Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Sep 25;7(9):e015363.
doi: 10.1136/bmjopen-2016-015363.

Evolving landscape of stroke prevention in atrial fibrillation within the UK between 2012 and 2016: a cross-sectional analysis study using CPRD

Laure Lacoin  1 , Matthew Lumley  2 , Essra Ridha  1 , Marta Pereira  3 , Laura McDonald  3 , Sreeram Ramagopalan  3 , Cinira Lefèvre  4   5 , David Evans  5 , Julian P Halcox  6
Affiliations

Evolving landscape of stroke prevention in atrial fibrillation within the UK between 2012 and 2016: a cross-sectional analysis study using CPRD

Laure Lacoin et al. BMJ Open. .

Abstract

Objective: To describe the changes in prescribing of oral anticoagulant (AC) and antiplatelet (AP) agents in patients with non-valvular atrial fibrillation (NVAF) in the UK and to identify the characteristics associated with deviation from guideline-based recommendations.

Design: Five cross-sectional analyses in a large retrospective population-based cohort study.

Setting: General practices contributing data to the UK Clinical Practice Research Datalink.

Participants: The study included patients with a diagnosis of NVAF and eligible for anticoagulation (CHA2DS2-VASc score ≥2) on 1 April of 2012, 2013, 2014, 2015 and 1st January 2016.

Results: The proportion of patients being treated with AC increased at each index date, showing an absolute rise of 16.7% over the study period. At the same time, the proportion of patients treated with an AP alone was reduced by half, showing an absolute decrease of 16.8%. The proportion of patients not receiving any antithrombotic (AT) treatment remained the same across the study period. A number of predictors were identified for AP alone or no treatment compared with AC treatment.

Conclusion: Major improvements in the AT management of patients with NVAF for stroke prevention in the UK were observed between April 2012 and January 2016. Despite this, nearly 20% of at-risk patients still received AP alone and over 15% were on no AT agents in January 2016.

Keywords: atrial fibrillation; drug therapy; electronic health records; great britain; stroke.

PubMed Disclaimer

Conflict of interest statement

Competing interests: MP, LM and SR were employees of Evidera and who were paid consultants to Bristol-Myers Squibb (BMS) in connection with conducting this study and with the development of this manuscript. JPH received consultancy fees from BMS for the conduct of this study. DE, ER, CL and LL were BMS employees at the time of the research. ML is a full-time employee of Pfizer.

Figures

Figure 1
Figure 1
Flow chart describing the sample used in each year. AF, atrial fibrillation; GP, general practitioner; NVAF, non-valvular atrial fibrillation.
Figure 2
Figure 2
Evolution of the proportion of patients treated with each anticoagulant, with antiplatelet therapy alone or no antithrombotic therapy among patients with NVAF with CHA2DS2-VASc ≥2 separately in newly diagnosed patients (A) and patients diagnosed since 12 months or more (B). NOACs, novel oral anticoagulants; VKAs, vitamin K antagonists.
See this image and copyright information in PMC

References

    1. Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 2001;285:2370–5. - PubMed
    1. Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation 2014;129:837–47. 10.1161/CIRCULATIONAHA.113.005119 - DOI - PMC - PubMed
    1. England PH. Atrial fibrillation prevalence estimates in England: application of recent population estimates of AF in Sweden. 2015;2015 http://www.yhpho.org.uk//resource/view.aspx?RID=207902
    1. Kirchhof P, Auricchio A, Bax J, et al. Outcome parameters for trials in atrial fibrillation: executive summary. Eur Heart J 2007;28:2803–17. 10.1093/eurheartj/ehm358 - DOI - PubMed
    1. Royal College of Physicians. Sentinel Stroke National Audit Programme (SSNAP). Clinical audit April - June 2015 report prepared by Royal College of Physicians, Clinical Effectiveness and Evaluation Unit on behalf of the Intercollegiate Stroke Working Party. 2015.

MeSH terms

Substances