Translational phases of evidence in a prognostic biomarker: a systematic review and meta-analysis of natriuretic peptides and the prognosis of stable coronary disease

Sutaria, Shailen; Philipson, Pete; Abrams, Keith R.; Moreno, Santiago; Hingorani, Aroon D.; Hemingway, Harry

doi:10.1136/heartjnl-2011-300862

Cited by 11 publications

(6 citation statements)

References 58 publications

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“…в web-приложе-нии) [70][71][72]. Магнитно-резонансную томография (МРТ) сер-дца также можно использовать для выявления струк-турных нарушений сердца и оценки функции желу-дочков [87].…”

Section: неинвазивные методы исследования сердцаunclassified

2013 Esc Guidelines on the Management of Stable Coronary Artery Disease

Montalescot

Sechtem²,

Achenbach³

et al. 2014

Russ J Cardiol

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Section: неинвазивные методы исследования сердцаunclassified

2013 Esc Guidelines on the Management of Stable Coronary Artery Disease

Montalescot

Sechtem²,

Achenbach³

et al. 2014

Russ J Cardiol

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“…NIHR Journals Library www.journalslibrary.nihr.ac.uk Based on our published findings (Sutaria et al 511 ), the evidence update recommended extending existing systematic reviews continued DOI: 10.3310/pgfar05040 PROGRAMME GRANTS FOR APPLIED RESEARCH 2017 VOL. 5 NO.…”

Section: Conclusion and Implications For Clinical Practice And Furthmentioning

confidence: 99%

Using nationwide ‘big data’ from linked electronic health records to help improve outcomes in cardiovascular diseases: 33 studies using methods from epidemiology, informatics, economics and social science in the ClinicAl disease research using LInked Bespoke studies and Electronic health Records (CALIBER) programme

Hemingway

Feder

Denaxas

et al. 2017

Programme Grants Appl Res

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BackgroundElectronic health records (EHRs), when linked across primary and secondary care and curated for research use, have the potential to improve our understanding of care quality and outcomes.ObjectiveTo evaluate new opportunities arising from linked EHRs for improving quality of care and outcomes for patients at risk of or with coronary disease across the patient journey.DesignEpidemiological cohort, health informatics, health economics and ethnographic approaches were used.Setting230 NHS hospitals and 226 general practices in England and Wales.ParticipantsUp to 2 million initially healthy adults, 100,000 people with stable coronary artery disease (SCAD) and up to 300,000 patients with acute coronary syndrome.Main outcome measuresQuality of care, fatal and non-fatal cardiovascular disease (CVD) events.Data platform and methodsWe created a novel research platform [ClinicAl disease research using LInked Bespoke studies and Electronic health Records (CALIBER)] based on linkage of four major sources of EHR data in primary care and national registries. We carried out 33 complementary studies within the CALIBER framework. We developed a web-based clinical decision support system (CDSS) in hospital chest pain clinics. We established a novel consented prognostic clinical cohort of SCAD patients.ResultsCALIBER was successfully established as a valid research platform based on linked EHR data in nearly 2 million adults with > 600 EHR phenotypes implemented on the web portal (seehttps://caliberresearch.org/portal). Despite national guidance, key opportunities for investigation and treatment were missed across the patient journey, resulting in a worse prognosis for patients in the UK compared with patients in health systems in other countries. Our novel, contemporary, high-resolution studies showed heterogeneous associations for CVD risk factors across CVDs. The CDSS did not alter the decision-making behaviour of clinicians in chest pain clinics. Prognostic models using real-world data validly discriminated risk of death and events, and were used in cost-effectiveness decision models.ConclusionsEmerging ‘big data’ opportunities arising from the linkage of records at different stages of a patient’s journey are vital to the generation of actionable insights into the diagnosis, risk stratification and cost-effective treatment of people at risk of, or with, CVD.Future workThe vast majority of NHS data remain inaccessible to research and this hampers efforts to improve efficiency and quality of care and to drive innovation. We propose three priority directions for further research. First, there is an urgent need to ‘unlock’ more detailed data within hospitals for the scale of the UK’s 65 million population. Second, there is a need for scaled approaches to using EHRs to design and carry out trials, and interpret the implementation of trial results. Third, large-scale, disease agnostic genetic and biological collections linked to such EHRs are required in order to deliver precision medicine and to innovate discovery.Study registrationCALIBER studies are registered as follows: study 2 – NCT01569139, study 4 – NCT02176174 and NCT01164371, study 5 – NCT01163513, studies 6 and 7 – NCT01804439, study 8 – NCT02285322, and studies 26–29 – NCT01162187. Optimising the Management of Angina is registered as Current Controlled Trials ISRCTN54381840.FundingThe National Institute for Health Research (NIHR) Programme Grants for Applied Research programme (RP-PG-0407-10314) (all 33 studies) and additional funding from the Wellcome Trust (study 1), Medical Research Council Partnership grant (study 3), Servier (study 16), NIHR Research Methods Fellowship funding (study 19) and NIHR Research for Patient Benefit (study 33).

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“…74 The same authors were equally critical of 19 BNP studies in patients with stable coronary disease, reporting that clinically useful measures of prediction and discrimination were generally unavailable, and concluding that the unbiased strength of association of BNP with prognosis in stable coronary disease is unclear. 75 The availability of highsensitivity assays has seen renewed interest in troponins as markers of risk in stable coronary disease, a US study of 984 patients in the Heart and Soul Study reporting that each doubling in hs-cTnT level is associated with a 37% higher rate of cardiovascular events. 76 Meanwhile the PEACE investigators have reported that among 3623 patients with stable coronary artery disease, hs-cTNI is independently associated with cardiovascular death or heart failure (HR 1.88 (1.33 to 2.66; p<0.001)), the association with non-fatal myocardial infarction being weaker (1.03 to 2.01; p=0.031).…”

Section: Prognostic Biomarkers In Stable Cadmentioning

confidence: 99%

Almanac 2013: Stable coronary artery disease the national society journals present selected research that has driven recent advances in clinical cardiology

Translational phases of evidence in a prognostic biomarker: a systematic review and meta-analysis of natriuretic peptides and the prognosis of stable coronary disease

Cited by 11 publications

References 58 publications

2013 Esc Guidelines on the Management of Stable Coronary Artery Disease

2013 Esc Guidelines on the Management of Stable Coronary Artery Disease

Almanac 2013: Stable coronary artery disease the national society journals present selected research that has driven recent advances in clinical cardiology

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