The treatment of paroxysmal atrial fibrillation in UK primary care

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Colleges, School and Institutes

Abstract

Objective
To determine whether patients with paroxysmal atrial fibrillation (AF) are less likely to be treated with anticoagulants than patients with persistent/permanent AF, and to investigate trends in treatment between 2000 and 2015. UK and European guidelines recommend that anticoagulants are offered to all AF patients at increased risk of stroke, irrespective of AF type.

Methods
16 sequential cross-sectional analyses from 2000 to 2015 were carried out with index dates on 1st May each year. The data source was primary care data from 648 practices across the UK contributing to The Health Improvement Network (THIN) database. All patients with a diagnosis of AF aged ≥ 35 years and registered for at least one year were included. The main outcome measure was prescription of anticoagulant medication.

Results
The proportion of AF patients with a diagnosis of paroxysmal AF increased from 7.4% (95% CI 7.0, 7.8) in 2000 to 14.0% (95% CI 13.7, 14.3) in 2015. Among patients with a CHADS2 score ≥ 1, between 2000 and 2015 the proportion prescribed anticoagulants increased from 18.8% (95% CI 16.4, 21.4) to 56.2% (95% CI 55.0, 57.3) and from 34.2% (95% CI 33.3, 35.0) to 69.4% (95% CI 68.9, 69.8) in paroxysmal and other (persistent/permanent) AF patients respectively; RR for treatment of paroxysmal AF patients compared to other AF patients increased from 0.48 (95% CI 0.42, 0.55) to 0.76 (95% CI 0.74, 0.77). Adjusting for age, sex, Townsend score and presence or absence of contraindications had little effect on the results.

Conclusions
In 2000, eligible paroxysmal AF patients were half as likely to be treated with anticoagulants as other AF patients; this has improved over time, but in 2015, eligible paroxysmal AF patients were still around 20% less likely to be prescribed anticoagulant medication.

Details

Original languageEnglish
Pages (from-to)1502-1507
JournalHeart
Volume103
Issue number19
Publication statusPublished - 1 Jun 2017

Keywords

  • Atrial Fibrillation, Paroxysmal atrial fibrillation, Anticoagulant, Stroke prevention, Primary care