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Arrhythmias and sudden death
Original research article
The treatment of paroxysmal atrial fibrillation in UK primary care
  1. Andrea Isaew,
  2. Nicola Jaime Adderley,
  3. Ronan Ryan,
  4. David Fitzmaurice,
  5. Tom Marshall
  1. Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr Nicola Jaime Adderley, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK; n.j.adderley{at}bham.ac.uk

Abstract

Objective To determine whether patients with paroxysmal atrial fibrillation (AF) are less likely to be treated with anticoagulants than patients with persistent/permanent AF and to investigate trends in treatment between 2000 and 2015. UK and European guidelines recommend that anticoagulants are offered to all patients with AF at increased risk of stroke, irrespective of AF type.

Methods Sixteen sequential cross-sectional analyses from 2000 to 2015 were carried out with index dates on 1st of May each year. The data source was primary care data from 648 practices across the UK contributing to The Health Improvement Network database. All patients with a diagnosis of AF aged ≥35 years and registered for at least 1 year were included. The main outcome measure was prescription of anticoagulant medication.

Results The proportion of patients with AF with a diagnosis of paroxysmal AF increased from 7.4% (95% CI 7.0 to 7.8) in 2000 to 14.0% (95% CI 13.7 to 14.3) in 2015. Among patients with a CHADS2 score of ≥1, between 2000 and 2015 the proportion prescribed anticoagulants increased from 18.8% (95% CI 16.4 to 21.4) to 56.2% (95% CI 55.0 to 57.3) and from 34.2% (95% CI 33.3 to 35.0) to 69.4% (95% CI 68.9 to 69.8) in patients with paroxysmal and other (persistent/permanent) AF, respectively; RR for treatment of patients with paroxysmal AF compared with patients with other AF increased from 0.48 (95% CI 0.42 to 0.55) to 0.76 (95% CI 0.74 to 0.77). Adjusting for age, sex, Townsend score and presence or absence of contraindications had little effect on the results.

Conclusions In 2000, eligible patients with paroxysmal AF were half as likely to be treated with anticoagulants as patients with other AF; this has improved over time, but in 2015, eligible patients with paroxysmal AF were still around 20% less likely to be prescribed anticoagulant medication.

  • Atrial fibrillation
  • Cardiac arrhythmias and resuscitation science
  • DISEASES
  • PRIMARY CARE
  • QUALITY OF CARE AND OUTCOMES

https://doi.org/10.1136/heartjnl-2016-310927

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    Footnotes

    • Contributors AI had the original research idea. RR undertook data extraction. NJA designed and performed the analysis. NJA and AI wrote the first draft of the paper, which was revised in collaboration with TM, DF and RR.

    • Funding NJA and TM are funded by the NIHR CLAHRC West Midlands initiative. This paper presents independent research, and the views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

    • Competing interests None declared.

    • Ethics approval The THIN data collection scheme and research carried out using THIN data were approved by the NHS South-East Multicentre Research Ethics Committee (MREC) in 2003; under the terms of this ethics approval, studies must undergo scientific review. Approval for this analysis was obtained from the Scientific Review Committee (for the use of THIN data) on 2 April 2015 (SRC reference number 15THIN021).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with ‘BMJ Publishing Group’. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.