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Published on: March 15, 2020
Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016
Nicola Jaime Adderley1, Ronan Ryan1, Krishnarajah Nirantharakumar1
1Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Insights
The prevalence of atrial fibrillation (AF) increased in the UK from 2000-2016. Anticoagulant treatment for eligible AF patients more than doubled, improving stroke prevention.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Atrial fibrillation (AF) is the most common cardiac arrhythmia and a significant stroke risk factor.
- Anticoagulant therapy is crucial for reducing stroke risk in AF patients.
- UK-specific trends in AF prevalence and treatment rates were previously unknown.
Purpose of the Study:
- To determine trends in age-sex specific prevalence of AF in the UK from 2000 to 2016.
- To analyze changes in anticoagulant treatment rates for AF patients over the same period.
- To assess the impact of AF prevalence and treatment on stroke risk management.
Main Methods:
- Utilized 17 sequential cross-sectional analyses of UK electronic primary care records (2000-2016).
- Determined AF prevalence, stroke risk (CHA 2 DS 2 -VASc score), and anticoagulant prescription rates.
- Analyzed age-sex standardized prevalence and treatment trends over time.
Main Results:
- Age-sex standardized AF prevalence rose from 2.14% in 2000 to 3.29% in 2016.
- Anticoagulant use in high-stroke-risk AF patients increased from 35.4% to 75.5%; moderate-risk increased from 32.8% to 47.1%.
- Anticoagulant use in low-stroke-risk patients decreased from 19.9% to 9.7%; practice-level prescribing varied significantly.
Conclusions:
- Recorded AF prevalence increased across all demographics in the UK between 2000 and 2016.
- Anticoagulant treatment for eligible AF patients more than doubled, with significant improvements noted since 2011.
- A reduction in anticoagulant use among ineligible AF patients was observed, alongside variations in prescribing performance across general practices.
Objective:
Atrial fibrillation (AF) is the most common cardiac arrhythmia and an important risk factor for stroke. Treatment with anticoagulants substantially reduces risk of stroke. Current prevalence and treatment rates of AF in the UK as well as changes in recent years are not known. The aim of this analysis was to determine trends in age-sex specific prevalence and treatment of AF in the UK from 2000 to 2016.
Methods:
17 sequential cross-sectional analyses were carried out between 2000 and 2016 using a large database of electronic primary care records of patients registered with UK general practitioners. These determined the prevalence of patients diagnosed with AF, the stroke risk of those with AF and the proportion of AF patients currently receiving anticoagulants. Stroke risk was assessed using CHA2DS2-VASc score.
Results:
Age-sex standardised AF prevalence increased from 2.14% (95% CI 2.11% to 2.17%) in 2000 to 3.29% (95% CI 3.27% to 3.32%) in 2016. Between 2000 and 2016, the proportion of patients with AF prescribed anticoagulants increased from 35.4% (95% CI 34.7% to 36.1%) to 75.5% (95% CI 75.1% to 75.8%) in those with high stroke risk (p for change over time <0.001) and from 32.8% (95% CI 30.5% to 35.2%) to 47.1% (95% CI 45.4% to 48.7%) in those with moderate stroke risk (p<0.001). In patients with low risk of stroke, the proportion decreased from 19.9% (95% CI 17.8% to 22.2%) to 9.7% (95% CI 8.4% to 11.1%) (p<0.001). Anticoagulant prescribing performance varied between practices; in 2016, the proportion of eligible patients treated was 82.9% (95% CI 82.2% to 83.7%) and 62.0% (95% CI 61.0% to 63.0%) in the highest-performing and lowest-performing practice quintiles, respectively. There was poor agreement in individual practice performance over time from 2006 to 2016: linear-weighted κ=0.10 (95% CI 0.02 to 0.19).
Conclusions:
From 2000 to 2016, the prevalence of recorded AF has increased in all age groups and both sexes. Anticoagulant treatment of eligible patients with AF has more than doubled, with marked improvements since 2011, alongside a reduction in the use of anticoagulants in ineligible patients with AF.
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