The prognostic value of emergency department measured hypertension: A systematic review and meta‐analysis
AuthorsReynard, Charles; orcid: 0000-0002-7534-2668; email: Charles.email@example.com
van den Berg, Patricia; orcid: 0000-0001-8148-1130
Oliver, Govind; orcid: 0000-0001-6051-6090
Naguib, Mina Peter
McMillan, Brian; orcid: 0000-0002-0683-3877
Heagerty, Anthony; orcid: 0000-0002-9043-2119
Body, Richard; orcid: 0000-0001-9089-8130
MetadataShow full item record
AbstractAbstract: Objectives: The objective was to assess the prognostic value of hypertension detected in the emergency department (ED). Methods: The ED presents a unique opportunity to predict long‐term cardiovascular disease (CVD) outcomes with its potential for high‐footfall, and large‐scale routine data collection applied to underserved patient populations. A systematic review and meta‐analyses were conducted to assess the prognostic performance and feasibility of ED‐measured hypertension as a risk factor for long‐term CVD outcomes. We searched MEDLINE and Embase databases and gray literature sources. The target populations were undifferentiated ED patients. The prognostic factor of interest was hypertension. Feasibility outcomes included prevalence, reliability, and follow‐up attendance. Meta‐analyses were performed for feasibility using a random effect and exact likelihood. Results: The searches identified 1072 studies after title and abstract review, 53 studies had their full text assessed for eligibility, and 26 studies were included. Significant heterogeneity was identified, likely due to the international populations and differing study design. The meta‐analyses estimate of prevalence for ED‐measured hypertension was 0.31 (95% confidence interval 0.25–0.37). ED hypertension was persistent outside the ED (FE estimate of 0.50). The proportion of patients attending follow‐up was low with an exact likelihood estimate of 0.41. Three studies examined the prognostic performance of hypertension and demonstrated an increased risk of long‐term CVD outcomes. Conclusion: Hypertension can be measured feasibly in the ED and consequently used in a long‐term cardiovascular risk prediction model. There is an opportunity to intervene in targeted individuals, using routinely collected data.
CitationAcademic Emergency Medicine
DescriptionFrom Wiley via Jisc Publications Router
History: received 2021-03-25, rev-recd 2021-06-07, accepted 2021-06-15, pub-electronic 2021-09-22
Article version: VoR
Publication status: Published
Funder: Royal College of Emergency Medicine; Id: http://dx.doi.org/10.13039/501100007566
Funder: National Institute of Health Research (UK)
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No Difference in Penetrance between Truncating and Missense/Aberrant Splicing Pathogenic Variants in MLH1 and MSH2: A Prospective Lynch Syndrome Database StudyDominguez-Valentin, Mev; orcid: 0000-0001-7856-0057; email: Mev.Dominguez.Valentin@rr-research.no; Plazzer, John-Paul; orcid: 0000-0001-5114-4301; email: firstname.lastname@example.org; Sampson, Julian R.; email: Sampson@cardiff.ac.uk; Engel, Christoph; orcid: 0000-0002-7247-282X; email: email@example.com; Aretz, Stefan; orcid: 0000-0002-5228-1890; email: firstname.lastname@example.org; Jenkins, Mark A.; email: email@example.com; Sunde, Lone; email: firstname.lastname@example.org; Bernstein, Inge; email: email@example.com; Capella, Gabriel; orcid: 0000-0002-4669-7320; email: firstname.lastname@example.org; Balaguer, Francesc; orcid: 0000-0002-0206-0539; email: email@example.com; et al. (MDPI, 2021-06-28)Background. Lynch syndrome is the most common genetic predisposition for hereditary cancer. Carriers of pathogenic changes in mismatch repair (MMR) genes have an increased risk of developing colorectal (CRC), endometrial, ovarian, urinary tract, prostate, and other cancers, depending on which gene is malfunctioning. In Lynch syndrome, differences in cancer incidence (penetrance) according to the gene involved have led to the stratification of cancer surveillance. By contrast, any differences in penetrance determined by the type of pathogenic variant remain unknown. Objective. To determine cumulative incidences of cancer in carriers of truncating and missense or aberrant splicing pathogenic variants of the MLH1 and MSH2 genes. Methods. Carriers of pathogenic variants of MLH1 (path_MLH1) and MSH2 (path_MSH2) genes filed in the Prospective Lynch Syndrome Database (PLSD) were categorized as truncating or missense/aberrant splicing according to the InSiGHT criteria for pathogenicity. Results. Among 5199 carriers, 1045 had missense or aberrant splicing variants, and 3930 had truncating variants. Prospective observation years for the two groups were 8205 and 34,141 years, respectively, after which there were no significant differences in incidences for cancer overall or for colorectal cancer or endometrial cancers separately. Conclusion. Truncating and missense or aberrant splicing pathogenic variants were associated with similar average cumulative incidences of cancer in carriers of path MLH1 and path_MSH2.
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