Publications (2)5.23 Total impact
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Article: Multimorbidity and risk among patients with established cardiovascular disease: a cohort study.
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ABSTRACT: Most patients managed in primary care have more than one condition. Multimorbidity presents challenges for the patient and the clinician, not only in terms of the process of care, but also in terms of management and risk assessment. To examine the effect of the presence of chronic kidney disease and diabetes on mortality and morbidity among patients with established cardiovascular disease. Retrospective cohort study. Random selection of 35 general practices in the west of Ireland. A practice-based sample of 1609 patients with established cardiovascular disease was generated in 2000-2001 and followed for 5 years. The primary endpoint was death from any cause and the secondary endpoint was a cardiovascular composite endpoint that included death from a cardiovascular cause or any of the following cardiovascular events: myocardial infarction, heart failure, peripheral vascular disease, or stroke. Risk of death from any cause was significantly increased in patients with increased multimorbidity (P<0.001), as was the risk of the cardiovascular composite endpoint (P<0.001). Patients with cardiovascular disease and diabetes had a similar survival pattern to those with cardiovascular disease and chronic kidney disease, but experienced more cardiovascular events. Level of multimorbidity is an independent predictor of prognosis among patients with established cardiovascular disease. In such patients, the presence of chronic kidney disease carries a similar mortality risk to diabetes. Multimorbidity may be a useful factor in prioritising management of patients in the community with significant cardiovascular risk.British Journal of General Practice 07/2008; 58(552):488-94. · 1.83 Impact Factor -
Article: Chronic kidney disease and mortality and morbidity among patients with established cardiovascular disease: a West of Ireland community-based cohort study.
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ABSTRACT: The importance of chronic kidney disease as an independent risk factor for morbidity and mortality in patients with cardiovascular disease in the community is not widely recognized. A retrospective cohort study based in the West of Ireland followed a randomized practice-based sample of patients with cardiovascular disease. A database of 1609 patients with established cardiovascular disease was established in 2000. This was generated from a randomized sample of 35 general practices in the West of Ireland. The primary endpoint was a cardiovascular composite endpoint, which included death from a cardiovascular cause or any of the cardiovascular events of myocardial infarction (MI), heart failure, peripheral vascular disease and stroke. The secondary endpoint was death from any cause. Of the original community-based cohort of 1609 patients with cardiovascular disease, 1272 (79%) had one or more serum creatinine measurements during the study period and 31 (1.9%) patients were lost to follow-up. Median follow-up was 2.90 years (SD 1.47) and the risk of the cardiovascular composite endpoint (total of 219 events) was significantly increased in those patients with reduced estimated glomerular filtration rate (GFR) [log rank (Mantel-Cox) 26.74, P<0.001] as was the risk of death from any cause (total of 214 deaths) [Log Rank (Mantel-Cox) 56.97, P<0.001]. On the basis of the proportional hazards model, while adjusting for other significant covariates, reduced estimated GFR was associated with a significant increase in risk of the primary and secondary outcomes (P<0.01). For every 10 ml decrement in estimated GFR there was a corresponding 20% increase in hazard of the cardiovascular composite endpoint and a 33% increase in hazard of death from any cause. Estimated GFR appears to discriminate prognosis between patients with established cardiovascular disease. These results emphasise the importance of recognising chronic kidney disease as a significant risk factor in patients with cardiovascular disease in the community.Nephrology Dialysis Transplantation 09/2007; 22(9):2586-94. · 3.40 Impact Factor
