Laura Pasea

• University College London

Background Effective management of coexisting heart failure (HF), chronic kidney disease (CKD) and type 2 diabetes mellitus (T2D) is critical, yet evidence of adherence to guideline-recommended standards in routine care remains unclear. We aimed to assess primary care adherence to guideline-recommended standards for patients with overlapping HF, CK...

Background There is a perception that income-based disparities are present in most countries but may differ in magnitude. However, there are few international comparisons that describe income-based disparities across countries and none that focus on hip fractures. Objective To compare treatment patterns and outcomes of high- and low-income older a...

Background Abdominal aortic aneurysms (AAA) can be safely repaired using either endovascular aneurysm repair (EVAR) or open repair when intact, but after rupture morbidity and mortality are extremely high. Treatment patterns and outcomes for intact AAA are likely to differ between countries due to differences in AAA screening policies, health syste...

Introduction For COVID-19 and Long COVID, determining the highest-risk subgroups, particularly in the context of compound pressures such as influenza and cardiovascular disease (CVD), may identify effective interventions to prevent adverse health outcomes, and inform public health and policy decisions. Methods Using national, linked electronic hea...

Introduction None of the studies of type 2 diabetes (T2D) subtyping to date have used linked population-level data for incident and prevalent T2D, incorporating a diverse set of variables, explainable methods for cluster characterization, or adhered to an established framework. We aimed to develop and validate machine learning (ML)-informed subtype...

BACKGROUND Sex differences in acute myocardial infarction treatment and outcomes are well documented, but it is unclear whether differences are consistent across countries. The objective of this study was to investigate the epidemiology, use of interventional procedures, and outcomes for older females and males hospitalized with ST-segment–elevatio...

Background Heart failure (HF), type 2 diabetes (T2D) and chronic kidney disease (CKD) commonly coexist. We studied characteristics, prognosis and healthcare utilisation of individuals with two of these conditions. Methods We performed a retrospective, population-based linked electronic health records study from 1998 to 2020 in England to identify...

Background: Hip fractures are costly and common in older adults, but there is limited understanding of how treatment patterns and outcomes might differ between countries. Methods: We performed a retrospective serial cross-sectional cohort study of adults aged ≥66 years hospitalized with hip fracture between 2011 and 2018 in the US, Canada, Engla...

Biography Dr Stephen Walsh is a clinician scientist with an interest in both rare renal tubular disorders and disorders of blood pressure. His research involves the physiology of epithelial solute transport, and how that relates to blood pressure control, kidney stone formation and renal failure. He collaborates with both NASA and the ESA on the ef...

Background: Machine learning has been used to analyse heart failure subtypes, but not across large, distinct, population-based datasets, across the whole spectrum of causes and presentations, or with clinical and non-clinical validation by different machine learning methods. Using our published framework, we aimed to discover heart failure subtype...

Importance: Differences in the organization and financing of health systems may produce more or less equitable outcomes for advantaged vs disadvantaged populations. We compared treatments and outcomes of older high- and low-income patients across 6 countries. Objective: To determine whether treatment patterns and outcomes for patients presenting...

Background: Although chronic kidney disease (CKD) is associated with high multimorbidity, polypharmacy, morbidity and mortality, existing classification systems (mild to severe, usually based on estimated glomerular filtration rate, proteinuria or urine albumin-creatinine ratio) and risk prediction models largely ignore the complexity of CKD, its...

Objectives To use national, pre- and post-pandemic electronic health records (EHR) to develop and validate a scenario-based model incorporating baseline mortality risk, infection rate (IR) and relative risk (RR) of death for prediction of excess deaths. Design An EHR-based, retrospective cohort study. Setting Linked EHR in Clinical Practice Resea...

Background Reliable identification of heart failure (HF) subtypes might allow targeted management. Machine learning (ML) has been used to explore HF subtypes, but neither across large, independent, population-based datasets, nor across the full spectrum of causes and presentations, nor with clinical and non-clinical validation by different ML metho...

Background Assessing the spectrum of disease risk associated with hypertriglyceridemia is needed to inform potential benefits from emerging triglyceride lowering treatments. We sought to examine the associations between a full range of plasma triglyceride concentration with five clinical outcomes. Methods We used linked data from primary and secon...

BACKGROUND: Updatable estimates of COVID-19 onset, progression, and trajectories underpin pandemic mitigation efforts. To identify and characterise disease trajectories, we aimed to define and validate ten COVID-19 phenotypes from nationwide linked electronic health records (EHR) using an extensible framework. METHODS: In this cohort study, we used...

Objectives To compare treatment and outcomes for patients admitted to hospital with a primary diagnosis of ST elevation or non-ST elevation myocardial infarction (STEMI or NSTEMI) in six high income countries with very different healthcare delivery systems. Design Retrospective cross sectional cohort study. Setting Patient level administrative da...

Background Throughout the pandemic, research, public health, and policy emphasised prediction and surveillance of excess deaths, which have mostly occurred in older individuals with underlying conditions, highlighting importance of baseline mortality risk, infection rate (IR) and pandemic-related relative risk (RR). We now use national, pre-and pos...

Background Primary prevention strategies for heart failure(HF) have had limited success, possibly due to a wide range of underlying risk factors(RFs). Systematic evaluations of the prognostic burden and preventive potential across this wide range of risk factors are lacking. Objective To estimate evidence, prevalence and co-occurrence for primary...

Patients and public have sought mortality risk information throughout the pandemic, but their needs may not be served by current risk prediction tools. Our mixed methods study involved: (1) systematic review of published risk tools for prognosis, (2) provision and patient testing of new mortality risk estimates for people with high-risk conditions...

Background: Targeted obesity prevention policies would benefit from the identification of population groups with the highest risk of weight gain. The relative importance of adult age, sex, ethnicity, geographical region, and degree of social deprivation on weight gain is not known. We aimed to identify high-risk groups for changes in weight and BM...

Objective To describe a novel England-wide electronic health record (EHR) resource enabling whole population research on covid-19 and cardiovascular disease while ensuring data security and privacy and maintaining public trust. Design Data resource comprising linked person level records from national healthcare settings for the English population,...

Aims Cardiovascular diseases (CVDs) increase mortality risk from coronavirus infection (COVID-19). There are also concerns that the pandemic has affected supply and demand of acute cardiovascular care. We estimated excess mortality in specific CVDs, both ‘direct’, through infection, and ‘indirect’, through changes in healthcare. Methods and result...

Background: Adult obesity prevention policies, which are largely untargeted, have met with limited success globally. Population groups with the highest risk of weight gain, if they could be reliably identified using readily available information, might benefit from targeted policy. The relative importance of age, sex, ethnicity, geographical region...

Objectives Obesity is a modifiable risk factor for coronavirus(COVID-19)-related mortality. We estimated excess mortality in obesity, both “direct”, through infection, and “indirect”, through changes in healthcare, and also due to potential increasing obesity during lockdown. Study design Retrospective cohort study and causal inference methods. M...

Objectives: To estimate the impact of the COVID-19 pandemic on cancer care services and overall (direct and indirect) excess deaths in people with cancer. Methods: We employed near real-time weekly data on cancer care to determine the adverse effect of the pandemic on cancer services. We also used these data, together with national death registr...

Background ESC and AHA guidelines identify 92 putative aetiological factors for heart failure, but primary prevention strategies for heart failure (HF) have had limited success. There are no previous studies systematically evaluating the potential for prevention among such a wide range of clinically manifest aetiologic factors. Objective To estima...

Objectives We aimed to model the impact of coronavirus (COVID-19) on the clinical academic response in England, and to provide recommendations for COVID-related research. Design A stochastic model to determine clinical academic capacity in England, incorporating the following key factors which affect the ability to conduct research in the COVID-19...

Background: Obesity is a modifiable risk factor for coronavirus(COVID-19)-related mortality. We estimated excess mortality in obesity, both 'direct', through infection, and 'indirect', through changes in healthcare, and also due to potential increasing obesity during lockdown. Methods: In population-based electronic health records for 1 958 638 ind...

Background: Cardiovascular diseases(CVD) increase mortality risk from coronavirus infection(COVID-19), but there are concerns that the pandemic has affected supply and demand of acute cardiovascular care. We estimated excess mortality in specific CVDs, both direct, through infection, and indirect, through changes in healthcare. Methods: We used pop...

Background: Cancer and multiple non-cancer conditions are considered by the Centers for Disease Control and Prevention (CDC) as high risk conditions in the COVID-19 emergency. Professional societies have recommended changes in cancer service provision to minimize COVID-19 risks to cancer patients and health care workers. However, we do not know the...

Background The medical, societal, and economic impact of the coronavirus disease 2019 (COVID-19) pandemic has unknown effects on overall population mortality. Previous models of population mortality are based on death over days among infected people, nearly all of whom thus far have underlying conditions. Models have not incorporated information on...

Predicted estimate of excess deaths in cancer patients related to the Covid-19 emergency. Data from England, Northern Ireland and US.

Beyond the profound challenges presented by coronavirus (COVID-19) to health systems around the world, the pandemic will lead to major shortages of clinical academics. Clinical academics are doctors at the interface of clinical care and research and are particularly needed to ensure that timely advances in prevention and treatment can be achieved,...

RAPID COMMUNICATION 22 March 2020 Estimating excess 1- year mortality from COVID-19 according to underlying conditions and age in England: a rapid analysis using NHS health records in 3.8 million adults Background: The medical, health service, societal and economic impact of the COVID-19 emergency has unknown effects on overall population mortality...

Background: The medical, health service, societal and economic impact of the COVID-19 emergency has unknown effects on overall population mortality. Previous models of population mortality are based on death over days among infected people, nearly all of whom (to date at least) have underlying conditions. Models have not incorporated information on...

Background: Clinical guidelines and public health authorities lack recommendations on scalable approaches to defining and monitoring the occurrence and severity of bleeding in populations prescribed antithrombotic therapy. Methods: We examined linked primary care, hospital admission and death registry electronic health records (CALIBER 1998-2010...

Objective: Electronic health records (EHRs) are a rich source of information on human diseases, but the information is variably structured, fragmented, curated using different coding systems, and collected for purposes other than medical research. We describe an approach for developing, validating, and sharing reproducible phenotypes from national...

The aim was to build a prediction model for subsequent atherothrombotic events for patients who survived a myocardial infarction. The dataset contained 7,582 patients from a national Electronic Health Record. The prediction is a binary outcome (event and no event) in a period of five years after a myocardial infarction. Different classifiers were t...

Objective: Electronic health records are a rich source of information on human diseases, but the information is variably structured, fragmented, curated using different coding systems and collected for purposes other than medical research. We describe an approach for developing, validating and sharing reproducible phenotypes from national structure...

Background: Clinical guidelines and public health authorities lack recommendations on scalable approaches to defining and monitoring the occurrence and severity of bleeding in populations prescribed antithrombotic therapy. We aimed to develop electronic health record algorithms for different bleeding phenotypes, and to determine the incidence, time...

Antithrombotic drugs are increasingly used for the prevention of atherothrombotic events in cardiovascular diseases and represent a paradigm for the study of personalised medicine because of the need to balance potential benefits with the substantial risks of bleeding harms. To be effective, personalised medicine needs validated prognostic risk mod...

Background The time a patient spends with blood pressure at target level is an intuitive measure of successful BP management, but population studies on its effectiveness are as yet unavailable. Method We identified a population-based cohort of 169,082 individuals with newly identified high blood pressure who were free of cardiovascular disease fro...

Annual time at target blood pressure (%), by follow-up year and year of newly identified hypertension. (DOCX)

Estimation of cardiovascular deaths and events delayed or prevented if BP control increases by one category of TITRE. (DOCX)

The extent of missing (%) of case-mix and treatment variables for multivariate models. (DOCX)

Calculation of time at target (TITRE). (DOCX)

Model examination and performance results. (DOCX)

Categorical time at target (TITRE) and risk of all cardiovascular disease and death by groups defined by average number of follow-up blood pressure measure categories. (DOCX)

Categorical time at target (TITRE) and risk of all cardiovascular disease and death in multiple imputed data and complete case analyses. (DOCX)

Estimated deaths and cardiovascular events delayed or deferred. (DOCX)

Management of missing values. (DOCX)

Categorical time at target (TITRE) and risk of non-cardiovascular mortality. (DOCX)

Akaike’s information criteria comparing performances of models for all cardiovascular diseases and death. (DOCX)

Snapshot control status and risk of all cardiovascular disease and death according to time at target (TITRE). (DOCX)

Antihypertensive medication use and risk of all cardiovascular disease and death according to time at target (TITRE) categories. (DOCX)

Objectives To investigate the incidence and determinants of heart failure (HF) following a myocardial infarction (MI) in a contemporary cohort of patients with MI using routinely collected primary and hospital care electronic health records (EHRs). Methods Data were used from the CALIBER programme, linking EHRs in England from primary care, hospit...

Aims: The aim of this study is to develop models to aid the decision to prolong dual antiplatelet therapy (DAPT) that requires balancing an individual patient's potential benefits and harms. Methods and results: Using population-based electronic health records (EHRs) (CALIBER, England, 2000-10), of patients evaluated 1 year after acute myocardia...

Objective: To estimate the potential magnitude in unselected patients of the benefits and harms of prolonged dual antiplatelet therapy after acute myocardial infarction seen in selected patients with high risk characteristics in trials. Design: Observational population based cohort study. Setting: PEGASUS-TIMI-54 trial population and CALIBER (...

Early graft loss (EGL) after kidney transplantation is a catastrophic outcome that is assumed to be more likely after the use of kidneys from suboptimal donors. We therefore examined its incidence, risk factors and consequences in our center in relation to different donor types. Of 801 recipients who received a kidney-only transplant from deceased...

Background Ischaemia /reperfusion injury (IRI) that develops after liver implantation may prejudice long-term graft survival, but remains poorly understood.Methods Here we correlate the severity of IRI, as determined by histological grading of ‘time-zero' biopsies sampled following graft revascularisation, with patient and graft outcomes.ResultsTim...

Peanut allergy is a common disease that causes severe and fatal food allergic reactions. Currently, the best treatment is avoidance as repeated reactions can occur. Quality of life (QoL) is reduced by fear of severe reactions and social limitations. Oral immunotherapy (OIT) is a novel treatment that may be an effective treatment for peanut allergy....

Purpose The Stickler syndromes are the most common causes of inherited and childhood retinal detachment; however, no consensus exists regarding the effectiveness of prophylactic intervention. We evaluate the long-term safety and efficacy of the Cambridge prophylactic cryotherapy protocol, a standardized retinal prophylactic treatment developed to p...

Small studies suggest peanut oral immunotherapy (OIT) might be effective in the treatment of peanut allergy. We aimed to establish the efficacy of OIT for the desensitisation of children with allergy to peanuts. We did a randomised controlled crossover trial to compare the efficacy of active OIT (using characterised peanut flour; protein doses of 2...

Systolic blood pressure variability is an independent risk factor for mortality and cardiovascular events. Standard measures of blood pressure predict outcome poorly in haemodialysis patients. We investigated whether systolic blood pressure variability was associated with mortality in incident haemodialysis patients. We performed a longitudinal obs...