased from 36 of 488 (3.2/100 person‐years) in patients with neither AF nor HF, to 55 of 354 (7.1/100 person‐years) in patients with AF only, 92 of 369 (12.1/100 person‐years) in patients with HF only, and 128 of 405 (17.7/100 person‐years) in patients with AF plus HF ( P <0.001). Higher NT‐proBNP concentrations predicted the outcome in patients with AF only (C‐statistic, 0.82; 95% CI, 0.77–0.86; P <0.001) and in other phenotype groups (C‐statistic in AF plus HF, 0.66; [95% CI, 0.61–0.70]; P <0.001). Conclusions Elevated NT‐proBNP concentrations predict future HF events in patients with AF irrespective of the presence of HF, encouraging routine quantification of NT‐proBNP in the assessment of patients with AF.

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Prevalence and demographic variation of cardiovascular, renal, metabolic, and mental health conditions in 12 million english primary care records

Cooper,

Nirantharakumar,

Crowe

et al. 2023

BMC Med Inform Decis Mak

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Background Primary care electronic health records (EHR) are widely used to study long-term conditions in epidemiological and health services research. Therefore, it is important to understand how well the recorded prevalence of these conditions in EHRs, compares to other reliable sources overall, and varies by socio-demographic characteristics. We aimed to describe the prevalence and socio-demographic variation of cardiovascular, renal, and metabolic (CRM) and mental health (MH) conditions in a large, nationally representative, English primary care database and compare with prevalence estimates from other population-based studies. Methods This was a cross-sectional study using the Clinical Practice Research Datalink (CPRD) Aurum primary care database. We calculated prevalence of 18 conditions and used logistic regression to assess how this varied by age, sex, ethnicity, and socio-economic status. We searched the literature for population prevalence estimates from other sources for comparison with the prevalences in CPRD Aurum. Results Depression (16.0%, 95%CI 16.0–16.0%) and hypertension (15.3%, 95%CI 15.2–15.3%) were the most prevalent conditions among 12.4 million patients. Prevalence of most conditions increased with socio-economic deprivation and age. CRM conditions, schizophrenia and substance misuse were higher in men, whilst anxiety, depression, bipolar and eating disorders were more common in women. Cardiovascular risk factors (hypertension and diabetes) were more prevalent in black and Asian patients compared with white, but the trends in prevalence of cardiovascular diseases by ethnicity were more variable. The recorded prevalences of mental health conditions were typically twice as high in white patients compared with other ethnic groups. However, PTSD and schizophrenia were more prevalent in black patients. The prevalence of most conditions was similar or higher in the primary care database than diagnosed disease prevalence reported in national health surveys. However, screening studies typically reported higher prevalence estimates than primary care data, especially for PTSD, bipolar disorder and eating disorders. Conclusions The prevalence of many clinically diagnosed conditions in primary care records closely matched that of other sources. However, we found important variations by sex and ethnicity, which may reflect true variation in prevalence or systematic differences in clinical presentation and practice. Primary care data may underrepresent the prevalence of undiagnosed conditions, particularly in mental health.

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Temporal variation in the diagnosis of resolved atrial fibrillation and the influence of performance targets on clinical coding: cohort study

Cited by 4 publications

References 18 publications

An interrupted time-series analysis of the effects of withdrawal of financial incentives on diagnosis of atrial fibrillation as resolved. Does withdrawal of an incentive reverse its unintended effects?

An interrupted time-series analysis of the effects of withdrawal of financial incentives on diagnosis of atrial fibrillation as resolved. Does withdrawal of an incentive reverse its unintended effects?

Interactions Between Atrial Fibrillation and Natriuretic Peptide in Predicting Heart Failure Hospitalization or Cardiovascular Death

Prevalence and demographic variation of cardiovascular, renal, metabolic, and mental health conditions in 12 million english primary care records

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