Prognostic Models for People With Stable Coronary Artery Disease
试验速览
- 阶段
- 不适用
- 入组人数
- 300,000
- 试验地点
- 1
研究概览
简要总结
There is currently no published algorithm for secondary prevention prognosis of CHD that is representative of the England GP-registered population and that includes both symptomatic and asymptomatic patients (as identified through primary care). In this paper the investigators will exploit routinely collected information in clinical practice to model CHD prognosis based on a large contemporary open cohort of stable CAD patients. Although the investigators model is based on data from GP practices in England only, the investigators believe that this population is sufficiently heterogeneous in terms of ethnic mix, socioeconomic background, predisposing characteristics and lifestyles to generate a prognostic model with good generalizing power to the wider population.
Among the research questions the investigators will try to answer is whether established risk factors for primary care prevention (smoking, hypertension, dyslipidaemia, diabetes) are also reliable for risk-stratification of patients who have already developed CAD. Similarly, the investigators will examine whether strong predictors of adverse outcomes in ACS patients in the short term, such as admission SBP and heart rate, are also associated with their long term prognosis.
详细描述
Objectives
- To use routinely collected primary care and clinical audit (MINAP) data for patients in England to develop and validate prognostic models for people with stable CAD.
- To identify key prognostic factors for progression to MI or fatal CHD and compare their strength among clinically important subgroups.
- To estimate the risk distribution to specific time horizons overall and within clinically important subgroups.
- To use estimates derived from the model to inform subsequent decision models relating to e.g. selection of patients for CABG or second-line anti-platelet agents (e.g. clopidogrel).
The outcome of primary interest is fatal CHD & non-fatal MI. As a secondary outcome we will model all cause mortality. Incidence for these endpoints will be estimated over a period of up to 5 years depending on the quality and availability of follow-up in the cohort. We may cautiously extend to other endpoints, including CVD and endpoints that reflect symptomatic status (e.g. nitrate use).
We plan to follow the reporting guidelines set out in the forthcoming work led by Atman and Moons.
Data and methods
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —(Adult, Older Adult)
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Eligible general practices were defined as practices that meet standards for acceptable levels of data recording (i.e. audits demonstrated that "at least 95% of relevant patient encounters are recorded and data meet quality standards for epidemiological research"7), and have consented to linkage with HES and MINAP (approximately 200 practices).
排除标准
- 未提供
研究者
Harry Hemingway
Professor of Clinical Epidemiology
University College, London
