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Original research
Trends in the pharmacological management of atrial fibrillation in UK general practice 2008–2018
  1. Katherine Phillips1,
  2. Anuradhaa Subramanian1,
  3. G Neil Thomas1,
  4. Nazish Khan2,3,
  5. Joht Singh Chandan1,
  6. Paul Brady3,4,
  7. Tom Marshall1,
  8. Krishnarajah Nirantharakumar1,
  9. Larissa Fabritz3,4,
  10. Nicola Jaime Adderley1
  1. 1 Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  2. 2 Department of Cardiology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
  3. 3 Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
  4. 4 Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Dr Nicola Jaime Adderley, University of Birmingham Institute of Applied Health Research, Birmingham B15 2TT, UK; n.j.adderley{at}


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 coexisting heart failure.

Results Between 2008 and 2018, the proportion of patients prescribed anticoagulants increased from 45.3% (95% CI 45.0% to 45.7%) to 71.1% (95% CI 70.7% to 71.5%) driven by increased prescription of non-vitamin K antagonist anticoagulants. The proportion of patients prescribed rate control drugs remained constant between 2008 and 2018 (69.3% (95% CI 68.9% to 69.6%) to 71.6% (95% CI 71.2% to 71.9%)). The proportion of patients prescribed rhythm control therapy by general practitioners (GPs) decreased from 9.5% (95% CI 9.3% to 9.7%) to 5.4% (95% CI 5.2% to 5.6%).

Conclusions There has been an increase in the proportion of patients with AF appropriately prescribed anticoagulants following National Institute for Health and Care Excellence and European Society of Cardiology 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.

  • atrial fibrillation
  • epidemiology
  • stroke

Data availability statement

No data are available. IMRD is used under licence, and the dataset cannot be shared.

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Data availability statement

No data are available. IMRD is used under licence, and the dataset cannot be shared.

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  • Contributors KN, TM, NJA and LF conceived the research question. AS and NJA designed the analysis. AS and KP performed the analysis. KP, AS and NJA drafted the manuscript. PB reviewed the Read codes used in the analysis during the revision process. All authors reviewed the manuscript and provided critical feedback.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests LF has received institutional research grants and non-financial support from European Union, British Heart Foundation, Medical Research Council (UK), several biomedical companies and previously DFG. The Institute of Cardiovascular Research, University of Birmingham, has received an Accelerator Award by the British Heart Foundation AA/18/2/34218. LF is listed as inventor of two patents held by University of Birmingham (Atrial Fibrillation Therapy WO 2015140571, Markers for Atrial Fibrillation WO 2016012783).

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.