Cardiovascular disease and mortality in people with schizophrenia or antipsychotic treatment: A cohort study in primary care.

People with schizophrenia (SZ) or under treatment with antipsychotic drugs (TAD) are considered to be at high risk of cardiovascular (CV) morbidity and mortality, but the reasons are not fully understood. In addition, no longitudinal studies in the setting of primary care in Spain have been performed. We aimed at analysing the incidence of cardiovascular disease (CVD) and CV mortality in the population with SZ and in the population without SZ but under TAD (NS-TAD). METHODS: Retrospective cohort study in primary care in Spain, based on data from computerized medical records and mortality recorded in the National Statistics Institute. Three groups were generated: SZ, NS-TAD and control group, with a 4-year follow-up period (2008 to 2011). RESULTS: In an adjusted model, SZ was established as an independent risk factor for CV mortality although not with non-fatal CVD incidence. The NS-TAD group was an independent risk factor for mortality of any cause and CVD, but not CV mortality. CONCLUSIONS: Differences between SZ and NS-TAD support that SZ has an increased risk of CVD independently of TAD. Further studies to evaluate the origin and management are needed. The detection of CVD and the consequent secondary CV prevention in these high-risk populations should be prioritized. Herein, a greater interaction between primary care and mental health services is eagerly needed.

Clinical characteristics and factors associated with triple therapy use in newly diagnosed patients with COPD.

There is limited information about the initiation of triple therapy (TT) in patients with chronic obstructive pulmonary disease (COPD) in primary care. This was an observational, population-based study in patients identified from a primary care electronic medical records database in Catalonia from 2011 to 2015 aimed to identify the use of TT in patients with newly diagnosed COPD. A total of 69,668 newly diagnosed patients were identified of whom 11,524 (16.5%) initiated TT, of whom 8626 initiated TT at or immediately after COPD diagnosis. Among them, 72.3% were GOLD A/B, 14.6% were frequent exacerbators, and 7.1% had asthma-COPD overlap (ACO). Variables associated with TT initiation were: male sex, older age, previous exacerbations, ACO, a previous treatment regimen containing an inhaled corticosteroid, previous pneumonia, and history of lung cancer. A significant number of COPD patients in Primary Care initiated TT shortly after or even before an established COPD diagnosis.

Treatment Pathways Before and After Triple Therapy in COPD: A Population-based Study in Primary Care in Spain / Vías de tratamiento antes y después de la triple terapia en EPOC: estudio poblacional en atención primaria en España

Background: Recent data from real world clinical practices on the use of Triple Therapy (TT) in patients with COPD are scarce.Methods: Observational population-based study with longitudinal follow-up in patients with COPD identified in a primary care electronic medical records database in Catalonia, covering 80% of the general population. The aims were to characterize COPD patients who initiated TT and to describe treatment pathways before and after TT initiation. Time to and probability of step down or complete discontinuation of TT was described using restricted mean survival time and Kaplan•Meier analysis.Results: A total of 34,018 COPD patients initiated TT during the study period. Of them, 23,867 (70.1%) were GOLD A/B. 18,453 (54.2%) were non-exacerbators, 9931 (29.2%) infrequent exacerbators, 5634 (16.5%) frequent exacerbators and 1923 (5.6%) had asthma-COPD overlap. Drugs most frequently used prior to initiation of TT were long-acting antimuscarinics (22.5%) and combination of long-acting beta2 agonists/inhaled corticosteroids (15.2%). A total of 11,666 (34.3%) stepped down and 1091 (3.2%) discontinued TT during follow-up. Step down following TT was more likely in patients with severe COPD, especially during the first year; however, discontinuation was more common among patients with mild COPD. (AU)

Antecedentes: Se dispone de pocos datos recientes de práctica clínica en el mundo real sobre el uso de la triple terapia (TT) en pacientes con EPOC.Métodos: Estudio observacional de base poblacional con seguimiento longitudinal en pacientes con EPOC identificados en una base de datos de historiales médicos electrónicos de atención primaria en Cataluña, que abarca el 80% de la población general. Los objetivos fueron caracterizar a los pacientes con EPOC que iniciaron la TT, y describir las vías de tratamiento antes y después del inicio de la TT. Se describió el tiempo y la probabilidad de desescalada o la suspensión completa de la TT utilizando el tiempo de supervivencia medio restringido y el análisis de Kaplan-Meier.Resultados: Un total de 34.018 pacientes con EPOC iniciaron TT durante el período de estudio. De ellos, 23.867 (70,1%) eran GOLD A/B, 18.453 (54,2%) eran no exacerbadores, 9.931 (29,2%) exacerbadores infrecuentes, 5.634 (16,5%) exacerbadores frecuentes y 1.923 (5,6%) presentaban superposición asma-EPOC. Los fármacos que se usaron con mayor frecuencia antes del inicio de la TT fueron los antimuscarínicos de acción prolongada (22,5%), y la combinación de agonistas beta2 de acción prolongada/corticosteroides inhalados (15,2%). Un total de 11.666 pacientes (34,3%) desescalaron la TT y 1.091 (3,2%) suspendieron el tratamiento durante el seguimiento. La desescalada después de la TT fue más probable en pacientes con EPOC grave, especialmente durante el primer año; sin embargo, la suspensión fue más común en pacientes con EPOC leve. (AU)

Blood Eosinophil Counts and Their Variability and Risk of Exacerbations in COPD: A Population-Based Study / Recuento de eosinófilos en sangre y variabilidad de este y el riesgo de exacerbaciones en la EPOC: un estudio poblacional

BACKGROUND: There is controversy regarding the role of blood eosinophil levels as a biomarker of exacerbation risk in chronic obstructive pulmonary disease (COPD). Our aim was to quantify blood eosinophil levels and determine the risk of exacerbations associated with these levels and their variability. METHODS: Observational, retrospective, population-based study with longitudinal follow-up in patients with COPD identified in a primary care electronic medical record database in Catalonia, Spain, covering 80% of the general population. Patients were classified into 4 groups using the following cut-offs: (a) < 150cells/Mul; (b) ≥ 150 and < 300cells/Mul; (c) ≥ 300 and < 500cells/Mul; (d) ≥ 500cells/Mul. RESULTS: A total of 57,209 patients were identified with a mean age of 70.2 years, a mean FEV1(% predicted) of 64.1% and 51.6% had at least one exacerbation the previous year. The number of exacerbations in the previous year was higher in patients with the lowest and the highest eosinophil levels compared with the intermediate groups. During follow-up the number of exacerbations was slightly higher in the group with the lowest blood eosinophil levels and in those with higher variability in eosinophil counts, but ROC curves did not identify a reliable threshold of blood eosinophilia to discriminate an increased risk of exacerbations. CONCLUSIONS: Our results do not support the use of blood eosinophil count as a reliable biomarker of the risk of exacerbation in COPD in a predominantly non-exacerbating population. Of note was that the small group of patients with the highest variability in blood eosinophils more frequently presented exacerbations

CONTEXTO GENERAL: Existe cierta controversia con respecto al papel de los niveles de eosinófilos en sangre como biomarcador del riesgo de exacerbación en la enfermedad pulmonar obstructiva crónica (EPOC). Nuestro objetivo fue cuantificar los niveles de eosinófilos en sangre y determinar el riesgo de exacerbaciones asociadas con estos niveles y su variabilidad. MÉTODOS: Estudio observacional, retrospectivo y poblacional con seguimiento longitudinal en pacientes con EPOC identificados en una base de datos electrónica de historiales médicos de atención primaria en Cataluña, España, que abarca el 80% de la población general. Los pacientes se clasificaron en 4 grupos utilizando los siguientes puntos de corte: a) < 150 células/mil; b) ≥ 150 y < 300 células/mil; c) ≥ 300 y < 500 células/mil, y d) ≥ 500 células/mil. RESULTADOS: Se identificaron un total de 57.209 pacientes con una edad media de 70,2 años, un FEV1 medio (% del predicho) el 64,1 y el 51,6% habían sufrido al menos una exacerbación el año anterior. El número de exacerbaciones en el año previo fue mayor en aquellos pacientes con los niveles más bajos y los más altos de eosinófilos en comparación con los grupos intermedios. Durante el seguimiento, el número de exacerbaciones fue ligeramente mayor en el grupo con los niveles más bajos de eosinófilos en sangre y en aquellos con mayor variabilidad en el recuento, pero las curvas ROC no identificaron un umbral fiable de eosinofilia en sangre para discriminar un mayor riesgo de exacerbaciones. CONCLUSIONES: Nuestros resultados no apoyan el uso del recuento de eosinófilos en sangre como un biomarcador fiable del riesgo de exacerbación de la EPOC en una población predominantemente no exacerbada. Cabe destacar que el pequeño grupo de pacientes con mayor variabilidad en los niveles de eosinófilos en sangre presentaba exacerbaciones con mayor frecuencia

Blood Eosinophil Counts and Their Variability and Risk of Exacerbations in COPD: A Population-Based Study.

BACKGROUND: There is controversy regarding the role of blood eosinophil levels as a biomarker of exacerbation risk in chronic obstructive pulmonary disease (COPD). Our aim was to quantify blood eosinophil levels and determine the risk of exacerbations associated with these levels and their variability. METHODS: Observational, retrospective, population-based study with longitudinal follow-up in patients with COPD identified in a primary care electronic medical record database in Catalonia, Spain, covering 80% of the general population. Patients were classified into 4 groups using the following cut-offs: (a) <150cells/µl; (b) ≥150 and <300cells/µl; (c) ≥300 and <500cells/µl; (d) ≥500cells/µl. RESULTS: A total of 57,209 patients were identified with a mean age of 70.2 years, a mean FEV1(% predicted) of 64.1% and 51.6% had at least one exacerbation the previous year. The number of exacerbations in the previous year was higher in patients with the lowest and the highest eosinophil levels compared with the intermediate groups. During follow-up the number of exacerbations was slightly higher in the group with the lowest blood eosinophil levels and in those with higher variability in eosinophil counts, but ROC curves did not identify a reliable threshold of blood eosinophilia to discriminate an increased risk of exacerbations. CONCLUSIONS: Our results do not support the use of blood eosinophil count as a reliable biomarker of the risk of exacerbation in COPD in a predominantly non-exacerbating population. Of note was that the small group of patients with the highest variability in blood eosinophils more frequently presented exacerbations.

Treatment Pathways Before and After Triple Therapy in COPD: A Population-based Study in Primary Care in Spain.

BACKGROUND: Recent data from real world clinical practices on the use of Triple Therapy (TT) in patients with COPD are scarce. METHODS: Observational population-based study with longitudinal follow-up in patients with COPD identified in a primary care electronic medical records database in Catalonia, covering 80% of the general population. The aims were to characterize COPD patients who initiated TT and to describe treatment pathways before and after TT initiation. Time to and probability of step down or complete discontinuation of TT was described using restricted mean survival time and Kaplan-Meier analysis. RESULTS: A total of 34,018 COPD patients initiated TT during the study period. Of them, 23,867 (70.1%) were GOLD A/B. 18,453 (54.2%) were non-exacerbators, 9931 (29.2%) infrequent exacerbators, 5634 (16.5%) frequent exacerbators and 1923 (5.6%) had asthma-COPD overlap. Drugs most frequently used prior to initiation of TT were long-acting antimuscarinics (22.5%) and combination of long-acting beta2 agonists/inhaled corticosteroids (15.2%). A total of 11,666 (34.3%) stepped down and 1091 (3.2%) discontinued TT during follow-up. Step down following TT was more likely in patients with severe COPD, especially during the first year; however, discontinuation was more common among patients with mild COPD. CONCLUSION: Most patients initiating treatment with TT were non exacerbators and continued on the same treatment over time regardless severity of disease. Stepping down was more frequent in severe patients, while discontinuation was more common among mild patients. Overall, it appears that TT is extensively used in primary care for treatment of patients with COPD.