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. 2018 Aug 21;39(32):2975-2983.
doi: 10.1093/eurheartj/ehy411.

A 10 year study of hospitalized atrial fibrillation-related stroke in England and its association with uptake of oral anticoagulation

J Campbell Cowan  1 , Jianhua Wu  2 , Marlous Hall  3 , Andi Orlowski  4 , Robert M West  5 , Chris P Gale  3   6
Affiliations

A 10 year study of hospitalized atrial fibrillation-related stroke in England and its association with uptake of oral anticoagulation

J Campbell Cowan et al. Eur Heart J. .

Abstract

Aims: To determine whether changing patterns of anticoagulant use in atrial fibrillation (AF) have impacted on stroke rates in England.

Methods and results: English national databases, 2006-2016, were interrogated to assess stroke admissions and oral anticoagulant use. The number of patients with known AF increased linearly from 692 054 to 983 254 (prevalence 1.29% vs. 1.71%). Hospital episodes of AF-related stroke/100 000 AF patients increased from 80/week in 2006 to 98/week in 2011 and declined to 86/week in 2016 (2006-2011 difference 18.0, 95% confidence interval (CI) 17.9-18.1, 2011-2016 difference -12.0, 95% CI -12.1 to -11.9). Anticoagulant use amongst patients with CHA2DS2-VASc ≥2 increased from 48.0% to 78.6% and anti-platelet use declined from 42.9% to 16.1%; the greatest rate of change occurred in the second 5 year period (for anticoagulants 2006-2011 difference 4.8%, 95% CI 4.5-5.1%, 2011-2016 difference 25.8%, 95% CI 25.5-26.1%). After adjustment for AF prevalence, a 1% increase in anticoagulant use was associated with a 0.8% decrease in the weekly rate of AF-related stroke (incidence rate ratio 0.992, 95% CI 0.989-0.994). Had the use of anticoagulants remained at 2009 levels, 4068 (95% CI 4046-4089) more strokes would have been predicted in 2015/2016.

Conclusion: Between 2006 and 2016, AF prevalence and anticoagulant use in England increased. From 2011, hospitalized AF-related stroke rates declined and were significantly associated with increased anticoagulant uptake.

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Figures

Figure 1
Figure 1
STROBE diagram of the derivation of the analytical cohorts and their associated timeframes. HES: Hospital Episode Statistics; QOF: Quality and Outcomes Framework; GRASP: Guidance on Risk Assessment for Stroke Prevention in AF; Holt et al.
Figure 2
Figure 2
Temporal trend in finished consultant episodes of atrial fibrillation-related stroke and national prevalence of atrial fibrillation.
Figure 3
Figure 3
Temporal trend in finished consultant episodes of atrial fibrillation-related stroke per 100 000 patients with atrial fibrillation and uptake of oral anticoagulants and anti-platelet drugs for patients with atrial fibrillation and a CHA2DS2VASc score ≥2. The anticoagulant timeline is a weighted trend derived from Holt et al., GRASP AF, and Quality and Outcomes Framework.
Figure 4
Figure 4
The temporal trend of atrial fibrillation-related stroke stratified by stroke pathogenesis.
Figure 5
Figure 5
Direct oral anticoagulant uptake (as a percentage of all those taking an oral anticoagulant) amongst patients with CHA2DS2-VASc ≥2 in the GRASP cohort.
Take home figure
Take home figure
None
See this image and copyright information in PMC

Comment in

References

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