Trends in the pharmacological management of atrial fibrillation in UK general practice 2008-2018

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Colleges, School and Institutes

Abstract

Objective: The pharmacological management of atrial fibrillation (AF) comprises anticoagulation, for stroke prophylaxis; and rate or rhythm control drugs, to alleviate symptoms and prevent heart failure. The aim of this study was to investigate trends in the proportion of patients with AF prescribed pharmacological therapies in the UK between 2008 and 2018.

Methods: Eleven sequential cross-sectional analyses were performed yearly from 2008 to 2018. Data were derived from an anonymised UK primary care database. Outcomes were the proportion of patients with AF prescribed anticoagulants, rhythm and rate control drugs in the whole cohort, those at high risk of stroke, and those with co-existing heart failure.

Results: Between 2008 and 2018, the proportion of patients prescribed anticoagulants increased from 45.3% (95% CI 45.0-45.7%) to 71.1% (95% CI 70.7-71.5%) driven by increased prescription of non-vitamin K antagonist anticoagulants (NOACs). The proportion of patients prescribed rate control drugs remained constant between 2008 and 2018 (69.3% (95% CI 68.9-69.6%) to 71.6% (95% CI 71.2%-71.9%)). The proportion of patients prescribed rhythm control therapy by GPs decreased from 9.5% (95% CI 9.3-9.7%) to 5.4% (95% CI 5.2-5.6%).

Conclusions: There has been an increase in the proportion of patients with AF appropriately prescribed anticoagulants following NICE and ESC guidelines which correlates with improvements in mortality and stroke outcomes. Beta blockers appear increasingly favoured over digoxin for rate control. There has been a steady decline in GP prescribing rates for rhythm control drugs, possibly related to concerns over efficacy and safety and increased availability of AF ablation.

Details

Original languageEnglish
JournalHeart
Early online date5 Jul 2021
Publication statusE-pub ahead of print - 5 Jul 2021