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Published on: February 26, 2013
Evolving landscape of stroke prevention in atrial fibrillation within the UK between 2012 and 2016: a cross-sectional
Laure Lacoin1, Matthew Lumley2, Essra Ridha1
1UK Medical Department, Bristol-Myers Squibb, Uxbridge, UK.
Insights
Prescribing of oral anticoagulants for non-valvular atrial fibrillation (NVAF) improved in the UK. However, many at-risk patients still received antiplatelet agents alone or no antithrombotic treatment.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Non-valvular atrial fibrillation (NVAF) increases stroke risk.
- Guideline-based recommendations exist for antithrombotic (AT) treatment in NVAF.
- Optimal AT management is crucial for stroke prevention.
Purpose of the Study:
- To analyze trends in oral anticoagulant (AC) and antiplatelet (AP) prescribing for NVAF patients in the UK.
- To identify factors associated with non-adherence to AT guidelines.
Main Methods:
- Retrospective, population-based cohort study using UK Clinical Practice Research Datalink data.
- Five cross-sectional analyses from April 2012 to January 2016.
- Inclusion of NVAF patients eligible for anticoagulation (CHA2DS2-VASc score ≥2).
Main Results:
- AC prescribing increased by 16.7% from 2012 to 2016.
- AP monotherapy decreased by 16.8% during the same period.
- No significant change in patients receiving no AT treatment.
Conclusions:
- Significant improvements in AT management for NVAF stroke prevention were observed in the UK.
- Despite improvements, approximately 20% received AP alone and over 15% received no AT treatment in January 2016.
- Further efforts are needed to ensure guideline-adherent AT prescribing in NVAF.
Objective:
To describe the changes in prescribing of oral anticoagulant (AC) and antiplatelet (AP) agents in patients with non-valvular atrial fibrillation (NVAF) in the UK and to identify the characteristics associated with deviation from guideline-based recommendations.
Design:
Five cross-sectional analyses in a large retrospective population-based cohort study.
Setting:
General practices contributing data to the UK Clinical Practice Research Datalink.
Participants:
The study included patients with a diagnosis of NVAF and eligible for anticoagulation (CHA2DS2-VASc score ≥2) on 1 April of 2012, 2013, 2014, 2015 and 1st January 2016.
Results:
The proportion of patients being treated with AC increased at each index date, showing an absolute rise of 16.7% over the study period. At the same time, the proportion of patients treated with an AP alone was reduced by half, showing an absolute decrease of 16.8%. The proportion of patients not receiving any antithrombotic (AT) treatment remained the same across the study period. A number of predictors were identified for AP alone or no treatment compared with AC treatment.
Conclusion:
Major improvements in the AT management of patients with NVAF for stroke prevention in the UK were observed between April 2012 and January 2016. Despite this, nearly 20% of at-risk patients still received AP alone and over 15% were on no AT agents in January 2016.
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