National trends in heart failure mortality in men and women, United Kingdom, 2000–2017

Aims: To understand gender differences in the prognosis of women and men with heart failure, we compared mortality, cause of death and survival trends over time. Methods and results: We analysed UK primary care data for 26 725 women and 29 234 men over age 45 years with a new diagnosis of heart failure between 1 January 2000 and 31 December 2017 using the Clinical Practice Research Datalink, inpatient Hospital Episode Statistics and the Office for National Statistics death registry. Age-specific overall survival and cause-specific mortality rates were calculated by gender and year. During the study period 15 084 women and 15 822 men with heart failure died. Women were on average 5 years older at diagnosis (79.6 vs. 74.8 years). Median survival was lower in women compared to men (3.99 vs. 4.47 years), but women had a 14% age-adjusted lower risk of all-cause mortality [hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.84–0.88]. Heart failure was equally likely to be cause of death in women and men (HR 1.03, 95% CI 0.96–1.12). There were modest improvements in survival for both genders, but these were greater in men. The reduction in mortality risk in women was greatest for those diagnosed in the community (HR 0.83, 95% CI 0.80–0.85). Conclusions: Women are diagnosed with heart failure older than men but have a better age-adjusted prognosis. Survival gains were less in women over the last two decades. Addressing gender differences in heart failure diagnostic and treatment pathways should be a clinical and research priority.</p

The creative disruption of degree apprenticeships in the UK

The introduction of an apprenticeship levy for employers with a payroll above £3m in 2017 has transformed the landscape for higher-level skills in the UK. While there is some evidence of the economic benefits of higher education, it seems to be largely operating to reproduce economic position rather than as an agent of social mobility. At the same time, UK employers have made it clear that graduates do not possess the range of skills that they require and yet have a poor record of investing in the development of their employees. In this problematized context, degree apprenticeships can operate to creatively disrupt our understanding of the relationship between higher education and work. Assumptions about the presumed differences between academic and professional standards, knowledge and competence, on-and-off-the-job learning are all challenged by the introduction of degree apprenticeships. Can universities overcome these challenges to rethink the role of higher education as the worlds of work and learning align

Factors associated with consultation rates in general practice in England, 2013-2014:a cross-sectional study

Background Workload in general practice has risen during the last decade, but the factors associated with this increase are unclear. Aim To examine factors associated with consultation rates in general practice. Design and setting A cross-sectional study. A sample of 304,937 patients registered at 316 English practices between 2013 and 2014 was drawn from the Clinical Practice Research Datalink. Method We linked age, sex, ethnicity, smoking status, and deprivation measures with practice level data on staffing, rurality, training practice status, and Quality and Outcomes Framework performance. We conducted multilevel analyses of patient consultation rates. Results Consultations were grouped into three types: General practitioner or nurse (All), general practitioner (GP), and nurse. Non-smokers consulted less than current smokers (All: RR=0.88, 95% CI: 0.87 to 0.89; GP: 0.88 [0.87 to 0.89]; nurse: 0.91 [0.90 to 0.92]. Consultation rates were higher for those in the most deprived quintile compared to the least deprived quintile (All: 1.18 [1.16 to 1.19]; GP: 1.17 [1.15 to 1.19]; nurse: 1.13 [1.11 to 1.15]. For all three consultation types, consultation rates increased with age, female sex, and varied by ethnicity. Rates in practices with between >8 and Conclusions Our analyses show consistent trends in factors related to consultation rates in general practice across three types of consultation. These data can be used inform the development of more sophisticated staffing models, and resource allocation formulae.</p

Patient consultation rate and clinical and NHS outcomes:A cross-sectional analysis of English primary care data from 2.7 million patients in 238 practices

Supplementary results. This file contains additional tables presenting results from the analyses which could not be included in the main manuscript. (DOCX 29 kb