Imperial College London

Alex Bottle

Faculty of MedicineSchool of Public Health

Professor of Medical Statistics
 
 
 
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Contact

 

+44 (0)20 7594 0913robert.bottle Website

 
 
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Location

 

3 Dorset Rise, London EC4Y 8ENCharing Cross HospitalCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
to

385 results found

Bottle A, Neale FK, Foley KA, Viner RM, Kenny S, Aylin P, Saxena S, Hargreaves DSet al., 2022, Impact of COVID-19 on outpatient appointments in children and young people in England: an observational study., BMJ Open, Vol: 12

OBJECTIVES: To describe the impact of the COVID-19 pandemic on outpatient appointments for children and young people. SETTING: All National Health Service (public) hospitals in England. PARTICIPANTS: All people in England aged <25 years. OUTCOME MEASURES: Outpatient department attendance numbers, rates and modes (face to face vs telephone) by age group, sex and socioeconomic deprivation. RESULTS: Compared with the average for January 2017 to December 2019, there was a 3.8 million appointment shortfall (23.5%) for the under-25 population in England between March 2020 and February 2021, despite a total rise in phone appointments of 2.6 million during that time. This was true for each age group, sex and deprivation fifth, but there were smaller decreases in face to face and total appointments for babies under 1 year. For all ages combined, around one in six first and one in four follow-up appointments were by phone in the most recent period. The proportion of appointments attended was high, at over 95% for telephone and over 90% for face-to-face appointments for all ages. CONCLUSIONS: COVID-19 led to a dramatic fall in total outpatient appointments and a large rise in the proportion of those appointments conducted by telephone. The impact that this has had on patient outcomes is still unknown. The differential impact of COVID-19 on outpatient activity in different sociodemographic groups may also inform design of paediatric outpatient services in the post-COVID period.

Journal article

Warner M, Burn S, Stoye G, Aylin PP, Bottle A, Propper Cet al., 2022, Socioeconomic deprivation and ethnicity inequalities in disruption to NHS hospital admissions during the COVID-19 pandemic: a national observational study, BMJ Quality & Safety, Vol: 31, Pages: 590-598, ISSN: 2044-5415

Introduction Hospital admissions in many countries fell dramatically at the onset of the COVID-19 pandemic. Less is known about how care patterns differed by patient groups. We sought to determine whether areas with higher levels of socioeconomic deprivation or larger ethnic minority populations saw larger falls in emergency and planned admissions in England.Methods We conducted a national observational study of hospital care in the English National Health Service (NHS) in 2019–2020. Weekly volumes of elective (planned) and emergency admissions in 2020 compared with 2019 were calculated for each census area. Multiple linear regression analysis was used to estimate the reductions in volumes for areas in different quintiles of socioeconomic deprivation and ethnic minority populations after controlling for national time trends and local area composition.Results Between March and December 2020, there were 35.5% (3.0 million) fewer elective admissions and 22.0% (1.2 million) fewer emergency admissions with a non-COVID-19 primary diagnosis than in 2019. Areas with the largest share of ethnic minority populations experienced a 36.7% (95% CI 24.1% to 49.3%) larger reduction in non-primary COVID-19 emergency admissions compared with those with the smallest. The most deprived areas experienced a 10.1% (95% CI 2.6% to 17.7%) smaller reduction in non-COVID-19 emergency admissions compared with the least deprived. These patterns are not explained by differential prevalence of COVID-19 cases by area.Conclusions Even in a healthcare system founded on the principle of equal access for equal need, the impact of COVID-19 on NHS hospital care for non-COVID patients has not been spread evenly by ethnicity and deprivation in England. While we cannot conclusively determine the mechanisms behind these differences, they risk exacerbating prepandemic health inequalities.Data availability statementData may be obtained from a third party and are not publicly available.

Journal article

Bottle R, Faitna P, Brett S, Aylin Pet al., 2022, Factors associated with, and variations in, COVID-19 hospital death rates in England’s first two waves: observational study, BMJ Open, Vol: 12, Pages: 1-11, ISSN: 2044-6055

Objectives:To assess patient- and hospital-level predictors of death and variation in death rates following admission for COVID-19 in England’s first two waves after accounting for random variation. To quantify the correlation between hospitals’ first and second wave death rates.Design:Observational study using administrative data.Setting:Acute non-specialist hospitals in England.Participants:All patients admitted with a primary diagnosis of COVID-19.Primary and secondary outcomes:In-hospital death.Results:Hospital Episode Statistics (HES) data were extracted for all acute hospitals in England for COVID-19 admissions for March 2020 to March 2021. In wave one (March-July 2020) there were 74,484 admissions and 21,883 deaths (crude rate 29.4%); in wave two (August 2020 to March 2021) there were 165,642 admissions and 36,040 deaths (21.8%). Wave two patients were younger, with more hypertension and obesity but lower rates of other comorbidities. Mortality improved for all ages; in wave two it peaked in December 2020 at 24.2% (lower than wave one’s peak) but halved by March 2021. In multiple multilevel modelling combining HES with hospital-level data from Situational Reports, wave two and wave one variables significantly associated with death were mostly the same. The median odds ratio for wave one was just 1.05 and for wave two was 1.07. At 99.8% control limits, 3% of hospitals were high and 7% were low funnel plot outliers in wave one; these figures were 9% and 12% for wave two. Four hospitals were (low) outliers in both waves. The correlation between hospitals’ adjusted mortality rates between waves was 0.45 (p<0.0001). Length of stay was similar in each wave.Conclusions:England’s first two COVID-19 waves were similar regarding predictors and moderate inter-hospital variation. Despite the challenges, variation in death rates and length of stay between hospitals was modest and might be accounted for by unobserved patient factors.

Journal article

Foley K, Maile E, Bottle R, Neale F, Viner R, Kenny S, Majeed F, Hargreaves D, Saxena Set al., 2022, Impact of covid-19 on primary care contacts with children and young people aged 0-24 years in England; longitudinal trends study 2015-2020, British Journal of General Practice, ISSN: 0960-1643

Background: The NHS response to covid-19 altered provision and access to primary care.Aim: To examine the impact of covid-19 on general practitioner (GP) contacts with children and young people in England. Design and Setting: Longitudinal trends analysis using electronic health records from the Clinical Practice Research Datalink Aurum database.Methods: We included all children and young people younger than 25 years registered with a GP. We compared the number of total, remote and face-to-face contacts during the first UK lockdown (March to June 2020) with the mean contacts for comparable weeks from 2015 to 2019.Results: We examined 47 607 765 GP contacts with 4 307 120 million children and young people. GP contacts fell 41% during the first lockdown compared with previous years. Children aged 1-14 had greater falls in total contacts (>50%) compared with infants and 15-24s. Face-to-face contacts fell by 88% with the greatest falls occurring among children aged 1-14 (> 90%). Remote contacts more than doubled, increasing most in infants (over 2.5 fold). Total contacts for respiratory illnesses fell by 74% whereas contacts for common non-transmissible conditions shifted largely to remote, mitigating the total fall (31%). Conclusion: During the covid-19 pandemic, children and young people’s contact with GPs fell, particularly for face-to-face assessment. This may be explained by a lower incidence of respiratory illnesses due to fewer social contacts and changing health seeking behaviour. The large shift to remote contacts mitigated total falls in contacts for some age groups and for common non-transmissible conditions.

Journal article

Blackwell J, Saxena S, Jayasooriya N, Petersen I, Hotopf M, Creese H, Bottle A, Pollok RCGet al., 2022, Stoma Formation in Crohn's Disease and the Likelihood of Antidepressant Use: A Population-Based Cohort Study, CLINICAL GASTROENTEROLOGY AND HEPATOLOGY, Vol: 20, Pages: E703-E710, ISSN: 1542-3565

Journal article

Bottle R, Newson R, Faitna P, Hayhoe B, Cowie Met al., 2022, Changes in heart failure management and long-term mortality over ten years: observational study, Open Heart, Vol: 9, ISSN: 2053-3624

Objectives: To estimate the long-term survival of two cohorts of people diagnosed with heart failure 10 years apart and to assess differences in patient characteristics, clinical guideline compliance and survival by diagnosis setting.Methods Data: for patients aged 18 and over with a new diagnosis of heart failure in the Clinical Practice Research Datalink in 2001–2002 (5966 patients in 156 practices) and 2011–2012 (12 827 patients in 331 practices). Survival rates since diagnosis were described using Kaplan-Meier plots. Compliance with national guidelines was summarised.Results: 2011/2012 patients were older than those diagnosed a decade before, with lower blood pressure and cholesterol but more comorbidity and healthcare contacts. For those diagnosed in 2001/2002, the 5-year survival was 40.0% (40.2% in the 2011/2012 cohort), 10-year survival was 20.8%, and 15-year survival 11.1%. Improvement in survival between the two time periods was seen only in those diagnosed in primary care (5-year survival 46.0% vs 57.4%, compared with 33.9% and 32.6% for hospital-diagnosed patients).Beta-blocker use rose from 24.3% to 39.1%; renin–angiotensin system blockers rose from 31.8% to 54.3% (both p<0.001). There was little change for loop diuretics and none for thiazide diuretics. For the 9963 patients with symptoms recorded by their general practitioner before diagnosis, brain natriuretic peptide (BNP) testing was low, but echocardiogram use rose from 8.3% to 19.3%, and specialist referral rose from 7.2% to 24.6% (all p<0.001).

Journal article

Jayasooriya N, Blackwell J, Saxena S, Bottle A, Petersen I, Creese H, Hotopf M, Pollok RCGet al., 2022, Antidepressant medication use in Inflammatory Bowel Disease: a nationally representative population-based study, ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Vol: 55, Pages: 1330-1341, ISSN: 0269-2813

Journal article

Sharma A, Lai H, Chang K, Sharabiani M, Bottle A, Valabhji J, Middleton L, Majeed A, Millett C, Vamos Eet al., 2022, A 20-year follow-up of cardiometabolic trajectories amongst individuals with type 2 diabetes before dementia diagnosis by ethnic group, DUK, Publisher: WILEY, ISSN: 0742-3071

Conference paper

Deputy M, Sahnan K, Worley G, Patel K, Balinskaite V, Bottle A, Aylin P, Burns EM, Hart A, Faiz Oet al., 2022, The use of, and outcomes for, inflammatory bowel disease services during the Covid-19 pandemic: a nationwide observational study, ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Vol: 55, Pages: 836-846, ISSN: 0269-2813

Journal article

Marang-van de Mheen PJ, Putter H, Bastiaannet E, Bottle Aet al., 2021, Competing risks in quality and safety research: a framework to guide choice of analysis and improve reporting, BMJ QUALITY & SAFETY, Vol: 30, Pages: 1031-1037, ISSN: 2044-5415

Journal article

Orlowski A, Snow S, Humphreys H, Smith W, Jones RS, Ashton R, Buck J, Bottle Aet al., 2021, Bridging the impactibility gap in population health management: a systematic review, BMJ OPEN, Vol: 11, ISSN: 2044-6055

Journal article

Jayasooriya N, Pollok R, Blackwell J, Petersen I, Bottle A, Creese H, Saxena Set al., 2021, ADHERENCE AND DISCONTINUATION OF ORAL 5-AMINOSALICYLIC ACID AMONGST ADOLESCENTS AND YOUNG ADULTS WITH ULCERATIVE COLITIS, Publisher: BMJ PUBLISHING GROUP, Pages: A30-A31, ISSN: 0017-5749

Conference paper

Balinskaite V, Hayhoe B, Quint J, Bottle Aet al., 2021, Identifying patients with first chronic obstructive pulmonary disease diagnosis in routine databases: a descriptive study, Annual National Conference on Public Health Science dedicated to New Research in UK Public Health, Publisher: ELSEVIER SCIENCE INC, Pages: 21-21, ISSN: 0140-6736

Conference paper

Balinskaite V, Bottle A, Aylin P, 2021, Capacity planning for acute hospital inpatient care and adult critical care in England: a descriptive study using hospital administrative data, Annual National Conference on Public Health Science dedicated to New Research in UK Public Health, Publisher: ELSEVIER SCIENCE INC, Pages: 22-22, ISSN: 0140-6736

Conference paper

Jayasooriya N, Saxena S, Blackwell J, Petersen I, Bottle A, Creese H, Pollok Ret al., 2021, IMPACT OF CONSULTATION FREQUENCY AND TIME TO DIAGNOSIS ON SUBSEQUENT INFLAMMATORY BOWEL DISEASE OUTCOMES, Annual Meeting of the British-Society-of-Gastroenterology (BSG), Publisher: BMJ PUBLISHING GROUP, Pages: A78-A78, ISSN: 0017-5749

Conference paper

Bottle A, Browne J, 2021, Outsourcing care to the private sector: some reassuring evidence on patient outcomes, BMJ QUALITY & SAFETY, Vol: 31, Pages: 486-488, ISSN: 2044-5415

Journal article

Roshanghalb A, Mazzali C, Lettieri E, Paganoni AM, Bottle Aet al., 2021, Stability over time of the "hospital effect" on 30-day unplanned readmissions: Evidence from administrative data, HEALTH POLICY, Vol: 125, Pages: 1393-1397, ISSN: 0168-8510

Journal article

Mauricaite R, Le Calvez K, Brodbelt A, Bottle A, Williams Met al., 2021, GLIOCOVA: DEFINING PATIENT SAFETY EVENTS FOR BRAIN TUMOUR PATIENTS UNDERGOING NEUROSURGERY, Publisher: OXFORD UNIV PRESS INC, Pages: 16-16, ISSN: 1522-8517

Conference paper

Blackwell J, Saxena S, Petersen I, Hotopf M, Creese H, Bottle A, Alexakis C, Pollok RCet al., 2021, Depression in individuals who subsequently develop inflammatory bowel disease: a population-based nested case-control study, GUT, Vol: 70, Pages: 1642-1648, ISSN: 0017-5749

Journal article

Lai H, Chang K, Sharabiani M, Valabhji J, Middleton L, Majeed A, Millett C, Bottle A, Vamos Eet al., 2021, 19-YEAR TRAJECTORIES OF CARDIO-METABOLIC FACTORS AMONG PATIENTS WITH TYPE 2 DIABETES BY DEMENTIA STATUS IN ENGLAND, EDC, Publisher: BMJ PUBLISHING GROUP, Pages: A12-A12, ISSN: 0143-005X

Conference paper

Axson E, Bottle R, Cowie M, Quint Jet al., 2021, The relationship between heart failure and the risk of acute exacerbation of COPD, Thorax, Vol: 76, Pages: 807-814, ISSN: 0040-6376

Rationale: Heart failure (HF) management in chronic obstructive pulmonary disease (COPD) is often delayed or suboptimal.Objectives: To examine the effect of HF and HF medication use on moderate-to-severe COPD exacerbations.Methods and Measurements: Retrospective cohort studies from 2006-2016 using nationally-representative English primary care electronic healthcare records linked to national hospital and mortality data. COPD patients with diagnosed and possible HF were identified. Possible HF defined as continuous loop diuretic use in the absence of a non-cardiac indication. Incident exposure to HF medications was defined as ≥2 prescriptions within 90 days with no gaps >90 days during ≤6 months of continuous use; prevalent exposure as 6+ months continuous use. HF medications investigated were angiotensin receptor blockers, angiotensin converting enzyme inhibitors, beta-blockers, loop diuretics, and mineralocorticoid receptor antagonists. Cox regression, stratified on sex and age; further adjusted for patient characteristics, was used to determine the association of HF on exacerbation risk.Main Results: 86,795 COPD patients were categorized as; no evidence of HF (n=60,047); possible HF (n=8,476); newly diagnosed HF (n=2,066). Newly diagnosed HF (adjusted hazard ratio (aHR): 1.45, 95% confidence interval (CI): 1.30, 1.62) and possible HF (aHR: 1.65, 95%CI: 1.58, 1.72) similarly increased exacerbation risk. Incident and prevalent use of all HF medications were associated with increased exacerbation risk. Prevalent use was associated with reduced exacerbation risk compared with incident use.Conclusions: Earlier opportunities to improve diagnosis and management of HF in the COPD population are missed. Managing HF may reduce exacerbation risk in the longer term.

Journal article

Coughlan CH, Ruzangi J, Neale FK, Nezafat Maldonado B, Blair M, Bottle A, Saxena S, Hargreaves Det al., 2021, Social and ethnic group differences in healthcare use by children aged 0-14 years: a population-based cohort study in England from 2007 to 2017., Archives of Disease in Childhood, Vol: 107, Pages: 32-39, ISSN: 0003-9888

OBJECTIVE: To describe social and ethnic group differences in children's use of healthcare services in England, from 2007 to 2017. DESIGN: Population-based retrospective cohort study. SETTING/PATIENTS: We performed individual-level linkage of electronic health records from general practices and hospitals in England by creating an open cohort linking data from the Clinical Practice Research Datalink and Hospital Episode Statistics. 1 484 455 children aged 0-14 years were assigned to five composite ethnic groups and five ordered groups based on postcode mapped to index of multiple deprivation. MAIN OUTCOME MEASURES: Age-standardised annual general practitioner (GP) consultation, outpatient attendance, emergency department (ED) visit and emergency and elective hospital admission rates per 1000 child-years. RESULTS: In 2016/2017, children from the most deprived group had fewer GP consultations (1765 vs 1854 per 1000 child-years) and outpatient attendances than children in the least deprived group (705 vs 741 per 1000 child-years). At the end of the study period, children from the most deprived group had more ED visits (447 vs 314 per 1000 child-years) and emergency admissions (100 vs 76 per 1000 child-years) than children from the least deprived group.In 2016/2017, children from black and Asian ethnic groups had more GP consultations than children from white ethnic groups (1961 and 2397 vs 1824 per 1000 child-years, respectively). However, outpatient attendances were lower in children from black ethnic groups than in children from white ethnic groups (732 vs 809 per 1000 child-years). By 2016/2017, there were no differences in outpatient, ED and in-patient activity between children from white and Asian ethnic groups. CONCLUSIONS: Between 2007 and 2017, children living in more deprived areas of England made greater use of emergency services and received less scheduled care than children from affluent neighbourhoods. Children from Asian and black ethnic grou

Journal article

Cecil E, Bottle A, Majeed A, Aylin Pet al., 2021, Factors associated with potentially missed acute deterioration in primary care, British Journal of General Practice, Vol: 24/6/21, Pages: e547-e554, ISSN: 0960-1643

BACKGROUND: In the UK, the majority of primary care contacts are uncomplicated. However, safety incidents resulting in patient harm occur, such as failure to recognise a patient's deterioration in health. AIM: We aimed to determine patient and healthcare factors associated with potentially missed deterioration. DESIGN AND SETTING: A cohort of patients registered with English CPRD general practices between 01-04-2014 and 31-12-2017 with linked hospital data. METHODS: We defined a potentially missed deterioration as a patient, seen in primary care by a GP in the three days before hospitalisation, having a self-referred admission. We used generalised estimating equations to investigate factors associated with odds of a self-referred admission. We investigated all diagnoses and subsets of commonly reported missed conditions. RESULTS: There were 116,097 patients who contacted a GP three days prior to an emergency admission. Patients with sepsis or urinary tract infections were more likely to self-refer, adjusted odds ratio 1.10 95%CI(1.02-1.19) and 1.09 (1.04-1.14) respectively. GP appointment durations were associated with self-referral. On average, a 5-minute increase resulted in 10% decrease in odds of self-referred admissions, 0.90 (0.89-0.91). Patients having a telephone (compared with face-to-face) consultation 1.13 (1.09-1.16), previous health service use and health status were also associated with self-referred admission. CONCLUSIONS: Differentiating deterioration from self-limiting conditions can be difficult for clinicians, particularly in patients with sepsis, UTI or with long-term conditions. Our findings supports the call for longer GP consultations and cautions reliance on telephone consultations in primary care; however, research is needed to understand the underlying mechanisms.

Journal article

Balinskaite V, Aylin P, Bottle R, 2021, Assessing the impact of a shadowing programme on in-hospital mortality following trainee doctors’ changeover, BMC Health Services Research, Vol: 21, Pages: 1-7, ISSN: 1472-6963

BackgroundTo assess the impact on seven-day in-hospital mortality following the introduction in 2012 of a shadowing programme for new UK medical graduates requiring them to observe the doctor they are replacing for at least 4 days before starting work.MethodsData on emergency admissions were derived from Hospital Episode Statistics between 2003 and 2019. A generalised estimating equation model was used to examine whether the introduction of the programme was associated with a change in mortality.ResultsThere were 644,018 emergency admissions, of which 1.8% (7612) ended in death in hospital within a week following the admission. Throughout the study period, there was an annual increase in the number of emergency admissions during July and August, though in-hospital mortality rates declined. The generalised estimating equation analysis found no significant change in the odds of death within 7 days after admission for patients admitted on the first Wednesday in August compared with patients admitted on the last Wednesday in July (OR = 1.03, 95% CI 0.94–1.13, p = 0.53). Furthermore, there was no significant change observed for any clinical diagnosis category following the introduction of the shadowing programme.ConclusionThere was a rising trend in the number of emergency admissions over the study period, though mortality was decreasing. We found no significant association between the introduction of shadowing programme and in-hospital mortality; however, lack of power means that we cannot rule out a small effect on mortality. There are other outcomes that might have changed but were not examined in this study.

Journal article

Rao A, Razzaq H, Panamarenko B, Bottle A, Majeed A, Gray Eet al., 2021, Online application for self-referral of the patients with breast symptoms, Annals of Medicine and Surgery, Vol: 66, ISSN: 2049-0801

IntroductionThe study aimed to devise a self-referral mobile/web application for patients with new breast symptoms, giving them an outcome, thus bypassing the need for primary care consultation.MethodsThe online application was designed on the automated algorithm based on evidence-based guidelines for referral to breast onco-plastic units. A retrospective questionnaire-based anonymous survey was carried out at the breast unit in Southend University Hospital (January 2019 to March 2020). The outcome of the patients was recorded, the same data was entered in the software and its outcome was compared with their clinic outcome to assess and validate the software. Chi-square and t-test were used in formulating results.ResultsData was collected for 366 patients who were referred urgently to the clinic. Only 50.5% (n = 186) were appropriately referred, with the main complaint being breast lump (94.1%). 39.6% of referred patients did not require a secondary care referral. Sensitivity and specificity for identifying patients requiring urgent referral was 100% and 98%, respectively.ConclusionA significant number of urgent referrals to breast units do not require urgent specialist referral, and this results in a big strain on the hospital service. The discussed self-referral pathway is a promising alternative with the potential to reduce workload in primary and secondary care and improve patient satisfaction.

Journal article

Blackwell J, Alexakis C, Saxena S, Creese H, Bottle R, Petersen I, Matthew H, Pollok Ret al., 2021, The association between antidepressant medication use and steroid dependency in patients with ulcerative colitis: a population-based study, BMJ Open Gastroenterology, Vol: 8, ISSN: 2054-4774

Background: Animal studies indicate a potential protective role of antidepressant medication (ADM) in models of colitis but the effect of their use in humans with ulcerative colitis (UC) remains unclear. Objective: To study the relationship between ADM use and corticosteroid dependency in UC. Design: Using the Clinical Practice Research Datalink we identified patients diagnosed with UC between 2005-2016. We grouped patients according to serotonin selective reuptake inhibitor (SSRI) and tricyclic antidepressant (TCA) exposure in the 3 years following diagnosis: 'continuous users', 'intermittent users' and 'non users'. We used logistic regression to estimate the adjusted risk of corticosteroid dependency between ADM exposure groups. Results: We identified 6373 patients with UC. 5,230 (82%) use no ADMs, 627 (10%) were intermittent SSRI users and 282 (4%) were continuous SSRI users, 246 (4%) were intermittent TCA users and 63 (1%) were continuous TCA users. Corticosteroid dependency was more frequent in continuous SSRI and TCA users compared with non-users (19% vs. 24% vs. 14%, respectively, χ2 p=0.002). Intermittent SSRI and TCA users had similar risks of developing corticosteroid dependency to non-users (SSRI: OR 1.19, 95%CI 0.95-1.50, TCA: OR 1.14, CI 0.78-1.66). Continuous users of both SSRIs and TCAs had significantly higher risks of corticosteroid dependency compared to non-users (SSRI: OR 1.62, CI 1.15-2.27, TCA: OR 2.02, CI 1.07-3.81). Conclusions: Continuous ADM exposure has no protective effect in routine clinical practice in UC and identifies a population of patients requiring more intensive medical therapy. ADM use is a flag for potentially worse clinical outcomes in UC.

Journal article

Bottle R, Faitna P, Aylin P, Cowie Met al., 2021, Five-year outcomes following left ventricular assist device implantation in England, Open Heart, Vol: 8, Pages: 1-6, ISSN: 2053-3624

Objective Implant rates of mechanical circulatory supports such as left ventricular assist devices (LVAD) have steadily increased in the last decade. We assessed the utility of administrative data to provide information on hospital use and outcomes.Methods Using 2 years of national hospital administrative data for England linked to the death register, we identified all patients with an LVAD and extracted hospital activity for 5 years before and after the LVAD implantation date.Results In the two index years April 2011 to March 2013, 157 patients had an LVAD implanted. The mean age was 50.9 (SD 15.4), and 78.3% were men. After 5 years, 92 (58.6%) had died; the recorded cause of death was noncardiovascular in 67.4%. 42 (26.8%) patients received a heart±lung transplantation. Compared with the 12 months before implantation, the 12 months after but not including the month of implantation saw falls in total inpatient and day case admissions, a fall in admissions for heart failure (HF), a rise in non-HF admissions, a fall in emergency department visits not ending in admission and a rise in outpatient appointments (all per patient at risk). Postimplantation complications were common in the subsequent 5 years: 26.1% had a stroke, 23.6% had a device infection and 13.4% had a new LVAD implanted.Conclusions Despite patients’ young age, their mortality is high and their hospital use and complications are common in the 5 years following LVAD implantation. Administrative data provide important information on resource use in this patient group.

Journal article

Bottle A, Faitna P, Aylin P, Cowie MRet al., 2021, Five-year survival and use of hospital services following ICD and CRT implantation: comparing real-world data with RCTs, ESC Heart Failure, Vol: 8, Pages: 2438-2447, ISSN: 2055-5822

AimsGuidelines recommend the use of an implantable cardioverter-defibrillator (ICD) and/or cardiac resynchronization therapy (CRT) device based on the results of randomized controlled trials (RCTs), typically with selected patients and short follow-up.Methods and resultsWe describe the 5 year survival rate and use of hospital services following ICD and CRT implantation in England from April 2011 to March 2013 using the national hospital administrative database covering emergency department visits, inpatient admissions, and clinic appointments, linked to the national death register. Five-year survival was 64% after ICD implantation and 58% after CRT implantation, with median survival times of 6.8 and 6.2 years, respectively. Hospital use was high in both device groups, for the 5 years prior and after implantation, peaking around the implantation date. Most hospital activity was not primarily related to heart failure. Healthcare costs were dominated by admissions, but emergency department and clinic activity were both high. Only the CRT group saw total per-patient costs fall after the index month (implantation), driven by a slight fall in the heart failure admission rate. Patients were typically older than in the trials, but with similar co-morbidity except for substantially more atrial fibrillation and less dementia. Survival and device complications were similar to the RCTs.ConclusionsClinical and cost-effectiveness assessments of ICD and CRT implantation are supported by real-world data, although the prevalence of atrial fibrillation remains substantially higher than in the RCTs.

Journal article

Jayasooriya N, Saxena S, Blackwell J, Petersen I, Bottle A, Creese H, Pollok Ret al., 2021, Impact of consultation frequency and time to diagnosis on subsequent Inflammatory Bowel Disease outcomes, Publisher: OXFORD UNIV PRESS, Pages: S242-S243, ISSN: 1873-9946

Conference paper

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