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Title: Studies in cardiovascular epidemiology in Scotland
Author: Murphy, Niamh
Awarding Body: University of Glasgow
Current Institution: University of Glasgow
Date of Award: 2007
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Aim: The aim of this study was to describe the epidemiology of important cardiovascular diseases (including angina, AMI, acute coronary syndromes, heart failure, atrial fibrillation and obesity) in Scotland using routinely available sources of data as well as data available from the Renfrew Paisley study. Objectives: To report on the incidence, prevalence, primary care burden and prescribing practices of heart failure, angina and atrial fibrillation in Scotland and explore socioeconomic disparities. To examine trends in population hospitalisation rates for suspected acute coronary syndromes and short and long-term outcome following a hospitalisation with an acute coronary syndromes between 1990 and 2000. To examine between hospital variability in 30 day survival following an admission to hospital in Scotland with an acute myocardial infarction. To examine the long-term cardiovascular consequences of angina and of obesity in the Renfrew Paisley study. Results: I have shown that angina is a common condition, more so in men than in women. Deprived individuals are more likely to have angina but are less likely to consult their general practitioner. Guideline recommended treatments for angina are underused in women and the elderly. I also showed that heart failure is a common condition especially in older people. In the elderly, the community burden of heart failure is at least as great as that of angina or hypertension. People with heart failure have a high rate of concomitant respiratory tract infection. Compared with affluent patients, socioeconomically deprived individuals are 44% more likely to develop heart failure, but 23% less likely to see their general practitioner on an ongoing basis. Drugs proven to improve survival in heart failure are used less frequently in elderly patients and in women however prescribed therapy does not differ across socioeconomic gradients. I similarly showed that atrial fibrillation is a common condition, more so in men than in women. In contrast with heart failure and angina deprived individuals are less likely to have atrial fibrillation. As for heart failure and angina, recommended treatments for atrial fibrillation are underused in women and the elderly. I have also shown that the pattern of emergency admissions with heart disease to Scottish hospitals has changed dramatically over recent years. Conclusion: I have demonstrated the potential of using data from the Continuous Morbidity Recording in General Practice Scheme to examine the epidemiology and prescribing practices of conditions in primary care and explore socioeconomic discrepancies. I have also demonstrated the potential of using data from the Linked Scottish Morbidity Recording Scheme to examine trends in hospitalisations and outcome for diseases and explore inter-hospital variability in outcome. I have also used the Renfrew-Paisley study to examine the effect of baseline obesity or angina on long term cardiovascular hospitalisations and deaths.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral