GE Centricity Electronic Medical Record Research Articles

Leveraging unstructured data to identify hereditary angioedema patients in electronic medical records

BackgroundThe epidemiologic impact of hereditary angioedema (HAE) is difficult to quantify, due to misclassification in retrospective studies resulting from non-specific diagnostic coding. The aim of this study was to identify cohorts of patients with HAE-1/2 by evaluating structured and unstructured data in a US ambulatory electronic medical record (EMR) database.MethodsA retrospective feasibility study was performed using the GE Centricity EMR Database (2006–2017). Patients with ≥ 1 diagnosis code for HAE-1/2 (International Classification of Diseases, Ninth Revision, Clinical Modification 277.6 or International Classification of Diseases, Tenth Revision, Clinical Modification D84.1) and/or ≥ 1 physician note regarding HAE-1/2 and ≥ 6 months’ data before and after the earliest code or note (index date) were included. Two mutually exclusive cohorts were created: probable HAE (≥ 2 codes or ≥ 2 notes on separate days) and suspected HAE (only 1 code or note). The impact of manually reviewing physician notes on cohort formation was assessed, and demographic and clinical characteristics of the 2 final cohorts were described.ResultsInitially, 1691 patients were identified: 190 and 1501 in the probable and suspected HAE cohorts, respectively. After physician note review, the confirmed HAE cohort comprised 254 patients and the suspected HAE cohort decreased to 1299 patients; 138 patients were determined not to have HAE and were excluded. The overall false-positive rate for the initial algorithms was 8.2%. Across final cohorts, the median age was 50 years and > 60% of patients were female. HAE-specific prescriptions were identified for 31% and 2% of the confirmed and suspected HAE cohorts, respectively.ConclusionsUnstructured EMR data can provide valuable information for identifying patients with HAE-1/2. Further research is needed to develop algorithms for more representative HAE cohorts in retrospective studies.

Distance to glycemic goal at the time of treatment intensification in patients with type 2 diabetes mellitus failing metformin monotherapy in the United States

Background: A substantial proportion of patients with type 2 diabetes mellitus (T2DM) do not reach their target HbA1c level on metformin. The objective of this retrospective observational cohort study is to better characterize the distance between HbA1c target and patient’s actual HbA1c level (the distance to goal), using a target HbA1c of 7.0% (53 mmol/mol), in patients with T2DM who have started metformin monotherapy.Methods: We used data from the GE Centricity Electronic Medical Record database by IQVIA in 2016 in the United States (US) to identify adults with T2DM who started metformin monotherapy (MM) and received at least 90 days of treatment. Patients were categorized into three groups: those who achieved the goal of HbA1c <7.0%, those who did not achieve the goal of HbA1c <7.0% (i.e. failed MM) and received intensified treatment, and those who failed MM and did not receive intensified treatment. Distance to goal was computed for patients in each group.Results: We identified 20,704 patients in the US database who started MM; 1741 (8.4%) failed MM and received intensified treatment, while 4977 (24.0%) failed MM and did not receive intensified treatment. The mean post-MM HbA1c for those who failed MM and received intensified treatment was 8.7% (72 mmol/mol) (median 8.2%, 66 mmol/mol) and the mean distance to goal was 1.7% (median 1.2%). The mean post-MM HbA1c for those who failed MM and did not receive intensified treatment was 8.0% (64 mmol/mol) (median 7.5%, 58 mmol/mol) and the mean distance to goal was 1.0% (median 0.5%).Conclusion: A proportion of US T2DM patients do not achieve glycemic control (target HbA1c < 7.0%) despite 90 days of MM. Patients who failed MM and eventually received intensified treatment did so when their HbA1c distance to goal exceeded the level at which one add-on therapy alone might be sufficient to bring them to goal.

1495-P: Distance to Glycemic Target of Patients (Pts) with Type 2 Diabetes (T2D) and Established Cardiovascular Disease (eCVD) and/or Chronic Kidney Disease (CKD) Failing Metformin Monotherapy in the U.S.

Previous studies have shown that a large proportion of pts with T2D are not at glycemic target, but the distance to target is not well characterized, including among high risk patients such as those with eCVD/CKD. The objective of the study was to assess the distance to glycemic target by eCVD/CKD status. This retrospective study using GE Centricity Electronic Medical Record database (2016 data) included adult T2D pts on metformin monotherapy with ≥12 months of enrollment prior to index date (initiation of metformin) and prescribed an add-on agent. Distance to target was calculated as median difference from 3 HbA1c targets: &amp;lt;7%, &amp;lt;7.5% and &amp;lt;8%. Of the 1741 included pts, mean age was 57 years, 49% were female, 25% had eCVD/CKD. Table shows the distance to glycemic targets by eCVD/CKD status. Median difference from target ranged from 0.2%-1.2% depending on the specified threshold. 44.6%, 33.6% and 25.6% of pts were ≥1.5% away from targets of 7%, 7.5% and 8%, respectively, at time of add-on therapy. Difference from target and proportion of pts ≥1.5% from target was even higher for those without compared to with eCVD/CKD. In conclusion, a significant proportion of pts on metformin are more than 1.0% away from glycemic targets at the time of intensification and those without eCVD/CKD are likely to be intensified at much higher HbA1c. Disclosure G. Fernandes: None. B. Sawhney: Consultant; Self; Merck &amp; Co., Inc. H. Hannachi: Employee; Self; Merck &amp; Co., Inc. T. Wang: Employee; Spouse/Partner; Johnson &amp; Johnson. Employee; Self; Merck &amp; Co., Inc. A. McNeill: Employee; Self; Merck &amp; Co., Inc. K. Iglay: Employee; Self; Merck &amp; Co., Inc. Stock/Shareholder; Self; Merck &amp; Co., Inc. S. Rajpathak: None.

1496-P: Clinical Inertia in Relation to Sociodemographic Factors among Patients with Type 2 Diabetes (T2D) in the United States

Several studies focused on clinical inertia in the U.S. T2D population have demonstrated a significant delay in treatment intensification in real-world clinical practice. The objective of this study was to evaluate if there is a disparity in clinical inertia based on sociodemographic factors. The GE Centricity Electronic Medical Record database (2015 data) was used to identify T2D patients on dual therapy with metformin and another oral antihyperglycemic agent (OAHA). Included patients had ≥12 months of continuous enrollment prior to index date (initiation of dual therapy), further intensified therapy within 2 years following the index date and had an HbA1c measure available within 6 months prior to intensification. Treatment intensification was defined as addition of another OAHA or initiation of insulin/GLP-1RA. 991 patients met the inclusion criteria; mean age of 57.9 years and 47.4% were female. Table lists the distribution of sociodemographic factors by HbA1c categories. Results suggest that older patients were less likely to be intensified at higher HbA1c compared to younger patients. Furthermore, compared to whites, black patients were more likely to be intensified at higher HbA1c levels with no apparent pattern of intensification by region. In conclusion, decision to intensify in clinical practice may be associated with sociodemographic factors such as age and race. Disclosure G. Fernandes: None. B. Sawhney: Consultant; Self; Merck &amp; Co., Inc. H. Hannachi: Employee; Self; Merck &amp; Co., Inc. T. Wang: Employee; Spouse/Partner; Johnson &amp; Johnson. Employee; Self; Merck &amp; Co., Inc. A. McNeill: Employee; Self; Merck &amp; Co., Inc. K. Iglay: Employee; Self; Merck &amp; Co., Inc. Stock/Shareholder; Self; Merck &amp; Co., Inc. S. Rajpathak: None.

2352-PUB: Level of Glycemic Control in Type 2 Diabetes (T2D) Patients with Established Cardiovascular Disease (eCVD) or Chronic Kidney Disease (CKD) Prescribed an SGLT2i

The recent ADA/EASD consensus statement for management of hyperglycemia preferentially recommends the use of SGLT2i in patients with eCVD or CKD. However, no specific data exist on the level of glycemic control in this high-risk population currently receiving SGLT2i. Our study assessed glycemic control among adult T2D patients with eCVD/CKD on dual therapy (metformin+SGLT2i) at 3 different HbA1c targets (≥7%, ≥7.5%, ≥8%) using the GE Centricity Electronic Medical Record database (June 2015-June 2018). The index date was the most recent encounter for metformin+SGLT2i users. Patients were required to have ≥1 HbA1c measure in the 12 months prior to the index date and ≥1 year of medical history available. ECVD/CKD included patients with CVD only, CKD only, or both CVD and CKD. Results were examined in the overall study cohort and by subgroups of age, gender, and race. Of the 987 included study patients, 40% were female, median age was 62 years, and median A1c was 7.5%. Table 1 shows the level of glycemic control among the study population. 68%, 52% and 36% of patients had HbA1c ≥7%, ≥7.5%, and ≥8%, respectively. In conclusion, many patients with eCVD/CKD on dual therapy of metformin and SGLT2i were observed to have inadequate glycemic control and should be evaluated for medication adherence and further pharmacological intensification if appropriate. Disclosure K. Iglay: Employee; Self; Merck &amp; Co., Inc. Stock/Shareholder; Self; Merck &amp; Co., Inc. N. Bansal: Consultant; Self; Merck &amp; Co., Inc. T. Gulati: Consultant; Self; Merck &amp; Co., Inc. H. Hannachi: Employee; Self; Merck &amp; Co., Inc. G. Fernandes: None. S. Rajpathak: None.

2431-PUB: Distance from Glycemic Target at the Time of Intensification in Patients with Type 2 Diabetes (T2D) Failing Metformin Dual Therapy in the United States

Several studies have previously reported “clinical inertia” in the sequential treatment of T2D patients. The objective of the study was to quantify the distance from HbA1c target at the time of treatment intensification among patients failing dual therapy of metformin and another oral antihyperglycemic agent (OAHA). This retrospective study was conducted using GE Centricity Electronic Medical Record database (2015 data). Patients included those with diagnosed T2D on metformin dual therapy with at least 12 months of continuous enrollment prior to index date (initiation of dual therapy), documented HbA1c ≥7% and intensifying therapy within two years following index date. Treatment intensification was defined as either addition of another OAHA or initiation of insulin/glucagon-like peptide-1 receptor agonists. Distance from glycemic target was calculated as the median difference of HbA1c from target of 7% at the time of therapy intensification. 864 patients met the study criteria; mean age of 57.5 years, 48% were female, 26.3% had microvascular and 18.4% had macrovascular complications. Median difference from HbA1c target of 7% was 1.4%, with 29% (n=253) of patients between 1 to 2%, and 36% (n=315) greater than 2% distance from HbA1c target. When we excluded those for whom higher HbA1c target may be more appropriate (those ≥65 years, with micro- or macrovascular complications or with history of hypoglycemia), the median difference was 1.6%. This study suggests that majority of metformin dual therapy patients (65.7%) were at least 1% away from target of 7% at the time of intensification of therapy. Future studies should explore reasons behind this lack of earlier intensification and factors associated with clinical inertia. Disclosure G. Fernandes: None. B. Sawhney: Consultant; Self; Merck &amp; Co., Inc. H. Hannachi: Employee; Self; Merck &amp; Co., Inc. T. Wang: Employee; Spouse/Partner; Johnson &amp; Johnson. Employee; Self; Merck &amp; Co., Inc. A. McNeill: Employee; Self; Merck &amp; Co., Inc. K. Iglay: Employee; Self; Merck &amp; Co., Inc. Stock/Shareholder; Self; Merck &amp; Co., Inc. S. Rajpathak: None.

1143-P: Secondary Metformin Monotherapy Failure in Type 2 Diabetes Mellitus Patients

Clinical guidelines recommend metformin monotherapy (MM) as an initial glucose-lowering therapy for type 2 diabetes (T2D) patients [pts]. While studies have previously reported the incidence of metformin monotherapy failure, there are limited data specifically assessing the rate of “secondary” MM failure (defined as loss of control following initial achievement of glycemic control). The current study sought to characterize and evaluate factors associated with secondary failure among T2D pts on MM in a diverse U.S. population. Using the GE Centricity Electronic Medical Record database, we conducted a retrospective study of T2D pts ≥18 years initiating MM between 1/2013-5/2016 and achieving an HbA1c &amp;lt;7% (index date) within 6 months of initiation. Secondary MM failure was assessed at 6, 12, 18, and 24 months after index date and was defined based on HbA1c ≥7% or by treatment change (therapy switch or add-on intensification). Multivariable logistic regression was used to evaluate the factors associated with secondary MM failure. Of 4,775 pts included, 53.4% were female, the median age was 63 years and median HbA1c at index date was 6.4%. At 6 months, the proportion of pts who experienced MM failure by HbA1c ≥7% was 9.76% and by treatment change was 6.01%. At 12, 18 and 24 months, these proportions (%) were 16.20/8.00, 22.95/9.36, and 28.82/10.68, respectively. Factors positively associated with secondary MM failure (HbA1c ≥7%) at 24 months were male gender, HbA1c at index date and younger age (&amp;lt;65 years). These data suggest that after initially achieving an A1C &amp;lt;7%, a substantial proportion of pts on MM experience secondary failure within a relatively short period of time, with an increasing number experiencing failure within 2 years. Pts controlled on MM may benefit from regular HbA1c testing to ensure timely treatment modification. Further studies assessing whether initial metformin combination therapy would result in more durable glycemic control would also be of value. Disclosure T. Weiss: Employee; Self; Merck &amp; Co., Inc. K. Iglay: Employee; Self; Merck &amp; Co., Inc. Stock/Shareholder; Self; Merck &amp; Co., Inc. P. Verma: None. S. Rajpathak: None. L. Yang: Employee; Self; Bristol-Myers Squibb Company, Merck &amp; Co., Inc. L. Blonde: Consultant; Self; Gilead Sciences, Inc., Janssen Pharmaceuticals, Inc., Merck &amp; Co., Inc., Novo Nordisk Inc., Sanofi US. Research Support; Self; Janssen Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., Merck &amp; Co., Inc., Novo Nordisk Inc., Sanofi US. Speaker's Bureau; Self; Janssen Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi US.

Selection of patients with myelodysplastic syndromes from a large electronic medical records database and a study of the use of disease-modifying therapy in the United States

ObjectivesTreatment patterns for patients with myelodysplastic syndromes (MDS) outside clinical trials are not well described. Our objective was to evaluate treatment patterns and patient characteristics that influence time to disease-modifying...

Characteristics of patients potentially eligible for pharmacotherapy for weight loss in primary care practice in the United States.

SummaryObjectiveTo describe the characteristics of real‐world patients potentially eligible for adjunctive pharmacotherapy for weight loss.MethodsPatients from the GE Centricity electronic medical record database were selected if they had body mass index (BMI) ≥30 or ≥27 to <30 kg m−2 with ≥1 obesity‐associated comorbidity (hypertension, dyslipidemia, or type 2 diabetes) from 2002–2011; were aged ≥18 years and had ≥12 months of continuous enrollment before and after the date of first eligible BMI recorded (index date). Descriptive statistics and logistic regression were used for analysis.ResultsOf the 1,835,541 patients with overweight or obesity included, comorbidities were common (hypertension [55.4%], dyslipidemia [36.1%] and type 2 diabetes [13.4%]). The percentage of patients who received pharmacotherapy for weight loss was 0.7% within 12 months after the index date. Patients who received pharmacotherapy had higher BMI (median, 33.6 vs. 31.3 kg m−2), were younger (median, 42 vs. 52 years), primarily women (84.3 vs. 58.2%), commercially insured (70.1 vs. 50.4%) and had more frequent use of antidepressants (30.8 vs. 14.1%) and non‐steroidal anti‐inflammatory drugs (21.7 vs. 12.0%) than those who did not at baseline (all P values < 0.0001).ConclusionsFew eligible patients received pharmacotherapy for weight loss. Patients who received pharmacotherapy tended to be heavier, younger, female, commercially insured, and used more antidepressants and non‐steroidal anti‐inflammatory drugs.

Use of an Electronic Medical Record (EMR) Database to Identify a Real-World Cohort of US Patients (Pts) with Myelodysplastic Syndromes (MDS)

Introduction: Clinical trial data for MDS pts may not be representative of the general MDS pt population because some pts may be ineligible for clinical trials or may decline to participate. The GE Centricity™ EMR database (GE Healthcare IT, Princeton, NJ, USA), which is anonymized and compliant with the Health Insurance Portability and Accountability Act of 1996, contains clinical practice data from > 38 million US pts from 1994 onward (Asche CV, et al. ISRN Cardiol. 2011;2011:924343). Pt diagnoses in the database can be determined using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes; however, cohorts selected this way may include pts without MDS due to coding errors. We accessed the GE EMR database to identify a large, real-world cohort of MDS pts and compared them with MDS pts reported to the well-established, population-based Surveillance, Epidemiology, and End Results (SEER) Program.Methods: The GE EMR database is generally representative of the US population and contains data from single-physician offices to large practices and networks, covering 49 US states. Of > 30,000 participating clinicians, two-thirds are primary care physicians; the remainder are specialists. Using this database, we assembled a retrospective cohort of MDS pts with data entered during January 2006-February 2014. MDS pts were initially identified by the presence of ≥ 1 MDS-specific ICD-9-CM diagnosis code (codes: 238.72-238.75). Several different approaches were developed, evaluated, and applied to refine this cohort by excluding pts with a lower likelihood of MDS (Figure).Results: The Initial Cohort comprised 9,645 pts with ≥ 1 MDS-specific ICD-9-CM code; 31% of pts received supportive treatment (hematopoietic growth factors, iron-chelating therapy, or transfusions) and 8% received active treatment (azacitidine, decitabine, or lenalidomide). However, only 9% of pts in this cohort received transfusions; fewer than expected. This may be due to unrecorded transfusions occurring outside the EMR system, a limitation that may apply to other EMR databases. The Initial Cohort included 563 pts with ≥ 2 MDS-specific ICD-9-CM codes (Figure; 1st Modified Cohort); 15% of these pts had received transfusions; considerably higher than in the Initial Cohort. To exclude pts unlikely to have MDS in the Initial Cohort, the inclusion criteria were modified to include only pts with ≥ 1 MDS entry plus an entry for MDS-specific active treatment (N = 1,208) (Figure; 2nd Modified Cohort); supportive treatment was insufficient for inclusion as it is not MDS-specific. As diagnosis of MDS requires hemoglobin (Hb) measurement and bone marrow (BM) aspirate or biopsy prior to diagnosis, inclusion criteria were refined to include only those pts with either ≥ 2 MDS entries or ≥ 1 entry for MDS plus ≥ 1 of the following: prior MDS-specific active treatment; ≥ 2 Hb tests ≤ 1 year prior to code entry; or ≥ 1 BM procedure ≤ 1 year prior to code entry (N = 5,623) (Figure; 3rd Modified Cohort). This cohort was then further refined by excluding pts whose EMR included terms indicative of a non-diagnosis of MDS, such as "rule out," resulting in a Final Cohort of 5,162 pts most likely to have MDS (Figure; Final Cohort) whose baseline characteristics were generally comparable to MDS pts reported to the SEER Program during 2001-2011 (Table). In this Final Cohort, 35% received supportive care alone while 13% received active treatment; unrecorded transfusions may have contributed to underreporting of supportive care. Treatment patterns and the impact of variables such as age, insurance type, geographical location, and comorbidities will be presented.Conclusions: By leveraging the GE Centricity EMR database and evaluating different approaches for the ascertainment of MDS pts, we identified a large, real-world cohort of MDS pts whose baseline characteristics are comparable to MDS pts from the SEER Program. Although characteristics between the modified cohorts were similar, the Final Cohort was selected based on clinical and diagnostic features associated with the diagnosis of MDS in real-world clinical practice. Our methodology can inform other investigators interested in utilizing EMR databases for cancer outcomes research, and the cohort we identified will be useful in the further characterization of treatment patterns and outcomes of MDS pts who are more representative than participants of clinical trials. [Display omitted] [Display omitted] DisclosuresMa:Incyte Corporation: Consultancy; Celgene Corporation: Consultancy. Swern:Celgene Corporation: Employment, Equity Ownership. Kiselev:Celgene Corporation: Consultancy. Fliss:Celgene Corporation: Employment, Equity Ownership. Lu:Celgene Corporation: Employment. Scott:Celgene Corporation: Consultancy, Speakers Bureau. Steensma:Incyte: Consultancy; Amgen: Consultancy; Celgene: Consultancy; Onconova: Consultancy. Sugrue:Celgene Corporation: Employment, Equity Ownership.

Limitations of real-world treatment with atorvastatin monotherapy for lowering LDL-C in high-risk cardiovascular patients in the US.

BackgroundGuidelines endorse statin therapy for lowering low-density lipoprotein cholesterol (LDL-C) to recommended levels, in patients with cardiovascular disease (CVD) risk, if needed, after lifestyle changes. Atorvastatin is a common statin with greater LDL-C lowering efficacy than most other statins; its availability in generic form will likely increase its use. This study assessed attainment of guideline-recommended LDL-C levels in high-risk CVD patients treated with atorvastatin monotherapy.MethodsAnalyses of two retrospective US cohorts of patients who received a prescription for atorvastatin monotherapy between January 1, 2008 and December 31, 2010 (index date defined as first prescription date) in the GE Centricity Electronic Medical Record (EMR) (N=10,693) and Humana Medicare (N=16,798) databases. Eligible patients were ≥18 years, diagnosed with coronary heart disease or atherosclerotic vascular disease, with ≥1 LDL-C measurement between 3 months and 1 year postindex date, and continuously enrolled for 1 year prior to and following the index date.ResultsOf the eligible patients, 21.8%, 29.6%, 29.9%, and 18.7% (GE Centricity EMR) and 25.4%, 32.9%, 27.8%, and 14.0% (Humana Medicare) received 10, 20, 40, and 80 mg doses of atorvastatin, respectively. The mean ± standard deviation (SD) follow-up LDL-C levels were 2.1±0.8 mmol/L (83±30 mg/dL) and 2.3±0.8 mmol/L (88±31 mg/dL) for the GE Centricity EMR and Humana Medicare cohorts, respectively. Regardless of dose, only 28.3%–34.8% of patients had LDL-C levels <1.8 mmol/L (<70 mg/dL), and 72.0%–78.0% achieved LDL-C <2.6 mmol/L (<100 mg/dL) in both cohorts. As many as 41% and 13% of patients had LDL-C levels ≥0.5 mmol/L (≥20 mg/dL) above LDL-C 1.8 mmol/L (70 mg/dL) and 2.6 mmol/L (100 mg/dL), respectively, in both cohorts; these percentages were generally similar across atorvastatin doses.ConclusionIn this real-world US setting, a large number of high-risk CVD patients did not attain guideline-recommended LDL-C levels with atorvastatin monotherapy. More than 65% of the patients had LDL-C levels >1.8 mmol/L (>70 mg/dL), and of these, 30%–40% had LDL-C levels ≥0.5 mmol/L (≥20 mg/dL) above this, regardless of dose. This suggests that more effective lipid-lowering strategies, such as statin uptitration, switching to a higher efficacy statin, and/or combination therapy, may be required to achieve optimal LDL-C lowering in high-risk patients.

Evaluation of cardiovascular risk factors, events, and costs across four BMI categories

The purpose of this study was to analyze the 1-year cost of cardiovascular (CV) events by body mass index (BMI) subgroups from a US employer health plan perspective. Patients aged 20-64 years from the GE Centricity Electronic Medical Record, National Health and Nutrition Examination Survey, and MarketScan databases were used to determine prevalence of risk factors (RFs) and CV events and 1-year costs. Risk factors included hypertension (HTN), diabetes, and hyperlipidemia (HLD) and CV events included myocardial infarction, angina, heart failure, and stroke. CV event costs were determined from claims by ICD-9 code in patients with overweight/obesity. Of 220,136 patients identified in GE, BMI was 25-26.9 in 19.4%, 27-29.9 in 30.4%, 30-34.9 in 27.9%, and ≥35 in 22.3%. Patients with diabetes, HTN, and HLD increased with BMI from 1.8% (25-26.9) to 11.4% (≥35) in males and 1.1% to 6.8% in females. Prevalence of CV events increased from 0.1% with no RFs up to 10.2% with multiple RFs. The average 1-year cost per patient increased from $1122 to $2383 as BMI increased. Patients with higher BMI values had an increased prevalence of RFs and CV events, which lead to higher average 1-year costs.

Presence of central nervous system, cardiovascular and overall co‐morbidity burden in patients with overactive bladder disorder in a real‐world setting

• To determine the proportion of patients with overactive bladder (OAB) potentially at risk for adverse events by assessing their pre-existing central nervous system (CNS), cardiovascular (CV) and other co-morbidities. • The GE Centricity Electronic Medical Record database was utilized to identify patients with a diagnosis of OAB using International Classification of Diseases, Ninth Revision (ICD-9) codes or a prescription between 1 January 1996 and 30 March 2007 for an OAB anti-muscarinic agent. • Matched non-OAB patients were assigned the same index date as the corresponding OAB patient. Based on the presence of ≥ one pharmacy claim for an OAB anti-muscarinic agent, the OAB cohort was stratified as treated or untreated. A random sample of age- and gender-matched patients formed a non-OAB control cohort. • An additional and separate analysis focusing on all co-morbidities was performed examining non-OAB patients who were matched to OAB patients on 1:1 propensity score matching, based on age, body mass index (BMI) and gender at baseline. • Charlson Comorbidity Index (CCI), using ICD-9 codes, and the Chronic Disease Score (CDS), using prescribed drugs, were calculated. • When compared with non-OAB patients (N= 77,272; 83.2% women; median age 64 years), OAB patients (N= 41,440; 83.6% women; median age 65 years) had more overall CNS co-morbidities (45.4 vs 29.0%; P < 0.001). • In addition, OAB patients had a higher use of medications with anti-muscarinic effects (39.6 vs 25.4%; P < 0.001). OAB patients were also more likely to have CV co-morbidities (57.6 vs 44.6%; P < 0.001). • CNS co-morbidities were slightly more common in untreated (n= 8 106) than in treated (n= 33 334) OAB patients (47.2 vs 45.0%; P < 0.001). CV co-morbidities were higher in treated OAB patients (58.8 vs 53.7%; P < 0.001). • In the additional separate analysis, which focused on all co-morbidities, patients with OAB had higher mean CCI and CDS scores than patients without OAB (CCI: 1.17 vs 1.11 [P < 0.001]; CDS: 2.95 vs 1.74 [P < 0.001]). • After controlling for other covariates, the linear regressions (n= 22,544) showed that OAB patients had higher CCI and CDS than patients without OAB. • Among OAB patients, CNS, CV and all co-morbidities were more prevalent than in non-OAB patients. • Prior exposure to CNS medications was more prevalent in OAB patients who received anti-muscarinic treatment than in those who did not. • Co-morbidities and concomitant medications affecting the CNS and the CV system should be taken into account when making the decision on the most appropriate OAB treatment option for each individual patient.

Prevalence of Obesity, Type II Diabetes Mellitus, Hyperlipidemia, and Hypertension in the United States: Findings from the GE Centricity Electronic Medical Record Database

This study analyzed GE Centricity Electronic Medical Record (EMR) data to examine the effects of body mass index (BMI) and obesity, key risk factor components of metabolic syndrome, on the prevalence of 3 chronic diseases: type II diabetes mellitus, hyperlipidemia, and hypertension. These chronic diseases occur with high prevalence and impose high disease burdens. The rationale for using Centricity EMR data is 2-fold. First, EMRs may be a good source of BMI/obesity data, which are often underreported in surveys and administrative databases. Second, EMRs provide an ideal means to track variables over time and, thus, allow longitudinal analyses of relationships between risk factors and disease prevalence and progression. Analysis of Centricity EMR data showed associations of age, sex, race/ethnicity, and BMI with diagnosed prevalence of the 3 conditions. Results include uniform direct correlations between age and BMI and prevalence of each disease; uniformly greater disease prevalence for males than females; varying differences by race/ethnicity (ie, African Americans have the highest prevalence of diagnosed type II diabetes and hypertension, while whites have the highest prevalence of diagnosed hypertension); and adverse effects of comorbidities. The direct associations between BMI and disease prevalence are consistent for males and females and across all racial/ethnic groups. The results reported herein contribute to the growing literature about the adverse effects of obesity on chronic disease prevalence and about the potential value of EMR data to elucidate trends in disease prevalence and facilitate longitudinal analyses.

Comparison of GE Centricity Electronic Medical Record Database and National Ambulatory Medical Care Survey Findings on the Prevalence of Major Conditions in the United States

The study objective was to facilitate investigations by assessing the external validity and generalizability of the Centricity Electronic Medical Record (EMR) database and analytical results to the US population using the National Ambulatory Medical Care Survey (NAMCS) data and results as an appropriate validation resource. Demographic and diagnostic data from the NAMCS were compared to similar data from the Centricity EMR database, and the impact of the different methods of data collection was analyzed. Compared to NAMCS survey data on visits, Centricity EMR data shows higher proportions of visits by younger patients and by females. Other comparisons suggest more acute visits in Centricity and more chronic visits in NAMCS. The key finding from the Centricity EMR is more visits for the 13 chronic conditions highlighted in the NAMCS survey, with virtually all comparisons showing higher proportions in Centricity. Although data and results from Centricity and NAMCS are not perfectly comparable, once techniques are employed to deal with limitations, Centricity data appear more sensitive in capturing diagnoses, especially chronic diagnoses. Likely explanations include differences in data collection using the EMR versus the survey, particularly more comprehensive medical documentation requirements for the Centricity EMR and its inclusion of laboratory results and medication data collected over time, compared to the survey, which focused on the primary reason for that visit. It is likely that Centricity data reflect medical problems more accurately and provide a more accurate estimate of the distribution of diagnoses in ambulatory visits in the United States. Further research should address potential methodological approaches to maximize the validity and utility of EMR databases.

201: Simple Programming of the GE-Centricity Electronic Medical Record Facilitates Disease Management of Hyperlipidemia

201: Simple Programming of the GE-Centricity Electronic Medical Record Facilitates Disease Management of Hyperlipidemia

New Diagnosis of Hypertension among Celecoxib and Nonselective NSAID Users: A Population-Based Cohort Study

The use of nonsteroidal antiinflammatory drugs (NSAIDs) has been associated with increased blood pressure and hypertension. However, less is known about how the risk of hypertension is associated with cyclooxygenase 2 selective inhibitors (coxibs), especially celecoxib, the only coxib remaining on the market. To compare the risk of incident hypertension associated with the use of celecoxib and nonselective (NS) NSAIDs. A cohort study was conducted using secondary data from the GE Centricity Electronic Medical Record database, which contains millions of patient records seen by thousands of physicians across the US. The index date was defined as the date of the first NSNSAID or celecoxib prescription between January 1, 1999, and June 30, 2004. Patients were included if they were aged 18 years or older and were enrolled for at least 365 days prior to the index date. Excluded were patients who had any prior diagnosis of hypertension or pregnancy-related hypertension during the pre- or postindex date period. Also excluded were patients who had any prior prescription for antihypertensive drugs, coxibs, or NSNSAIDs. After applying inclusion/exclusion criteria, each celecoxib user was matched to 2 NSNSAID users by sex, age (+/-5 y), propensity score (within 0.2 SD), and number of unique drugs (+/-20%). Descriptive and survival analyses were conducted. The final sample consisted of 51,444 patients, of whom 17,148 were on celecoxib and 34,296 were on NSNSAIDs. Relative to NSNSAID users, patients on celecoxib had a similar rate of postexposure hypertension incidence (HR 1.013; 95% CI 0.862 to 1.190). Results from a population-based cohort analysis of electronic medical records did not show any difference in the hazard rates of incident hypertension between celecoxib and NSNSAID users.

Studies on breath methane: the effect of ethnic origins and lactulose.

The prevalence of methane production in an adult population of 256 subjects was 41%, but it was significantly higher in females (49%), than males (33%). When the population was subdivided into ethnic groups. Caucasians (48%) and Black (45%) had significantly more methane producers than Orientals (24%) and Indians (32%). when the ethnic groups were analysed by sex, female Caucasians had the highers prevalence (58%), significantly more than Caucasian males, Oriental males, and females and Indian males. In contrast with previous studies, a single dose of lactulose was found to significantly increase breath methane concentrations in six out of 12 methane producers, but not in 25 non-methane producers from the population study. In conclusion, any studies on breath methane must take into consideration the ethnic origin of the subjects and, contrary to previous advice, substrate intake, especially undigestible carbohydrates. Furthermore, a single breath sample may miss up to one-fifth of methane producers.