Mordi Ify R, Guignard-Duff Magalie, Hall Christopher, New Benjamin Jaa Ming, Lang Chim C
Division of Molecular & Clinical Medicine, School of Medicine, Ninewells Hospital & Medical School, University of Dundee, Dundee DD1 9SY, UK.
Health Informatics Centre, Ninewells Hospital & Medical School, Dundee DD1 9SY, UK.
Diseases. 2020 Dec 17;8(4):47. doi: 10.3390/diseases8040047.
There are common clinical scenarios in chronic heart disease where no randomized controlled data exist to guide management, and it is likely that well-designed observational studies will have to be used to inform clinical practice. Showing the clinical applicability of this type of study design, using record linkage of population electronic health records, we have provided key observational evidence that use of renin-angiotensin-system (RAS) blockers is associated with better outcomes in patients with aortic stenosis and that metformin could be used safely as an antiglycemic drug in patients with diabetes and heart failure. Each of these pieces of underpinning research has made a major contribution to relevant international clinical practice guidelines, helped the Food and Drug Administration in their decision making and changed prescribing practice.
在慢性心脏病领域,存在一些常见的临床情况,目前尚无随机对照数据来指导治疗,因此很可能需要采用精心设计的观察性研究来为临床实践提供依据。通过利用人群电子健康记录的记录链接,我们展示了这种研究设计的临床适用性,提供了关键的观察性证据,即使用肾素 - 血管紧张素系统(RAS)阻滞剂与主动脉瓣狭窄患者的更好预后相关,并且二甲双胍可作为糖尿病和心力衰竭患者的安全降糖药物使用。这些基础研究中的每一项都对相关的国际临床实践指南做出了重大贡献,帮助美国食品药品监督管理局进行决策,并改变了处方实践。