@article{78b977cfb5684a09b38c4ab6d7448e4f,
title = "Musculoskeletal pain and its impact on prognosis following acute coronary syndrome or stroke: A linked electronic health record cohort study",
abstract = "Objective: Musculoskeletal painful conditions are a risk factor for cardiovascular disease (CVD), but less is known about whether musculoskeletal pain also worsens prognosis from CVD. The objective was to determine whether patients with musculoskeletal pain have poorer prognosis following acute coronary syndrome (ACS) or stroke. Methods: The study utilised UK electronic primary care records (CPRD Aurum) with linkage to hospital and mortality records. Patients aged ≥45 years admitted to hospital with incident ACS/stroke were categorised by healthcare use for musculoskeletal pain (inflammatory conditions, osteoarthritis [OA], and regional pain) based on primary care consultations in the prior 24 months. Outcomes included mortality, length of stay, readmission and management of index condition (ACS/stroke). Results: There were 171,670 patients with incident ACS and 138,512 with stroke; 30% consulted for musculoskeletal pain prior to ACS/stroke and these patients had more comorbidity than those without musculoskeletal pain. Rates of mortality and readmission, and length of stay were higher in those with musculoskeletal pain, particularly OA and inflammatory conditions, in ACS. Readmission was also higher for patients with musculoskeletal pain in stroke. However, increased risks associated with musculoskeletal pain did not remain after adjustment for age and polypharmacy. Inflammatory conditions were associated with increased likelihood of prescriptions for dual anti-platelets (ACS only) and anti-coagulants. Conclusions: Patients with musculoskeletal pain have higher rates of poor outcome from ACS which relates to being older but also increased polypharmacy. The high rates of comorbidity including polypharmacy highlight the complexity of patients with musculoskeletal pain who have new onset ACS/stroke.",
keywords = "acute coronary syndrome, cerebrovascular accident, epidemiology, musculoskeletal pain, primary care, stroke",
author = "Mason, {Kayleigh J.} and Jordan, {Kelvin P.} and Neil Heron and Edwards, {John J.} and James Bailey and Achana, {Felix A.} and Ying Chen and Martin Frisher and Huntley, {Alyson L.} and Mallen, {Christian D.} and Mamas, {Mamas A.} and Png, {May Ee} and Stephen Tatton and Simon White and Michelle Marshall",
note = "Funding Information: CPRD: This study is based in part on data from the Clinical Practice Research Datalink obtained under licence from the UK Medicines and Healthcare products Regulatory Agency. The data is provided by patients and collected by the NHS as part of their care and support. The interpretation and conclusions contained in this study are those of the authors alone. ONS Data: The interpretation and conclusions contained in this study are those of the authors alone. HES Data/ONS Data: Copyright {\textcopyright} 2020, re‐used with the permission of The Health & Social Care Information Centre. All rights reserved. OPCS codes: The OPCS Classification of Interventions and Procedures, codes, terms and text is Crown copyright (2016) published by Health and Social Care Information Centre, also known as NHS Digital and licensed under the Open Government Licence available at www.nationalarchives.gov.uk/doc/open‐government‐licence/open‐government‐licence.htm . ISAC reference: The study was approved by the CPRD Independent Scientific Advisory Committee (ref 20_000105). The approved protocol was made available to reviewers. The pilot study was also approved by the CPRD Independent Scientific Advisory Committee (ref 19_025). PPIE/Advisory group: The authors would especially like to thank the members of the Keele Research User Group for their valuable contributions to this study. We are also thankful to Keele PPIE team for their support of the public contributors. The authors would also like to thank the project advisory group for the study. This project was funded by the Nuffield Foundation (OBF/43974). The Nuffield Foundation is an independent charitable trust with a mission to advance social well‐being. It funds research that informs social policy, primarily in Education, Welfare and Justice. It also funds student programmes that provide opportunities for young people to develop skills in quantitative and scientific methods. The Nuffield Foundation is the founder and co‐funder of the Nuffield Council on Bioethics and the Ada Lovelace Institute. The Foundation has funded this project, but the views expressed are those of the authors and not necessarily the Foundation. Visit www.nuffieldfoundation.org . The pilot study was funded by the National Institute for Health Research (NIHR) School for Primary Care Research (grant number C428). Kayleigh J. Mason, Kelvin P. Jordan and Christian D. Mallen are also supported by matched funding awarded to the NIHR Applied Research Collaboration West Midlands. Christian D. Mallen is also funded by the NIHR School for Primary Care Research. The School of Medicine, Keele University have received funding from Bristol Myers Squibb for a non‐pharmacological atrial fibrillation screening trial. Publisher Copyright: {\textcopyright} 2023 The Authors. Musculoskeletal Care published by John Wiley & Sons Ltd.",
year = "2023",
doi = "10.1002/msc.1748",
language = "English",
volume = "21",
pages = "749--762",
journal = "Musculoskeletal Care",
issn = "1478-2189",
number = "3",
}
