Secondary prevention of esophageal variceal bleeding is often imperfect: A national, population-based cohort study of 3,592 patients
Hannes Hagström 1, Ying Shang 2, Elliot B Tapper 3, Axel Wester 2, Linnea Widman 2
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- PMID: 37192714
- DOI: 10.1016/j.cgh.2023.05.003
Free article
Abstract
Background and aims: Secondary prevention of esophageal variceal bleeding is important to improve prognosis, but uptake of guidelines is unknown in a real-world setting. Here, we determined the proportion of patients receiving appropriate non-selective beta-blocker treatment and repeat upper endoscopy after a first episode of esophageal variceal bleeding within a reasonable timeframe.
Methods: Population-based registers were used to identify all patients with a first episode of esophageal variceal bleeding in Sweden, 2006-2020. Cross-linkage between registers was performed to receive information on the cumulative incidence of patients with a dispensation of non-selective beta-blockers and repeat upper endoscopy within 120 days from baseline. Overall mortality was investigated using Cox regression.
Results: In total, 3,592 patients were identified, with a median age of 63 years (IQR=54-71). The cumulative incidence of a dispensation of non-selective beta-blockers and a repeat endoscopy within 120 days was 33%. 77% received either of these treatments. Overall mortality was high, with 65% of patients dying after esophageal variceal bleeding during the full follow-up period (median 1.7 years). We observed an improved overall mortality during the later years of the study period (adjusted hazard ratio for the 2016-2020 period compared to the 2006-2010 period:0.80, 95%CI=0.71-0.89). Patients with receipt of non-selective beta-blockers and repeat upper endoscopy had better overall survival compared to those without (aHR=0.80, 95%CI=0.72-0.90).
Conclusions: Secondary prevention of esophageal variceal bleeding has not been widely undertaken, with many patients not receiving guideline-supported interventions within a reasonable timeframe. This highlights a need to raise awareness on appropriate prevention strategies to clinicians and patients.
Keywords: beta-blockade; cirrhosis; endoscopy; epidemiology; quality of care; variceal bleeding.