A National Survey of the Prevalence, Incidence, Primary Care Burden and Treatment of Atrial Fibrillation in Scotland

Niamh F Murphy ¹, Colin R Simpson ², Pardeep S Jhund ¹, Simon Stewart ³, Michelle Kirkpatrick ⁴, Jim Chalmers ⁴, Kate P MacIntyre ⁵ and John J V McMurray ^1*

¹ Western Infirmary, Glasgow, United Kingdom
² The University of Aberdeen, United Kingdom
³ Baker Heart Research Institute, Australia
⁴ Information Services, NHS National Services Scotland, United Kingdom
⁵ University of Glasgow, United Kingdom

^* To whom correspondence should be addressed. E-mail: j.mcmurray{at}bio.gla.ac.uk.

Accepted 14 November 2006

Abstract

Objective To examine the epidemiology, primary care burden and treatment of atrial fibrillation (AF).

Design Cross-sectional data from primary care practices participating in the Scottish Continuous Morbidity Recording scheme between April 2001 and March 2002.

Setting 55 primary care practices (362,155 patients).

Participants 3135 patients with AF.

Results The prevalence of AF in Scotland was 9.4/1000 in men and 7.9/1000 in women (p<0.0001) and increased with age (to 71/1000 in individuals >85 years). The prevalence of AF decreased with increasing socioeconomic deprivation (9.2/1,000 least deprived and 7.5/1,000 most deprived category, p=0.02 for trend). 71% of patients with AF received rate-controlling medication: beta-blocker 28%, rate-limiting CCB 42% and digoxin 43%. 42% of patients received warfarin, 44% aspirin and 78% 1 of these. Multivariable analysis showed men and women 75 were more likely (than <75 years) to be prescribed digoxin (men OR 1.41 95%CI 1.14-1.74; women OR 1.88, 95% CI 1.50-2.37) and aspirin (2.04, 1.66-2.51; 1.79, 1.42-2.25) and less likely to receive an antiarrhythmic drug (0.62, 0.48-0.81; 0.52, 0.39-0.70) or warfarin (0.74, 0.60-0.91; 0.58, 0.46-0.73). Adjusted analysis showed no socioeconomic gradient in prescribing

Conclusions AF is common condition, more so in men than in women. Deprived individuals are less likely to have AF, a finding raising concerns about socioeconomic gradients in detection and prognosis. Recommended treatments for AF were underused in women and the elderly. This is of particular concern given current trends in population demographics and the evidence that both groups are at higher risk of stroke.

Keywords: Angina, Atrial fibrillation, Heart Failure, Prescribing, Primary care

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