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Long-term outcomes in patients newly diagnosed with iron deficiency anaemia in general practice: a retrospective cohort study.

ABSTRACT: OBJECTIVES:To describe all iron deficiency anaemia (IDA)-related causes during follow-up of patients newly diagnosed with IDA and to assess whether a delayed colorectal cancer (CRC) diagnosis influences survival. DESIGN AND SETTING:Retrospective cohort study of patients from general practices in the Dordrecht area, the Netherlands. PARTICIPANTS:Men and women aged ?50 years with a new diagnosis of IDA (ie, no anaemia 2?years previously). METHOD:From February 2007 to February 2018, all relevant data were collected from the files of the referral hospital. Early IDA-related cause was defined as established within 18 weeks after IDA diagnosis. Cox proportional-hazards regression was used to analyse survival of patients with CRC diagnosis. RESULTS:587 patients with IDA were included with a median follow-up of 4.6 years. Early and late IDA-related causes could be established in 32% and 8% of patients, respectively. Early and late CRC was found in 8% and 2% of patients, respectively, and were located mainly right sided. After adjustment for age, gender and TNM classification, mortality risk was lower in patients with IDA with early CRC diagnosis, but not significantly (HR 0.30, 95%?CI 0.09 to 1.02). CONCLUSION:Even with extended follow-up, the cause of IDA remains elusive in the majority of patients with IDA in general practice. However, patients with IDA are at increased risk for in particular right-sided CRC and a late diagnosis of CRC appears to have a detrimental effect on survival in patients with IDA.

SUBMITTER: Schop A

PROVIDER: S-EPMC6924716 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Long-term outcomes in patients newly diagnosed with iron deficiency anaemia in general practice: a retrospective cohort study.

Schop Annemarie A Stouten Karlijn K Riedl Jurgen J van Houten Ron R van Rosmalen Joost J Wolfhagen Frank F Bindels Patrick J E PJE Levin Mark-David MD

BMJ open 20191128 11

<h4>Objectives</h4>To describe all iron deficiency anaemia (IDA)-related causes during follow-up of patients newly diagnosed with IDA and to assess whether a delayed colorectal cancer (CRC) diagnosis influences survival.<h4>Design and setting</h4>Retrospective cohort study of patients from general practices in the Dordrecht area, the Netherlands.<h4>Participants</h4>Men and women aged ≥50 years with a new diagnosis of IDA (ie, no anaemia 2 years previously).<h4>Method</h4>From February 2007 to F ...[more]

PMID: 31784447

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Project description:ObjectivesHypotension is of particular relevance for patients with heart failure (HF), since almost all HF drugs cause lowering of blood pressure (BP) and it is associated with a poor prognosis. We aimed to investigate hypotension incidence and risk factors in patients with incident HF in the UK.DesignRetrospective cohort study including nested case-control analyses.SettingThe Health Improvement Network UK primary care database.Participants18 677 adult patients with incident HF during 2000-2005 were followed and cases of hypotension (systolic BP ≤90 mm Hg) were identified. Controls were age-matched, sex-matched and date-matched to cases (1:2).Primary and secondary outcome measuresWe estimated hypotension incidence in the full study population and relevant subgroups (eg, sex and age). Potential risk factors for hypotension overall and for multiple versus single hypotensive episodes were evaluated using conditional logistic regression and unconditional regression models, respectively.ResultsDuring a mean follow-up of 3.31 years, 2565 patients (13.7%) developed hypotension. The incidence of hypotension was 3.17 cases per 100 patient years (95% confidence interval (CI): 3.05-3.30), and was markedly increased in women aged 18-39 years (n=32; 17.72 cases per 100 patient-years; 95% CI: 9.69-29.73). Hypotension risk factors included high healthcare utilisation (proxy measure for HF severity and general comorbidity; eg, ≥10 primary care physician visits versus none, odds ratio (OR): 2.29; 95% CI: 1.34-3.90), previous hypotensive episodes (OR: 2.32; 95% CI: 1.84-2.92), renal failure and use of aldosterone antagonists, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Risk factors identified for hypotension generally overlapped with those for multiple versus single hypotensive episodes.ConclusionsHypotension occurs frequently in patients with incident HF. Our findings may help identify patients most likely to benefit from close BP monitoring. The increased incidence of hypotension in young women with HF requires investigation.

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Long-term outcomes in patients newly diagnosed with iron deficiency anaemia in general practice: a retrospective cohort study.

Publications

Long-term outcomes in patients newly diagnosed with iron deficiency anaemia in general practice: a retrospective cohort study.

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