Evangelos Kontopantelis

• PhD in Computer Engineering
• Professor at The University of Manchester

Background The UK is dependent on international doctors, with a greater proportion of non-UK qualified doctors working in its universal health care system than in any other European country, except Ireland and Norway. The terms of the UK exit from the European Union can reduce the ability of European Economic Area (EEA) qualified doctors to work in...

Background Multiple imputation is frequently used to deal with missing data in healthcare research. Although it is known that the outcome should be included in the imputation model when imputing missing covariate values, it is not known whether it should be imputed. Similarly no clear recommendations exist on: the utility of incorporating a seconda...

To quantify the relationship between a national primary care pay-for-performance programme, the UK's Quality and Outcomes Framework (QOF), and all-cause and cause-specific premature mortality linked closely with conditions included in the framework. Longitudinal spatial study, at the level of the "lower layer super output area" (LSOA). 32482 LSOAs...

This article describes a new individual patient data (IPD) meta-analysis post-estimation command, ipdforest. The command produces a forest plot, following an one-stage meta-analysis with xtmixed or xtmelogit (renamed in Stata 13 to mixed and meqrlogit respectively; ipdforest is currently not compatible with the new names). The overall effect is obt...

Heterogeneity has a key role in meta-analysis methods and can greatly affect conclusions. However, true levels of heterogeneity are unknown and often researchers assume homogeneity. We aim to: a) investigate the prevalence of unobserved heterogeneity and the validity of the assumption of homogeneity; b) assess the performance of various meta-analys...

Objectives: To identify factors associated with long-term opioid therapy (L-TOT) discontinuation in people with chronic non-cancer pain (CNCP). Design and setting: Population-based retrospective cohort study using UK Clinical Practice Research Datalink Aurum data between 01/01/2000-31/12/2020. Population: The study cohort comprised adults (>=18 yea...

BACKGROUND Importance: Telemedicine has revolutionized the management of type 2 diabetes mellitus (T2DM) in primary care by improving access to healthcare services and enhancing health outcomes. Despite these advancements, it remains unclear whether telemedicine has reduced access inequalities among different demographic and socioeconomic groups....

Introduction Polycystic ovary syndrome (PCOS) is a widespread disease among women of childbearing age. This pathology embraces a complex spectrum of clinical manifestations. An altered secretion of gonadotropins and high levels of androgens determine menstrual irregularities and ovulatory dysfunction, infertility, hirsutism, alopecia and acne. More...

Aims Heart failure (HF) following acute myocardial infarction (AMI) is a global health concern, but data on risk factors associated with HF hospitalization post-AMI are limited. Methods and results We analysed data from the Myocardial Ischaemia National Audit Project, including patients admitted with AMI from 1 January 2006 to 31 March 2019. Data...

Objectives: To examine trends of opioid use, focusing on long-term opioid therapy (L-TOT) and its discontinuation among people with chronic non-cancer pain (CNCP). Design and setting: Retrospective cohort study using UK Clinical Practice Research Datalink Aurum data. Population: Incident opioid users (no opioid use in the prior year) with CNCP betw...

Background The declining trend in the number of primary care physicians worldwide has led to shortages especially within socioeconomically deprived areas. Socioeconomically deprived areas in the context of this review are defined by regions where there are lower levels of income and access to essential services such as primary healthcare compared t...

Introduction International guidelines make recommendations for the delivery of safe, high‐quality primary care for people with dementia including prescribing, personalised care planning and regular holistic reviews. It is unclear how the quality and safety of this healthcare varies with socio‐economic factors. Objective This scoping review aimed t...

This article provides an overview of the current evidence on the epidemiology, overlapping risk factors, and pathophysiology of cardiovascular disease (CVD) in patients with cancer. It explores the cardiotoxic effects of anticancer therapy and their impact on prognosis. Although cancer survival rates have improved over the last two decades, the ris...

Objectives To investigate healthcare utilisation and cost in individuals with long COVID (LC) at population level. Design Case–control cohort analysis with multiple age-, sex-, ethnicity-, deprivation-, region- and comorbidity-matched control groups: (1) COVID only, no LC; (2) pre-pandemic; (3) contemporary non-COVID; and (4) pre-LC (self-controll...

Introduction The pandemic saw widespread use of home pulse oximeters to patients diagnosed with COVID-19 to support early detection of low oxygen saturation levels and appropriate care. Rapid implementation made conventional evaluation challenging, highlighting the need for rigorous non-randomised methods to support decision-making about future use...

Objective This systematic review and meta-analysis aimed to assess interventions to reduce opioid use for patients with chronic non-cancer pain (CNCP) versus usual care or active controls in primary care settings. Methods In this registered study (PROSPERO: CRD42022338458), we searched MEDLINE, Embase PsycInfo, CINAHL, and Cochrane Library from in...

Introduction Health policy in the UK and globally regarding dementia, emphasises prevention and risk reduction. These goals could be facilitated by automated assessment of dementia risk in primary care using routinely collected patient data. However, existing applicable tools are weak at identifying patients at high risk for dementia. We set out to...

Aims/hypothesis The aim of this study was to investigate how diabetes mellitus affects longer term outcomes in individuals presenting to hospital with non-ST segment elevation myocardial infarction (NSTEMI). Methods We analysed data from 456,376 adults hospitalised between January 2005 and March 2019 with NSTEMI from the UK Myocardial Ischaemia Na...

Patients with lower socioeconomic status (SES) have poorer outcomes following acute myocardial infarction (AMI) than patients with higher SES; however, how sex modifies socioeconomic differences is unclear. Using the United Kingdom (UK) Myocardial Ischaemia National Audit Project (MINAP) registry, alongside Office of National Statistics (ONS) morta...

Background English primary care faces a reduction in GP supply and increased demand. Aim To explore trends in GP working time and supply, accounting for factors influencing demand for services. Design and setting Retrospective observational study in English primary care between 2015 and 2022. Method Trends in median GP contracted time commitment...

Background The use of locum doctors in the National Health Service is widely believed to have increased, and there have been widespread and sustained concerns among policy-makers, healthcare providers, professional associations and professional regulators about the quality/safety, cost and effective use of locum doctors. Objectives To provide evid...

Chronic kidney disease (CKD) is a global public health problem with major human and economic consequences. Despite advances in clinical guidelines, classification systems and evidence-based treatments, CKD remains underdiagnosed and undertreated and is predicted to be the fifth leading cause of death globally by 2040. This review aims to identify b...

Introduction There have been some concerns about the impact of temporary doctors, otherwise known as locums, on patient safety and the quality of care. Despite these concerns, research has paid little attention to the implications of locum working on patient experience. Methods A qualitative semi‐structured interview study was conducted with 130 p...

Background and Aims This study assessed the impact of incorporating cancer as a predictor on performance of the PRECISE-DAPT score. Methods A nationally linked cohort of ST-elevation myocardial infarction patients between 1 January 2005 and 31 March 2019 was derived from the UK Myocardial Ischaemia National Audit Project and the UK Hospital Episod...

Background Research activity usually improves outcomes by being translated into practice; however, there is developing evidence that research activity itself may improve the overall performance of healthcare organisations. Evidence that these relationships represent a causal impact of research activity is, however, less clear. Additionally, the bul...

Objective To compare the predictive performance of CHA2DS2-VASc and HAS-BLED scores in Atrial Fibrillation (AF) patients with and without cancer. Methods and Analysis Using data from the Clinical Practice Research Datalink (CPRD) in England, we performed a retrospective cohort study of patients with new diagnosis of AF from 2009-2019. Cancer was d...

Background The impact of the COVID‐19 pandemic on the mental health of children and young people (CYP) has been widely reported. Primary care electronic health records were utilised to examine trends in the diagnosing, recording and treating of these common mental disorders by ethnicity and social deprivation in Greater Manchester, England. Method...

Aims Telemedicine has been promoted as an effective way of managing type‐2 diabetes (T2DM) in primary care. However, the effectiveness of telemedicine is unclear. We investigated the clinical and cost‐effectiveness of different telemedicine interventions for people with T2DM, compared to usual care. Methods We searched Medline, Embase, Cochrane, C...

Introduction Electronic Health Records (EHRs) are vital repositories of patient information for medical research, but the prevalence of missing data presents an obstacle to the validity and reliability of research. This study aimed to review and category ise methods for handling missing data in EHRs, to help researchers better understand and addres...

Background Over the past decade, major society guidelines have recommended the use of newer P2Y 12 inhibitors over clopidogrel for those undergoing percutaneous coronary intervention for acute coronary syndrome. It is unclear what impact these recommendations had on clinical practice. Methods and Results All percutaneous coronary intervention proc...

Introduction: The Russian invasion of Ukraine in February 2022 resulted in displacement of approximately 12.5 million refugees to adjacent countries, including Poland, which may have strained health care service delivery. Objectives: Using the ST‑segment elevation myocardial infarction (STEMI) data, we aimed to evaluate whether the Russian invas...

Background The use of temporary doctors, known as locums, has been common practice for managing staffing shortages and maintaining service delivery internationally. However, there has been little empirical research on the implications of locum working for quality and safety. This study aimed to investigate the implications of locum working for qua...

Background Temporary doctors, known as locums, are a key component of the medical workforce in the NHS but evidence on differences in quality and safety between locum and permanent doctors is limited. We aimed to examine differences in the clinical practice, and prescribing safety for locum and permanent doctors working in primary care in England....

Objective: This systematic review and meta-analysis aimed to assess interventions to reduce opioid use for patients with chronic non-cancer pain (CNCP) versus usual care or active controls in primary care settings. Methods: In this registered study (PROSPERO: CRD42022338458), we searched MEDLINE, Embase PsycInfo, CINAHL, and Cochrane Library from i...

Background Contemporary studies demonstrate that non-ST-segment elevation myocardial infarction (NSTEMI) processes of care vary according to sex. Little is known regarding variation in practice between geographical areas and centres. Methods We identified 305 014 NSTEMI admissions in the United Kingdom (UK) Myocardial Ischaemia National Audit Proj...

Background There is little evidence and no agreement on what constitutes full-time working for GPs. This is essential for workforce planning, resource allocation, and accurately describing GP activity. Aim To clarify the definition of full-time working for GPs, how this has changed over time, and whether these changes are explained by GP demograph...

Introduction Research activity usually improves outcomes by being translated into practice. However, there is developing evidence that research activity itself may improve the overall performance of health care organisations. However, evidence that these relationships represent a causal impact of research activity is less clear. Additionally, the b...

Importance Three leading disease causes of age-related visual loss are cataract, age-related macular degeneration (AMD), and glaucoma. Although all 3 eye diseases have been implicated with falls and fracture risk, evidence is mixed, with the contribution of different eye diseases being uncertain. Objective To examine whether people with cataract,...

Background Anticoagulation of patients with atrial fibrillation (AF) and cancer is challenging because of their high risk for stroke and bleeding. Little is known of the variations of oral anticoagulant (OAC) prescribing in patients with AF with and without cancer. Methods Patients with first‐time AF during 2009–2019 from the Clinical Practice Res...

Objectives Develop an endometrial cancer risk prediction model and externally validate it for UK primary care use. Design Cohort study. Setting The UK Biobank was used for model development and a linked primary (Clinical Practice Research Datalink, CPRD) and secondary care (HES), mortality (ONS) and cancer register (NRCAS) dataset was used for ex...

Background The prevalence of multimorbidity in patients with acute myocardial infarction (AMI) is increasing. It is unclear whether comorbidities cluster into distinct phenogroups and whether are associated with clinical trajectories. Methods Survey-weighted analysis of the United States Nationwide Inpatient Sample (NIS) for patients admitted with...

Background In the UK alone, long Covid(LC) has affected over 2 million individuals, yet health system burden is poorly characterised. Understanding healthcare utilisation will inform clinical, service and policy planning for current and future LC care. Methods Using the British Heart Foundation/NHS England Secure Data Environment, we identified ind...

Introduction/Background Endometrial carcinoma is the most common gynecological tumor in developed countries. Clinical-pathological factors and molecular sub-types are used to stratify the risk of recurrence and to tailor adjuvant treatment. The main limitation of molecular and clinicopathological prognostic factors is the need of post-operative sur...

BACKGROUND The association between cancer and stroke or bleeding outcomes in atrial fibrillation is unclear. We sought to examine how certain types of cancer influence the balance between stroke and bleeding risk in patients with nonvalvular atrial fibrillation (NVAF). METHODS AND RESULTS We estimated stroke and bleeding risk among adult patients...

Background: It is unclear whether the future risk of cardiovascular events in breast cancer survivors is greater than in the general population. Objectives: This meta-analysis reports the incidence of cardiovascular events in patients with breast cancer, before quantifying the risk of cardiovascular disease development in breast cancer patients, co...

Individuals developing stroke have varying clinical characteristics, demographic, and biochemical profiles. This heterogeneity in phenotypic characteristics can impact on cardiovascular disease (CVD) morbidity and mortality outcomes. This study uses a novel clustering approach to stratify individuals with incident stroke into phenotypic clusters an...

BACKGROUND Sex-based outcome differences for women with ST-segment–elevation myocardial infarction (STEMI) have not been adequately addressed, and the role played by differences in prescription of potent P2Y 12 inhibitors (P-P2Y 12 ) is not well defined. This study explores the hypothesis that disparities in P-P2Y 12 (prasugrel or ticagrelor) use m...

Aims Central to the practice of precision medicine in percutaneous coronary intervention (PCI) is a risk-stratification tool to predict outcomes following the procedure. This study is intended to assess machine learning (ML)-based risk models to predict clinically relevant outcomes in PCI and to support individualized clinical decision-making in th...

Background Locum working in healthcare organisations has benefits for individual doctors and organisations but there are concerns about the impact of locum working on continuity of care, patient safety, team function and cost. We conducted a national survey of NHS Trusts in England to explore locum work, and better understand why and where locum do...

Background: Patients from lower socioeconomic status areas have poorer outcomes following acute myocardial infarction (AMI); however, how ethnicity modifies such socioeconomic disparities is unclear. Methods: Using the UK Myocardial Ischaemia National Audit Project (MINAP) registry, we divided 370 064 patients with AMI into quintiles based on In...

Aims It is unclear whether the future risk of cardiovascular events in breast cancer (Bc) survivors is greater than in the general population. This meta-analysis quantifies the risk of cardiovascular disease development in Bc patients, compared to the risk in a general matched cancer-free population, and reports the incidence of cardiovascular even...

Objectives To describe the current landscape of UK electronic health record (EHR) databases and considerations of access and use of these resources relevant to researchers. Design & setting Narrative review Data sources Information was collected from the Health Data Research Innovation Gateway, publicly available websites and other published data...

Background: Locum doctors give practices flexibility to deliver patient services but there are concerns about the impact of locum working on continuity of care, patient safety, team function, and cost. Aim: To explore locum working in English general practices, and understand why and where locum doctors were needed and how they were engaged, sup...

Background: Few studies have investigated the effect of the COVID-19 pandemic on mental health beyond 2020. This study quantifies changes to healthcare utilisation and symptoms for common mental health problems over the pandemic's first 21 months. Methods: Parallel cohort studies using primary care database and survey data for adults (≥16 years)...

The objective of this study is to determine whether dienogest therapy after endometriosis surgery reduces the risk of recurrence compared with placebo or alternative treatments (GnRH agonist, other progestins, and estro-progestins). The design used in this study is systematic review with meta-analysis. The data source includes PubMed and EMBASE sea...

Objective Endometrial carcinoma is the most common gynecological tumor in developed countries. Clinicopathological factors and molecular subtypes are used to stratify the risk of recurrence and to tailor adjuvant treatment. The present study aimed to assess the role of radiomics analysis in pre-operatively predicting molecular or clinicopathologica...

Background The prevention of type 2 diabetes (T2DM) is a major concern for health services around the world. The English NHS Diabetes Prevention Programme (NHS-DPP) offers a group face-to-face behaviour change intervention, based around exercise and diet, to adults with non-diabetic hyperglycaemia (NDH), referred from primary care. Previous analysi...

Objective To determine whether the withdrawal of the Quality and Outcomes Framework (QOF) scheme in primary care in Scotland in 2016 had an impact on selected recorded quality of care, compared with England where the scheme continued. Design Controlled interrupted time series regression analysis. Setting General practices in Scotland and England....

Background Two general practices close every week in the UK. Given the pressure on UK general practices, such closures are likely to persist. Yet little is known about the consequences. Closure refers to when a practice ceases to exist, merges, or is taken over. Aim To explore whether practice funding, list size, workforce composition, and quality...

Background: Age and socioeconomic status (SES) predict several health-related outcomes, including prescription opioid use. Contrasting findings from previous literature found higher prevalence of opioid use in both people over 65 years old and the working-age population of 35-55 years old. This study aimed to analyse if the association between age...

Background The NHS Diabetes Prevention Programme (NDPP) is a behaviour change programme for adults who are at risk of developing type 2 diabetes mellitus (T2DM): people with raised blood glucose levels, but not in the diabetic range, diagnosed with nondiabetic hyperglycaemia (NDH). We examined the association between referral to the programme and r...

Objective: The anti-inflammatory drug colchicine has recently shown benefits in the prevention of major adverse cardiovascular events (MACE) in patients with the acute coronary syndrome (ACS) and chronic coronary syndromes (CCS). This meta-analysis focuses on understanding Colchicine's effects on the high-sensitivity C-reactive protein (hs-CRP) to...

Objectives Temporary doctors, known as locum doctors, play an important role in the delivery of care in the National Health Service (NHS); however, little is known about the extent of locum use in NHS trusts. This study aimed to quantify and describe locum use for all NHS trusts in England in 2019–2021. Setting Descriptive analyses of data on locu...

Background Prescribing of strong opioids and antibiotics impacts patient safety, yet little is known about the effects GP wellness has on overprescribing of both medications in primary care. Aim To examine associations between strong opioid and antibiotic prescribing and practice- weighted GP burnout and wellness. Design and setting A retrospecti...

Objective English primary care faces significant challenges, including ‘persistent high turnover’ of general practitioners (GPs) in some partnerships. It is unknown whether there are specific predictors of persistent high turnover and whether it is associated with poorer population health outcomes. Design A retrospective observational study. Meth...

Background Heart failure (HF) is a global epidemic. Objective To assess global sex differences in HF epidemiology across country income levels. Methods Using Global Burden of Disease (GBD) data from 204 countries and territories 1990-2019, we assessed sex differences in HF prevalence, etiology, morbidity, and temporal trends across country sociod...

Background Asthma is a prevalent chronic respiratory condition and remains a common cause for hospitalization. However, contemporary data on asthma hospitalization rates, comorbidity burden, and in-hospital outcomes are lacking. Methods Survey-weighted analysis of hospitalization records with a primary diagnosis of asthma using data from the US Na...

Background: Heart failure (HF) is a global epidemic. Objectives: We assessed sex differences in HF across country income. Methods: Using Global Burden of Disease (GBD) data, we assessed sex differences in HF prevalence, etiology, morbidity, and temporal trends between 1990-2019 across 204 countries and territories and disaggregated results by count...

Introduction/Background Global endometrial cancer (EC) cases continue to increase, placing a significant health and financial burden on individuals and healthcare services. Effective primary disease prevention strategies are urgently required but remain under-researched. Identifying high-risk women for intervention would ensure therapies are target...

OBJECTIVE Heart failure (HF) often develops in patients with diabetes and is recognized for its role in increased cardiovascular morbidity and mortality in this population. Most existing models predict risk in patients with prevalent rather than incident diabetes and fail to account for sex differences in HF risk factors. We derived sex-specific mo...

This commentary refers to ‘Ethnicity-dependent performance of the Global Registry of Acute Coronary Events risk score for prediction of non-ST-segment elevation myocardial infarction in-hospital mortality: nationwide cohort study’, by S.M. Moledina et al., https://doi.org/10.1093/eurheartj/ehac052 and the discussion piece ‘Refitting the predictor v...

Objective In observational studies, researchers must select a method to control for confounding. Options include propensity score methods and regression. It remains unclear how dataset characteristics (size, overlap in propensity scores, exposure prevalence) influence the relative performance of the methods. Study Design A simulation study to eval...

Background Type 2 Diabetes (T2D) is common, with a prevalence of approximately 7% of the population in the United Kingdom. The quality of T2D care is inconsistent across the United Kingdom, and Greater Manchester (GM) does not currently achieve the National Institute for Health and Care Excellence treatment targets. Barriers to delivery of care inc...