Evangelos Kontopantelis

The University of Manchester · Faculty of Biology, Medicine and Health

Background The UK is dependent on international doctors, with a greater proportion of non-UK qualified doctors working in its universal health care system than in any other European country, except Ireland and Norway. The terms of the UK exit from the European Union can reduce the ability of European Economic Area (EEA) qualified doctors to work in...

Background Multiple imputation is frequently used to deal with missing data in healthcare research. Although it is known that the outcome should be included in the imputation model when imputing missing covariate values, it is not known whether it should be imputed. Similarly no clear recommendations exist on: the utility of incorporating a seconda...

To quantify the relationship between a national primary care pay-for-performance programme, the UK's Quality and Outcomes Framework (QOF), and all-cause and cause-specific premature mortality linked closely with conditions included in the framework. Longitudinal spatial study, at the level of the "lower layer super output area" (LSOA). 32482 LSOAs...

This article describes a new individual patient data (IPD) meta-analysis post-estimation command, ipdforest. The command produces a forest plot, following an one-stage meta-analysis with xtmixed or xtmelogit (renamed in Stata 13 to mixed and meqrlogit respectively; ipdforest is currently not compatible with the new names). The overall effect is obt...

Heterogeneity has a key role in meta-analysis methods and can greatly affect conclusions. However, true levels of heterogeneity are unknown and often researchers assume homogeneity. We aim to: a) investigate the prevalence of unobserved heterogeneity and the validity of the assumption of homogeneity; b) assess the performance of various meta-analys...

Objective To compare the predictive performance of CHA2DS2-VASc and HAS-BLED scores in Atrial Fibrillation (AF) patients with and without cancer. Methods and Analysis Using data from the Clinical Practice Research Datalink (CPRD) in England, we performed a retrospective cohort study of patients with new diagnosis of AF from 2009-2019. Cancer was d...

Aims Telemedicine has been promoted as an effective way of managing type‐2 diabetes (T2DM) in primary care. However, the effectiveness of telemedicine is unclear. We investigated the clinical and cost‐effectiveness of different telemedicine interventions for people with T2DM, compared to usual care. Methods We searched Medline, Embase, Cochrane, C...

Introduction Electronic Health Records (EHRs) are vital repositories of patient information for medical research, but the prevalence of missing data presents an obstacle to the validity and reliability of research. This study aimed to review and category ise methods for handling missing data in EHRs, to help researchers better understand and addres...

Background Over the past decade, major society guidelines have recommended the use of newer P2Y 12 inhibitors over clopidogrel for those undergoing percutaneous coronary intervention for acute coronary syndrome. It is unclear what impact these recommendations had on clinical practice. Methods and Results All percutaneous coronary intervention proc...

Background The use of temporary doctors, known as locums, has been common practice for managing staffing shortages and maintaining service delivery internationally. However, there has been little empirical research on the implications of locum working for quality and safety. This study aimed to investigate the implications of locum working for qua...

Background Temporary doctors, known as locums, are a key component of the medical workforce in the NHS but evidence on differences in quality and safety between locum and permanent doctors is limited. We aimed to examine differences in the clinical practice, and prescribing safety for locum and permanent doctors working in primary care in England....

Objective: This systematic review and meta-analysis aimed to assess interventions to reduce opioid use for patients with chronic non-cancer pain (CNCP) versus usual care or active controls in primary care settings. Methods: In this registered study (PROSPERO: CRD42022338458), we searched MEDLINE, Embase PsycInfo, CINAHL, and Cochrane Library from i...

Background Contemporary studies demonstrate that non-ST-segment elevation myocardial infarction (NSTEMI) processes of care vary according to sex. Little is known regarding variation in practice between geographical areas and centres. Methods We identified 305 014 NSTEMI admissions in the United Kingdom (UK) Myocardial Ischaemia National Audit Proj...

Background: There is little evidence and no agreement on what constitutes full-time working for general practitioners (GPs). This is essential for workforce planning, resource allocation and accurately describing GP activity. Aim: To clarify the definition of full-time working for general practitioners, how this has changed over time and whether th...

Introduction Research activity usually improves outcomes by being translated into practice. However, there is developing evidence that research activity itself may improve the overall performance of health care organisations. However, evidence that these relationships represent a causal impact of research activity is less clear. Additionally, the b...

Importance Three leading disease causes of age-related visual loss are cataract, age-related macular degeneration (AMD), and glaucoma. Although all 3 eye diseases have been implicated with falls and fracture risk, evidence is mixed, with the contribution of different eye diseases being uncertain. Objective To examine whether people with cataract,...

Background Anticoagulation of patients with atrial fibrillation (AF) and cancer is challenging because of their high risk for stroke and bleeding. Little is known of the variations of oral anticoagulant (OAC) prescribing in patients with AF with and without cancer. Methods Patients with first‐time AF during 2009–2019 from the Clinical Practice Res...

Objectives Develop an endometrial cancer risk prediction model and externally validate it for UK primary care use. Design Cohort study. Setting The UK Biobank was used for model development and a linked primary (Clinical Practice Research Datalink, CPRD) and secondary care (HES), mortality (ONS) and cancer register (NRCAS) dataset was used for ex...

Background The prevalence of multimorbidity in patients with acute myocardial infarction (AMI) is increasing. It is unclear whether comorbidities cluster into distinct phenogroups and whether are associated with clinical trajectories. Methods Survey-weighted analysis of the United States Nationwide Inpatient Sample (NIS) for patients admitted with...

Background In the UK alone, long Covid(LC) has affected over 2 million individuals, yet health system burden is poorly characterised. Understanding healthcare utilisation will inform clinical, service and policy planning for current and future LC care. Methods Using the British Heart Foundation/NHS England Secure Data Environment, we identified ind...

Introduction/Background Endometrial carcinoma is the most common gynecological tumor in developed countries. Clinical-pathological factors and molecular sub-types are used to stratify the risk of recurrence and to tailor adjuvant treatment. The main limitation of molecular and clinicopathological prognostic factors is the need of post-operative sur...

BACKGROUND The association between cancer and stroke or bleeding outcomes in atrial fibrillation is unclear. We sought to examine how certain types of cancer influence the balance between stroke and bleeding risk in patients with nonvalvular atrial fibrillation (NVAF). METHODS AND RESULTS We estimated stroke and bleeding risk among adult patients...

Background: It is unclear whether the future risk of cardiovascular events in breast cancer survivors is greater than in the general population. Objectives: This meta-analysis reports the incidence of cardiovascular events in patients with breast cancer, before quantifying the risk of cardiovascular disease development in breast cancer patients, co...

Individuals developing stroke have varying clinical characteristics, demographic, and biochemical profiles. This heterogeneity in phenotypic characteristics can impact on cardiovascular disease (CVD) morbidity and mortality outcomes. This study uses a novel clustering approach to stratify individuals with incident stroke into phenotypic clusters an...

BACKGROUND Sex-based outcome differences for women with ST-segment–elevation myocardial infarction (STEMI) have not been adequately addressed, and the role played by differences in prescription of potent P2Y 12 inhibitors (P-P2Y 12 ) is not well defined. This study explores the hypothesis that disparities in P-P2Y 12 (prasugrel or ticagrelor) use m...

Aims Central to the practice of precision medicine in percutaneous coronary intervention (PCI) is a risk-stratification tool to predict outcomes following the procedure. This study is intended to assess machine learning (ML)-based risk models to predict clinically relevant outcomes in PCI and to support individualized clinical decision-making in th...

Background Locum working in healthcare organisations has benefits for individual doctors and organisations but there are concerns about the impact of locum working on continuity of care, patient safety, team function and cost. We conducted a national survey of NHS Trusts in England to explore locum work, and better understand why and where locum do...

Background: Patients from lower socioeconomic status areas have poorer outcomes following acute myocardial infarction (AMI); however, how ethnicity modifies such socioeconomic disparities is unclear. Methods: Using the UK Myocardial Ischaemia National Audit Project (MINAP) registry, we divided 370 064 patients with AMI into quintiles based on In...

Aims It is unclear whether the future risk of cardiovascular events in breast cancer (Bc) survivors is greater than in the general population. This meta-analysis quantifies the risk of cardiovascular disease development in Bc patients, compared to the risk in a general matched cancer-free population, and reports the incidence of cardiovascular even...

Objectives To describe the current landscape of UK electronic health record (EHR) databases and considerations of access and use of these resources relevant to researchers. Design & setting Narrative review Data sources Information was collected from the Health Data Research Innovation Gateway, publicly available websites and other published data...

Background: Locum doctors give practices flexibility to deliver patient services but there are concerns about the impact of locum working on continuity of care, patient safety, team function, and cost. Aim: To explore locum working in English general practices, and understand why and where locum doctors were needed and how they were engaged, sup...

Background: Few studies have investigated the effect of the COVID-19 pandemic on mental health beyond 2020. This study quantifies changes to healthcare utilisation and symptoms for common mental health problems over the pandemic's first 21 months. Methods: Parallel cohort studies using primary care database and survey data for adults (≥16 years)...

The objective of this study is to determine whether dienogest therapy after endometriosis surgery reduces the risk of recurrence compared with placebo or alternative treatments (GnRH agonist, other progestins, and estro-progestins). The design used in this study is systematic review with meta-analysis. The data source includes PubMed and EMBASE sea...

Objective Endometrial carcinoma is the most common gynecological tumor in developed countries. Clinicopathological factors and molecular subtypes are used to stratify the risk of recurrence and to tailor adjuvant treatment. The present study aimed to assess the role of radiomics analysis in pre-operatively predicting molecular or clinicopathologica...

Background The prevention of type 2 diabetes (T2DM) is a major concern for health services around the world. The English NHS Diabetes Prevention Programme (NHS-DPP) offers a group face-to-face behaviour change intervention, based around exercise and diet, to adults with non-diabetic hyperglycaemia (NDH), referred from primary care. Previous analysi...

Objective To determine whether the withdrawal of the Quality and Outcomes Framework (QOF) scheme in primary care in Scotland in 2016 had an impact on selected recorded quality of care, compared with England where the scheme continued. Design Controlled interrupted time series regression analysis. Setting General practices in Scotland and England....

Background Two general practices close every week in the UK. Given the pressure on UK general practices, such closures are likely to persist. Yet little is known about the consequences. Closure refers to when a practice ceases to exist, merges, or is taken over. Aim To explore whether practice funding, list size, workforce composition, and quality...

Background: Age and socioeconomic status (SES) predict several health-related outcomes, including prescription opioid use. Contrasting findings from previous literature found higher prevalence of opioid use in both people over 65 years old and the working-age population of 35-55 years old. This study aimed to analyse if the association between age...

Background: The NHS Diabetes Prevention Programme (NDPP) is a behaviour change programme for adults who are at risk of developing type 2 diabetes mellitus (T2DM): people with raised blood glucose levels, but not in the diabetic range, diagnosed with nondiabetic hyperglycaemia (NDH). We examined the association between referral to the programme and...

Objective: The anti-inflammatory drug colchicine has recently shown benefits in the prevention of major adverse cardiovascular events (MACE) in patients with the acute coronary syndrome (ACS) and chronic coronary syndromes (CCS). This meta-analysis focuses on understanding Colchicine's effects on the high-sensitivity C-reactive protein (hs-CRP) to...

Objectives Temporary doctors, known as locum doctors, play an important role in the delivery of care in the National Health Service (NHS); however, little is known about the extent of locum use in NHS trusts. This study aimed to quantify and describe locum use for all NHS trusts in England in 2019–2021. Setting Descriptive analyses of data on locu...

Background Prescribing of strong opioids and antibiotics impacts patient safety, yet little is known about the effects GP wellness has on overprescribing of both medications in primary care. Aim To examine associations between strong opioid and antibiotic prescribing and practice- weighted GP burnout and wellness. Design and setting A retrospecti...

Objective English primary care faces significant challenges, including ‘persistent high turnover’ of general practitioners (GPs) in some partnerships. It is unknown whether there are specific predictors of persistent high turnover and whether it is associated with poorer population health outcomes. Design A retrospective observational study. Meth...

Background Heart failure (HF) is a global epidemic. Objective To assess global sex differences in HF epidemiology across country income levels. Methods Using Global Burden of Disease (GBD) data from 204 countries and territories 1990-2019, we assessed sex differences in HF prevalence, etiology, morbidity, and temporal trends across country sociod...

Background Asthma is a prevalent chronic respiratory condition and remains a common cause for hospitalization. However, contemporary data on asthma hospitalization rates, comorbidity burden, and in-hospital outcomes are lacking. Methods Survey-weighted analysis of hospitalization records with a primary diagnosis of asthma using data from the US Na...

Background: Heart failure (HF) is a global epidemic. Objectives: We assessed sex differences in HF across country income. Methods: Using Global Burden of Disease (GBD) data, we assessed sex differences in HF prevalence, etiology, morbidity, and temporal trends between 1990-2019 across 204 countries and territories and disaggregated results by count...

Introduction/Background Global endometrial cancer (EC) cases continue to increase, placing a significant health and financial burden on individuals and healthcare services. Effective primary disease prevention strategies are urgently required but remain under-researched. Identifying high-risk women for intervention would ensure therapies are target...

OBJECTIVE Heart failure (HF) often develops in patients with diabetes and is recognized for its role in increased cardiovascular morbidity and mortality in this population. Most existing models predict risk in patients with prevalent rather than incident diabetes and fail to account for sex differences in HF risk factors. We derived sex-specific mo...

This commentary refers to ‘Ethnicity-dependent performance of the Global Registry of Acute Coronary Events risk score for prediction of non-ST-segment elevation myocardial infarction in-hospital mortality: nationwide cohort study’, by S.M. Moledina et al., https://doi.org/10.1093/eurheartj/ehac052 and the discussion piece ‘Refitting the predictor v...

Objective In observational studies, researchers must select a method to control for confounding. Options include propensity score methods and regression. It remains unclear how dataset characteristics (size, overlap in propensity scores, exposure prevalence) influence the relative performance of the methods. Study Design A simulation study to eval...

Background Type 2 Diabetes (T2D) is common, with a prevalence of approximately 7% of the population in the United Kingdom. The quality of T2D care is inconsistent across the United Kingdom, and Greater Manchester (GM) does not currently achieve the National Institute for Health and Care Excellence treatment targets. Barriers to delivery of care inc...

Background General Practitioners (GPs) report high levels of burnout, job dissatisfaction, and turnover intention. The complexity of presenting problems to general practice makes diagnostic uncertainty a common occurrence that has been linked to burnout. The interrelationship between diagnostic uncertainty with other factors such as burnout, job sa...

Objective To assess the diagnostic Read code usage for 18 conditions by examining their frequency and diversity in UK primary care between 2000 and 2013. Design Population-based cohort study Setting 684 UK general practices contributing data to the Clinical Practice Research Datalink (CPRD) GOLD. Participants Patients with clinical codes for at...

Healthcare providers may game when faced with targets. We examine how family doctors responded to a temporary but substantial increase in the stringency of targets determining payments for controlling blood pressure among younger hypertensive patients. We apply difference-in-differences and bunching techniques to data from electronic health records...

BACKGROUND: Updatable estimates of COVID-19 onset, progression, and trajectories underpin pandemic mitigation efforts. To identify and characterise disease trajectories, we aimed to define and validate ten COVID-19 phenotypes from nationwide linked electronic health records (EHR) using an extensible framework. METHODS: In this cohort study, we used...

Background: Atrial fibrillation (AF) is an important risk factor for ischaemic stroke, and AF incidence is expected to increase. Guidelines recommend using oral anticoagulants (OACs) to prevent the development of stroke. However, studies have reported the frequent underuse of OACs in AF patients. The objective of this study is to describe nonvalvu...

Background: Current evidence supports the use of wearable trackers in by people with cardiometabolic conditions. However, as the health benefits are small and conflicted confounded by heterogeneity, there remains uncertainty of as to which patient groups are most helped by wearable trackers are most helpful. Objective: This study examined the eff...

Introduction Cardiovascular disease (CVD) remains one of the leading causes of preventable death in Europe, therefore any opportunity to intervene and improve care should be maximised. Known CVD risk factors are routinely collected in the emergency department (ED), yet they are often not acted on. If the risk factors have prognostic value and a pat...

Objective: To compare the efficacy of different statin therapies by intensity for prevention of cardiovascular disease (CVD) in people with diabetes according to non-high-density lipoprotein cholesterol (non-HDL-C). Design: Systematic review and network meta-analysis. Data Sources: Searches in MEDLINE, Cochrane Central Register of Controlled Tri...

In observational studies, researchers must select a method to control for confounding. Options include propensity score methods and regression. It remains unclear how dataset characteristics (size, overlap in propensity scores, exposure prevalence) influence the relative performance of the methods, making it difficult to select the best method for...

Aims: The Global Registry of Acute Coronary Events (GRACE) score was developed to evaluate risk in patients with the acute coronary syndrome with or without ST-segment elevation. Little is known about its performance at predicting in-hospital mortality for ethnic minority patients. Methods and results: We identified 326 160 admissions with non-S...

Background Deaths in the first year of the Coronavirus Disease 2019 (COVID-19) pandemic in England and Wales were unevenly distributed socioeconomically and geographically. However, the full scale of inequalities may have been underestimated to date, as most measures of excess mortality do not adequately account for varying age profiles of deaths b...

Purpose The adverse impact of hearing loss (HL) extends beyond auditory impairment and may affect the individuals' psychosocial wellbeing. We aimed to examine whether there exists a causal psychosocial pathway between HL and depression in later life, via socioeconomic factors and quality of life, and whether hearing aids usage alleviates depressive...

OBJECTIVES To assess associations between current use of sodium–glucose cotransporter 2 inhibitors (SGLT2is), glucagon-like peptide 1 receptor agonists (GLP-1RAs), and their combination and risk for major adverse cardiac and cerebrovascular events (MACCE) and heart failure (HF) in people with type 2 diabetes. RESEARCH DESIGN AND METHODS In three n...

Objectives: This study examines the safety and feasibility of same-day discharge (SDD) in patients undergoing percutaneous coronary intervention (PCI) to coronary chronic total occlusions (CTOs) and explores independent associations of clinical and procedural characteristics with SDD. Background: While the recently published consensus statements...

Objective: We aimed to update the prevalence estimates of hearing loss in older adults in England using a nationally representative sample of adults aged 50 years old and older. Design: A comparative cross-sectional study design was implemented. Hearing loss was defined as ≥35 dB HL at 3.0 kHz, as measured via Hearcheck in the better-hearing ear...

Objectives: To determine the average treatment effect (ATE) of primary percutaneous coronary intervention (pPCI) versus medical treatment (MT) on in-hospital outcomes across the spectrum of frailty in patients with ST-elevation myocardial infarction (STEMI). Methods: Adult patients hospitalized for STEMI between October 2015 until December 2017...

Worldwide, it is forecasted that 131.5 million people will suffer from dementia by 2050, and the annual cost of care will increase from 818 billion USD in 2016 to 2 trillion USD by 2030, with burgeoning social consequences. Given a timely prediction of a dementia outcome in patients, appropriate mitigating interventions can be applied to reduce ris...

Objective To investigate the utility of Charlson comorbidity index (CCI) as a measure of comorbidity burden to predict procedural outcomes after de novo cardiac implantable electronic device (CIED) implantation. Methods All de novo CIED implantations in the United States National Inpatient Sample between 2015 and 2018 were retrospectively analyzed...

Objective To describe the distribution of consultations at the practice level and examine whether increases are uniform or driven by people who consult more frequently. Design Retrospective cohort study. Setting UK general practice data from the Clinical Practice Research Datalink (CPRD) GOLD database. Participants 1 699 709 314 consultation eve...

Background The way we collect and use patient experience data is vital to optimise the quality and safety of health services. Yet, some patients and carers do not give feedback because of the limited ways data is collected, analysed and presented. In this study, we worked together with researchers, staff, patient and carer participants, and patient...

Background: Numbers of GP locums in the NHS have grown in recent years, yet evidence on the scale and scope of the locum workforce in general practice is sparse. Aim: To identify characteristics, geographical patterns and drivers of GP locum use. Design and setting: Observational study of routine data from general practices in England. Method...

Background The association between socioeconomic status (SES), sex, race/ethnicity and outcomes during hospitalization for heart failure (HF) has not previously been investigated. Methods We analyzed HF hospitalizations in the United States National Inpatient Sample between 2015-2017. Using a hierarchical, multivariable Poisson regression model to...

Background: Patient-reported outcomes measures (PROMs) assess a patient's subjective appraisal of health outcomes from their own perspective. Despite hypothesised benefits that feedback on PROMs can support decision-making in clinical practice and improve outcomes, there is uncertainty surrounding the effectiveness of PROMs feedback. Objectives:...

Background Patients presenting with chest pain represent a large proportion of attendances to emergency departments. In these patients clinicians often consider the diagnosis of acute myocardial infarction (AMI), the timely recognition and treatment of which is clinically important. Clinical prediction models (CPMs) have been used to enhance early...

Background There are limited data on the management strategies, temporal trends and clinical outcomes of patients who present with non–ST‐segment–elevation myocardial infarction and have a prior history of CABG. Methods and Results We identified 287 658 patients with non–ST‐segment–elevation myocardial infarction between 2010 and 2017 in the Unite...

Background Schizophrenia and bipolar disorder are severe mental illnesses which are highly prevalent worldwide. Risperidone and Paliperidone are treatments for either illnesses, but their efficacy compared to other antipsychotics and growing reports of hormonal imbalances continue to raise concerns . As existing evidence on both antipsychotics are...

Objective Evidence on sex differences in outcomes after developing coronary heart disease (CHD) has focused on recurrent CHD, all-cause mortality or revascularisation. We assessed sex disparities in subsequent major adverse cardiovascular events (MACE) in adults surviving their first-time CHD. Methods Using a population-based cohort obtained from...

Objective To quantify general practitioners’ (GPs’) turnover in England between 2007 and 2019, describe trends over time, regional differences and associations with social deprivation or other practice characteristics. Design A retrospective study of annual cross-sectional data. Setting All general practices in England (8085 in 2007, 6598 in 2019...

Importance Wearable physical activity (PA) trackers, such as accelerometers, fitness trackers, and pedometers, are accessible technologies that may encourage increased PA levels in line with current recommendations. However, whether their use is associated with improvements in PA levels in participants who experience 1 or more cardiometabolic condi...