The treatment of paroxysmal atrial fibrillation in UK primary care

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The treatment of paroxysmal atrial fibrillation in UK primary care. / Isaew, Andrea; Adderley, Nicola; Ryan, Ronan; Fitzmaurice, David; Marshall, Tom.

In: Heart, Vol. 103, No. 19, 01.06.2017, p. 1502-1507.

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@article{50b795a718cc4de7a884e4c878a02330,
title = "The treatment of paroxysmal atrial fibrillation in UK primary care",
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.Methods16 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.ResultsThe 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.ConclusionsIn 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. ",
keywords = "Atrial Fibrillation, Paroxysmal atrial fibrillation, Anticoagulant, Stroke prevention, Primary care",
author = "Andrea Isaew and Nicola Adderley and Ronan Ryan and David Fitzmaurice and Tom Marshall",
year = "2017",
month = jun,
day = "1",
doi = "10.1136/heartjnl-2016-310927",
language = "English",
volume = "103",
pages = "1502--1507",
journal = "Heart",
issn = "1355-6037",
publisher = "BMJ Publishing Group",
number = "19",

}

RIS

TY - JOUR

T1 - The treatment of paroxysmal atrial fibrillation in UK primary care

AU - Isaew, Andrea

AU - Adderley, Nicola

AU - Ryan, Ronan

AU - Fitzmaurice, David

AU - Marshall, Tom

PY - 2017/6/1

Y1 - 2017/6/1

N2 - 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.Methods16 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.ResultsThe 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.ConclusionsIn 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.

AB - 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.Methods16 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.ResultsThe 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.ConclusionsIn 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.

KW - Atrial Fibrillation

KW - Paroxysmal atrial fibrillation

KW - Anticoagulant

KW - Stroke prevention

KW - Primary care

U2 - 10.1136/heartjnl-2016-310927

DO - 10.1136/heartjnl-2016-310927

M3 - Article

VL - 103

SP - 1502

EP - 1507

JO - Heart

JF - Heart

SN - 1355-6037

IS - 19

ER -