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

Katherine Phillips; Anuradhaa Subramanian; G Neil Thomas; Nazish Khan; Joht Chandan; Paul Brady; Tom Marshall; Krishnarajah Nirantharakumar; Larissa Fabritz; Nicola Adderley

doi:10.1136/heartjnl-2021-319338

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

Katherine Phillips, Anuradhaa Subramanian, G Neil Thomas, Nazish Khan, Joht Chandan, Paul Brady, Tom Marshall, Krishnarajah Nirantharakumar, Larissa Fabritz, Nicola Adderley^*

^*Corresponding author for this work

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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.

Original language	English
Article number	319338
Pages (from-to)	517-522
Number of pages	6
Journal	Heart
Volume	108
Issue number	7
Early online date	5 Jul 2021
DOIs	https://doi.org/10.1136/heartjnl-2021-319338
Publication status	Published - 10 Mar 2022

Bibliographical note

Publisher Copyright:
© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

Keywords

epidemiology
atrial fibrillation
stroke

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

Access to Document

10.1136/heartjnl-2021-319338

PhillipsK2021Trends
This article has been accepted for publication in Heart, 2021 following peer review, and the Version of Record can be accessed online at: http://dx.doi.org/10.1136/heartjnl-2021-319338 © Author(s) (or their employer(s)). Reuse of this manuscript version (excluding any databases, tables, diagrams, photographs and other images or illustrative material included where a another copyright owner is identified) is permitted strictly pursuant to the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC-BY-NC 4.0) http://creativecommons.org https://creativecommons.org/licenses/by-nc/4.0/
Accepted author manuscript, 318 KBLicence: Creative Commons: Attribution-NonCommercial (CC BY-NC)
PhillipsK2021Trends_Figures
This article has been accepted for publication in Heart, 2021 following peer review, and the Version of Record can be accessed online at: http://dx.doi.org/10.1136/heartjnl-2021-319338 © Author(s) (or their employer(s)). Reuse of this manuscript version (excluding any databases, tables, diagrams, photographs and other images or illustrative material included where a another copyright owner is identified) is permitted strictly pursuant to the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC-BY-NC 4.0) http://creativecommons.org https://creativecommons.org/licenses/by-nc/4.0/
Accepted author manuscript, 281 KBLicence: Creative Commons: Attribution-NonCommercial (CC BY-NC)
PhillipsK2021Trends_Supplementary_Figures
This article has been accepted for publication in Heart, 2021 following peer review, and the Version of Record can be accessed online at: http://dx.doi.org/10.1136/heartjnl-2021-319338 © Author(s) (or their employer(s)). Reuse of this manuscript version (excluding any databases, tables, diagrams, photographs and other images or illustrative material included where a another copyright owner is identified) is permitted strictly pursuant to the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC-BY-NC 4.0) http://creativecommons.org https://creativecommons.org/licenses/by-nc/4.0/
Accepted author manuscript, 122 KBLicence: Creative Commons: Attribution-NonCommercial (CC BY-NC)

Cite this

@article{63a6345c1c77426c88743bfd45ab3064,

title = "Trends in the pharmacological management of atrial fibrillation in UK general practice 2008-2018",

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.",

keywords = "epidemiology, atrial fibrillation, stroke",

author = "Katherine Phillips and Anuradhaa Subramanian and Thomas, {G Neil} and Nazish Khan and Joht Chandan and Paul Brady and Tom Marshall and Krishnarajah Nirantharakumar and Larissa Fabritz and Nicola Adderley",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2022",

month = mar,

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doi = "10.1136/heartjnl-2021-319338",

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AU - Phillips, Katherine

AU - Subramanian, Anuradhaa

AU - Thomas, G Neil

AU - Khan, Nazish

AU - Chandan, Joht

AU - Brady, Paul

AU - Marshall, Tom

AU - Nirantharakumar, Krishnarajah

AU - Fabritz, Larissa

AU - Adderley, Nicola

PY - 2022/3/10

Y1 - 2022/3/10

N2 - 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.

AB - 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.

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DO - 10.1136/heartjnl-2021-319338

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EP - 522

JO - Heart

JF - Heart

IS - 7

M1 - 319338

ER -

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

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

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