The Swedish Primary Care Cardiovascular Database (SPCCD): 74 751 hypertensive primary care patients

Hasselström, Jan; Zarrinkoub, Ramin; Holmquist, Charlotte; Hjerpe, Per; Ljungman, Charlotta; Qvarnström, Miriam; Wettermark, Björn; Manhem, Karin; Kahan, Thomas; Boström, Kristina Bengtsson

doi:10.3109/08037051.2013.814829

Cited by 38 publications

(27 citation statements)

References 30 publications

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“…The Swedish Primary Care Cardiovascular Database (SPCCD) includes data from January 1, 2001 to December 31, 2008 in 74 751 patients diagnosed with hypertension aged 30 years or older and covers 2 primary health care regions in Sweden. Individual clinical data, including blood pressure measurements, registered in the medical records of each patient were automatically retrieved in to the SPCCD . Blood pressure measurement was performed by a nurse or physician at regular visits at the primary care centres following prevailing national guidelines with either oscillometric or auscultatory technique.…”

Section: Methodssupporting

confidence: 79%

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Drug adherence in treatment resistant and in controlled hypertension—Results from the Swedish Primary Care Cardiovascular Database (SPCCD)

Holmqvist

Boström

Kahan

et al. 2018

Pharmacoepidemiology and Drug

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Section: Methodssupporting

confidence: 79%

“…Clinical data including height, weight, smoking status, laboratory test (creatinine, low‐density lipoprotein) and ICD codes for co‐morbidities from each patient were linked, through unique personal identification numbers, to 5 different population‐based registers (Figure ). More details of the SPCCD have been described previously …”

Section: Methodssupporting

confidence: 79%

Drug adherence in treatment resistant and in controlled hypertension—Results from the Swedish Primary Care Cardiovascular Database (SPCCD)

Holmqvist

Boström

Kahan

et al. 2018

Pharmacoepidemiology and Drug

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“…The details of SPCCD have been described elsewhere. 26 The Regional Ethical Review Board in Gothenburg approved the study.…”

Section: Data Sourcementioning

confidence: 99%

“…The most recent blood pressure recorded has been analyzed and has proven to be a valid marker for an average of the last three measurements in a previous publication. 26 Two patients did not have a registered country of birth, and 1713 patients did not have a recorded level of education and were excluded from the analysis. Patients who deceased during the period (n = 1746) were excluded from analysis owing to incomplete prescription data.…”

Section: Study Cohortmentioning

confidence: 99%

Antihypertensive treatment and control according to gender, education, country of birth and psychiatric disorder: the Swedish Primary Care Cardiovascular Database (SPCCD)

et al. 2014

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The reasons why women and men are treated with different antihypertensive drugs are not clear. Whether socioeconomic factors influence prescription patterns and blood pressure control differently in women and men has not been investigated. This cross-sectional study performed in a cohort of hypertensive patients from the Swedish Primary Care Cardiovascular Database (SPCCD) examined the influence of educational level, country of birth, gender and concomitant psychiatric disorder on prescription pattern and blood pressure control in 40,825 hypertensive patients. Men were more often than women treated with calcium channel blocker and angiotensin-converting enzyme inhibitor (ACEI), irrespective of education, country of birth and psychiatric disorder. Educational level influenced the prescription pattern to some extent, where the gender differences were reduced in patients with a higher educational level. In women, but not in men, high educational level and concomitant psychiatric disorder were associated with a higher proportion reaching target blood pressure. The predominant use of ACEI and calcium channel blockers in men is not influenced by educational level, country of birth or psychiatric disorder. Thus other explanations must be considered such as gender differences in side effects. Educational level seems to have a greater impact on reaching target blood pressure in women compared with men.

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“…However, the different practices used to measure BP (298), and the risk of white-coat hypertension (299), may have affected the findings. Moreover, since the objective of this thesis was to assess the association of non-adherence with elevated BP, the visit with the highest BP values was considered, and the findings may therefore not be generalisable for patients with labile BP.…”

Section: Assessment Of Drug-related Morbiditiesmentioning

confidence: 99%

Inappropriate prescribing, non-adherence to long-term medications and related morbidities : Pharmacoepidemiological aspects

Hedna

2015

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Aim:The aim of this thesis is to estimate and analyse the burden of potentially inappropriate prescriptions (PIPs) in the elderly and non-adherence to long-term medications among adults across care settings, and to investigate how IUM is associated to DRMs. Methods:A meta-analysis summarised the previous evidence on the percentage of adverse drug reactions (ADRs) associated to IUM across healthcare settings (Study I). From a cohort in the general population, using medical records and register data, the prevalence of PIPs in the elderly and its association with ADRs were estimated retrospectively (Study II). From the same cohort, the factors associated with refill non-adherence to antihypertensive therapy, considering the use of multiple medications, and the association between non-adherence and sub-therapeutic effects (STEs) were investigated (Study III). A survey assessed the refill behaviour to antihypertensive, lipid lowering and oral antidiabetic medications (undersupply, adequate supply and oversupply), and its association with perceived ADRs and STEs (Study IV).Results: IUM was the cause 52% and 45% of ADRs occurring in adult outpatients and inpatients respectively. Across healthcare settings, 46% of the elderly refilled PIPs over a 6-month period;PIPs were considered the cause of 30% of all ADRs; and the elderly who were prescribed PIPs had increased odds to experience ADRs (OR 2.47, 95% CI 1.65-3.69). In total, 35% was nonadherent to the full multidrug therapy and 13% was non-adherent to any medication (complete vi non-adherence). Sociodemographic factors (working age and lower income) were associated with non-adherence to any medication, while clinical factors (use of specialised care, use of multiple medications, and being a new user) with non-adherence to the full multidrug therapy. STEs were associated with non-adherence to any medication a month prior to a healthcare visit (OR 3.27, 95% CI 1.27-8.49), but not with long-term measures of non-adherence. Among survey respondents, 22% of the medications were oversupplied and 12% were undersupplied. Inadequate refill behaviour was not associated with reporting ADRs or STEs (p<0.05). Conclusions:A large proportion of ADRs occurring in hospital is caused by IUM, but more knowledge is needed in other settings. PIPs are common in the elderly general population and associated with ADRs. Therefore decreasing PIPs could contribute towards ADR prevention.Considering the use of multiple medications may help to better understand the factors associated with non-adherence to a multidrug therapy for tailoring the interventions to patient needs.Monitoring the adherence prior to a healthcare visit may facilitate interpreting STEs. Yet, the absence of an association between long-term measures of refill non-adherence with clinical and perceived DRMs suggest the need to enhance the knowledge of this association in clinical practice.In summary, this thesis shows a significant potential for improvements of medication use and outcomes.Key words: Drug-related morbidity, medica...

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The Swedish Primary Care Cardiovascular Database (SPCCD): 74 751 hypertensive primary care patients

Abstract: This large and representative database shows that there is room for improvement of BP control in Sweden. The SPCCD will provide a rich source for further research of hypertension and its complications.

Cited by 38 publications

References 30 publications

Drug adherence in treatment resistant and in controlled hypertension—Results from the Swedish Primary Care Cardiovascular Database (SPCCD)

Drug adherence in treatment resistant and in controlled hypertension—Results from the Swedish Primary Care Cardiovascular Database (SPCCD)

Antihypertensive treatment and control according to gender, education, country of birth and psychiatric disorder: the Swedish Primary Care Cardiovascular Database (SPCCD)

Inappropriate prescribing, non-adherence to long-term medications and related morbidities : Pharmacoepidemiological aspects

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