Harry Hemingway | University College London (original) (raw)

Papers by Harry Hemingway

Understanding and improving the prognosis of a disease or health condition is a priority in clini... more Understanding and improving the prognosis of a disease or health condition is a priority in clinical research and practice. In this article, the authors introduce a framework of four interrelated themes in prognosis research, describe the importance of the first of these themes (understanding future outcomes in relation to current diagnostic and treatment practices), and introduce recommendations for the field of prognosis research

The Lancet, 2015

Background The contemporary associations of type 2 diabetes with a wide range of incident cardiov... more Background The contemporary associations of type 2 diabetes with a wide range of incident cardiovascular diseases have not been compared. We aimed to study associations between type 2 diabetes and 12 initial manifestations of cardiovascular disease. Methods We used linked primary care, hospital admission, disease registry, and death certifi cate records from the CALIBER programme, which links data for people in England recorded in four electronic health data sources. We included people who were (or turned) 30 years or older between Jan 1, 1998, to March 25, 2010, who were free from cardiovascular disease at baseline. The primary endpoint was the fi rst record of one of 12 cardiovascular presentations in any of the data sources. We compared cumulative incidence curves for the initial presentation of cardiovascular disease and used Cox models to estimate cause-specifi c hazard ratios (HRs). This study is registered at ClinicalTrials.gov (NCT01804439). Findings Our cohort consisted of 1 921 260 individuals, of whom 1 887 062 (98•2%) did not have diabetes and 34 198 (1•8%) had type 2 diabetes. We observed 113 638 fi rst presentations of cardiovascular disease during a median followup of 5•5 years (IQR 2•1-10•1). Of people with type 2 diabetes, 6137 (17•9%) had a fi rst cardiovascular presentation, the most common of which were peripheral arterial disease (reported in 992 [16•2%] of 6137 patients) and heart failure (866 [14•1%] of 6137 patients). Type 2 diabetes was positively associated with peripheral arterial disease (adjusted HR 2•98 [95% CI 2•76-3•22]), ischaemic stroke (1•72 [1•52-1•95]), stable angina (1•62 [1•49-1•77]), heart failure (1•56 [1•45-1•69]), and non-fatal myocardial infarction (1•54 [1•42-1•67]), but was inversely associated with abdominal aortic aneurysm (0•46 [0•35-0•59]) and subarachnoid haemorrhage (0•48 [0•26-0.89]), and not associated with arrhythmia or sudden cardiac death (0•95 [0•76-1•19]). Interpretation Heart failure and peripheral arterial disease are the most common initial manifestations of cardiovascular disease in type 2 diabetes. The diff erences between relative risks of diff erent cardiovascular diseases in patients with type 2 diabetes have implications for clinical risk assessment and trial design.

PLoS Medicine, 2010

Background: Systematic evaluations of the quality of research on a single prognostic biomarker ar... more Background: Systematic evaluations of the quality of research on a single prognostic biomarker are rare. We sought to evaluate the quality of prognostic research evidence for the association of C-reactive protein (CRP) with fatal and nonfatal events among patients with stable coronary disease.

BMJ, 2004

Objective To determine whether access to cardiac procedures and drugs contributes to social and e... more Objective To determine whether access to cardiac procedures and drugs contributes to social and ethnic differences in coronary heart disease in a population setting. Design Prospective study with follow up over 15 years. Civil service employment grade was used as a measure of individual socioeconomic position. Need for cardiac care was determined by the presence of angina, myocardial infarction, and coronary risk factors. Setting 20 civil service departments originally located in London. Participants 10 308 civil servants (3414 women; 560 South Asian) aged 35-55 years at baseline in 1985-8. Main outcome measures Use of exercise electrocardiography, coronary angiography, and coronary revascularisation procedures and secondary prevention drugs. Results Inverse social gradients existed in incident coronary morbidity and mortality. South Asian participants also had higher rates than white participants. After adjustment for clinical need, social position showed no association with the use of cardiac procedures or secondary prevention drugs. For example, men in the low versus high employment grade had an age adjusted odds ratio for angiography of 1.87 (95% confidence interval 1.32 to 2.64), which decreased to 1.27 (0.83 to 1.94) on adjustment for clinical need. South Asians tended to be more likely to have cardiac procedures and to be taking more secondary prevention drugs than white participants, even after adjustment for clinical need. Conclusion This population based study, which shows the widely observed social and ethnic patterning of coronary heart disease, found no evidence that low social position or South Asian ethnicity was associated with lower use of cardiac procedures or drugs, independently of clinical need. Differences in medical care are unlikely to contribute to social or ethnic differences in coronary heart disease in this cohort.

Heart (British Cardiac Society), Jan 12, 2015

Patients with chronic obstructive pulmonary disease (COPD) have increased mortality following myo... more Patients with chronic obstructive pulmonary disease (COPD) have increased mortality following myocardial infarction (MI) compared with patients without COPD. We investigated the extent to which differences in recognition and management after MI could explain the mortality difference. 300 161 patients with a first MI between 2003 and 2013 were identified in the UK Myocardial Ischaemia National Audit Project database. Logistic regression was used to compare mortality in hospital and at 180 days postdischarge between patients with and without COPD. Variables relating to inhospital factors (delay in diagnosis, use of reperfusion and time to reperfusion/use of angiography) and use of secondary prevention were sequentially added to models. Mortality was higher for patients with COPD both inhospital (4.6% vs 3.2%) and at 180 days (12.8% vs 7.7%). After adjusting for inhospital factors, the effect of COPD on inhospital mortality after MI was reduced for both ST-elevation myocardial infarcti...

European heart journal, Jan 14, 2014

Ischaemia in different arterial territories before acute myocardial infarction (AMI) may influenc... more Ischaemia in different arterial territories before acute myocardial infarction (AMI) may influence post-AMI outcomes. No studies have evaluated prospectively collected information on ischaemia and its effect on short- and long-term coronary mortality. The objective of this study was to compare patients with and without prospectively measured ischaemic presentations before AMI in terms of infarct characteristics and coronary mortality. As part of the CALIBER programme, we linked data from primary care, hospital admissions, the national acute coronary syndrome registry and cause-specific mortality to identify patients with first AMI (n = 16,439). We analysed time from AMI to coronary mortality (n = 5283 deaths) using Cox regression (median 2.6 years follow-up), comparing patients with and without recent ischaemic presentations. Patients with ischaemic presentations in the 90 days before AMI experienced lower coronary mortality in the first 7 days after AMI compared with those with no ...

International Journal of Cardiology, 2015

Electronic health records (EHR) offer the opportunity to ascertain clinical outcomes at large sca... more Electronic health records (EHR) offer the opportunity to ascertain clinical outcomes at large scale and low cost, thus facilitating cohort studies, quality of care research and clinical trials. For acute myocardial infarction (AMI) the extent to which different EHR sources are accessible and accurate remains uncertain.

International journal of epidemiology, 2015

It is not known how smoking affects the initial presentation of a wide range of chronic and acute... more It is not known how smoking affects the initial presentation of a wide range of chronic and acute cardiovascular diseases (CVDs), nor the extent to which associations are heterogeneous. We estimated the lifetime cumulative incidence of 12 CVD presentations, and examined associations with smoking and smoking cessation. Cohort study of 1.93 million people aged ≥30years, with no history of CVD, in 1997-2010. Individuals were drawn from linked electronic health records in England, covering primary care, hospitalizations, myocardial infarction (MI) registry and cause-specific mortality (the CALIBER programme). During 11.6 million person-years of follow-up, 114 859 people had an initial non-fatal or fatal CVD presentation. By age 90 years, current vs never smokers' lifetime risks varied from 0.4% vs 0.2% for subarachnoid haemorrhage (SAH), to 8.9% vs 2.6% for peripheral arterial disease (PAD). Current smoking showed no association with cardiac arrest or sudden cardiac death [hazard ra...

Lancet, 2000

... Harry Hemingway MRCP a , b , Corresponding Author Contact Information , E-mail The Correspond... more ... Harry Hemingway MRCP a , b , Corresponding Author Contact Information , E-mail The Corresponding Author , Angela M Crook MSc a , Gene Feder MD c , J Rex Dawson FRCP d and Adam Timmis FRCP d. a Department of Research and Development, Kensington & Chelsea ...

Social Science & Medicine, 2001

Although the prevalence of angina in women is increasing, women are less likely than men to under... more Although the prevalence of angina in women is increasing, women are less likely than men to undergo invasive management of coronary disease. Gender differences in language use may contribute to disparities in management, since the diagnosis of angina relies on a patient's description of their symptoms. This study set out to investigate whether gender differences exist in the language used when describing angina symptoms and perceived health problems at the time of angiography, which might influence the rate of subsequent revascularisation. Content analysis was used to analyse written accounts of 'symptoms and health problems' in 200 (96 female) patients randomly selected within age strata who were undergoing coronary angiography for chronic stable angina in the Appropriateness of Coronary Revascularisation (ACRE) study. Written free text was coded into seven categories: pain location (chest or arm and throat, neck or jaw); pain character; breathlessness; other symptoms; effects on lifestyle; symptom attributions; and patient discourses ('story' or 'factual'). Women described more throat, neck or jaw pain than men among those with low physical functioning (p=0.06), in the presence of coronary artery disease (p=0.04) and in those who were not subsequently revascularised (p=0.05). Women also gave more accounts than men of breathlessness and other symptoms, but there was little evidence for gender differences in the use of 'factual' discourses. We conclude that from the time of angiography, gender differences in language use do exist and description of angina pain may influence subsequent revascularisation. Further research is necessary to investigate the nature and consequences of gender differences in language use at this and earlier stages in the referral process. #

European journal of preventive cardiology, Jan 5, 2012

It is recommended that general practitioners (GPs) offer cessation advice and pharmacological int... more It is recommended that general practitioners (GPs) offer cessation advice and pharmacological interventions to smokers with acute coronary syndrome (ACS). The study objective was to describe the extent to which this is done, and to describe outcomes by smoking status. Patients aged 30+ hospitalised for troponin-positive ACS from 2002 to 2009, discharged home alive, were identified in the Myocardial Ischaemia National Audit Project registry. Patient data were linked to the General Practice Research Database, Hospital Episode Statistics, and Office of National Statistics mortality data, enabling a unique perspective of longitudinal smoking data. Patients who smoked prior to the hospitalisation had GP interventions and quitting status established in the 3 months following discharge, and were followed up for major clinical outcomes. The outcomes evaluated included death, repeat ACS, stroke, heart failure, and major adverse cardiac events (MACE). Of the 4834 patients included, 965 (20%) ...

Background—The causes of metabolic syndrome (MS), which may be a precursor of coronary disease, a... more Background—The causes of metabolic syndrome (MS), which may be a precursor of coronary disease, are uncertain. We hypothesize that disturbances in neuroendocrine and cardiac autonomic activity (CAA) contribute to development of MS. We examine reversibility and the power of psychosocial and behavioral factors to explain the neuroendocrine adaptations that accompany MS. Methods and Results—This was a double-blind case-control study of

The Lancet, 2014

Background International research for acute myocardial infarction lacks comparisons of whole heal... more Background International research for acute myocardial infarction lacks comparisons of whole health systems. We assessed time trends for care and outcomes in Sweden and the UK.

International Journal of Cardiology, 2014

Objectives: To compare management of patients with acute non-ST segment elevation myocardial infa... more Objectives: To compare management of patients with acute non-ST segment elevation myocardial infarction (NSTEMI) in three developed countries with national ongoing registries. Background: Results from clinical trials suggest significant variation in care across the world. However, international comparisons in "real world" registries are limited. Methods: We compared the use of in-hospital procedures and discharge medications for patients admitted with NSTEMI from 2007 to 2010 using the unselective MINAP/NICOR [England and Wales (UK); n = 137,009], the unselective SWEDEHEART/RIKS-HIA (Sweden; n = 45,069), and the selective ACTION Registry-GWTG/NCDR [United States (US); n = 147,438] clinical registries.

Eur Heart J, 2014

Antipsychotics increase the risk of stroke. Their effect on myocardial infarction remains uncerta... more Antipsychotics increase the risk of stroke. Their effect on myocardial infarction remains uncertain because people prescribed and not prescribed antipsychotic drugs differ in their underlying vascular risk making between-person comparisons difficult to interpret. The aim of our study was to investigate this association using the self-controlled case series design that eliminates between-person confounding effects.

Background: Recent experimental evidence suggests that socioeconomic characteristics of neighbour... more Background: Recent experimental evidence suggests that socioeconomic characteristics of neighbourhoods influence cardiovascular health, but observational studies which examine deprivation across a wide range of cardiovascular diseases (CVDs) are lacking.

Lancet, Jan 31, 2014

The associations of blood pressure with the different manifestations of incident cardiovascular d... more The associations of blood pressure with the different manifestations of incident cardiovascular disease in a contemporary population have not been compared. In this study, we aimed to analyse the associations of blood pressure with 12 different presentations of cardiovascular disease. We used linked electronic health records from 1997 to 2010 in the CALIBER (CArdiovascular research using LInked Bespoke studies and Electronic health Records) programme to assemble a cohort of 1·25 million patients, 30 years of age or older and initially free from cardiovascular disease, a fifth of whom received blood pressure-lowering treatments. We studied the heterogeneity in the age-specific associations of clinically measured blood pressure with 12 acute and chronic cardiovascular diseases, and estimated the lifetime risks (up to 95 years of age) and cardiovascular disease-free life-years lost adjusted for other risk factors at index ages 30, 60, and 80 years. This study is registered at ClinicalT...

PLoS ONE, 2014

Background: National electronic health records (EHR) are increasingly used for research but ident... more Background: National electronic health records (EHR) are increasingly used for research but identifying disease cases is challenging due to differences in information captured between sources (e.g. primary and secondary care). Our objective was to provide a transparent, reproducible model for integrating these data using atrial fibrillation (AF), a chronic condition diagnosed and managed in multiple ways in different healthcare settings, as a case study.

PLoS medicine, 2014

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The Lancet Diabetes & Endocrinology, 2015