Introduction/objectives

Canine cardiovascular (CV) diseases are often managed in primary care settings. The objectives were to describe CV therapeutic agent (CVTA) prescribing patterns in primary care practices in the United Kingdom (UK) and to evaluate recorded clinical signs, diagnostic tests and justifications for use of torasemide, a recently marketed and authorised loop-diuretic in the UK.

Animals, materials and methods

Electronic health records (EHRs) describing 3,579,420 consultations (1,043,042 unique dogs) were collated (1 April 2014 and 31 December 2018) by the Small Animal Veterinary Surveillance Network from 270 veterinary practices. Consultations prescribing at least one CVTA were identified. Annual variation in individual CVTA prescriptions was analysed using mixed-effects binomial regression models. Free-text clinical narratives were manually read to determine the first-prescribing event for torasemide.

Results

Twenty-nine thousand and seven consultations (0.81% of all consultations, 95% confidence interval [CI], 0.76–0.86) prescribed CVTA in 14,148 (1.36%) dogs. Furosemide (52.8% of CV-prescribing consultations, 95% CI 50.7–54.9) and pimobendan (51.9%, 95% CI 50.1–53.7) were most prescribed. Longitudinal analysis (2014–2018) showed a significant negative temporal trend for angiotensin-converting enzyme inhibitors (p < 0.001), and furosemide (p = 0.003) and a positive temporal trend for pimobendan (p = 0.020) and torasemide (p < 0.001). First prescriptions of torasemide were identified in 16.5% of torasemide-prescribing consultations. Where justification for prescription of torasemide was identified (32.5%), furosemide resistance was the most common (92.0%).

Conclusions

EHRs can be used to temporally monitor prescribing habits, including responses to market authorisations. Despite authorisation in the UK for torasemide use as a first-line diuretic, it was most commonly prescribed after furosemide resistance.

中文翻译：

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在英国初级保健兽医实践中使用电子健康记录分析犬心血管治疗剂处方

简介/目标

犬心血管 (CV) 疾病通常在初级保健机构进行管理。目的是描述英国 (UK) 初级保健实践中 CV 治疗剂 (CVTA) 的处方模式，并评估记录的临床症状、诊断测试和使用托拉塞米的理由，托拉塞米是一种最近在美国上市并获得批准的袢利尿剂。英国。

动物、材料和方法

描述 3,579,420 次咨询（1,043,042 只独特的狗）的电子健康记录 (EHR) 由 Small Animal Veterinary Surveillance Network 从 270 家兽医诊所整理（2014 年 4 月 1 日和 2018 年 12 月 31 日）。确定了规定至少一种 CVTA 的咨询。使用混合效应二项式回归模型分析单个 CVTA 处方的年度变化。人工阅读自由文本临床叙述以确定托拉塞米的首次处方事件。

结果

2907 次咨询（占所有咨询的 0.81%，95% 置信区间 [CI]，0.76-0.86）对 14,148 只（1.36%）只狗进行了 CVTA。呋塞米（52.8% 的 CV 处方咨询，95% CI 50.7-54.9）和匹莫苯（51.9%，95% CI 50.1-53.7）的处方最多。纵向分析（2014-2018）显示血管紧张素转换酶抑制剂（p  < 0.001）和速尿（p  = 0.003）呈显着负时间趋势，匹莫苯（p =  0.020）和托拉塞米（p ）呈正时间趋势 < 0.001)。在托拉塞米处方咨询中，有 16.5% 的患者首次开具托拉塞米处方。在确定开具托拉塞米的理由（32.5%）的情况下，呋塞米耐药最为常见（92.0%）。

结论

EHR 可用于临时监控处方习惯，包括对市场授权的反应。尽管英国授权将托拉塞米用作一线利尿剂，但它最常在呋塞米耐药后开具。