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Original research article
Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016
  1. Nicola Jaime Adderley,
  2. Ronan Ryan,
  3. Krishnarajah Nirantharakumar,
  4. Tom Marshall
  1. Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr Tom Marshall, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK; t.p.marshall{at}bham.ac.uk

Abstract

Objective Atrial fibrillation (AF) is the most common cardiac arrhythmia and an important risk factor for stroke. Treatment with anticoagulants substantially reduces risk of stroke. Current prevalence and treatment rates of AF in the UK as well as changes in recent years are not known. The aim of this analysis was to determine trends in age–sex specific prevalence and treatment of AF in the UK from 2000 to 2016.

Methods 17 sequential cross-sectional analyses were carried out between 2000 and 2016 using a large database of electronic primary care records of patients registered with UK general practitioners. These determined the prevalence of patients diagnosed with AF, the stroke risk of those with AF and the proportion of AF patients currently receiving anticoagulants. Stroke risk was assessed using CHA2DS2-VASc score.

Results Age–sex standardised AF prevalence increased from 2.14% (95% CI 2.11% to 2.17%) in 2000 to 3.29% (95% CI 3.27% to 3.32%) in 2016. Between 2000 and 2016, the proportion of patients with AF prescribed anticoagulants increased from 35.4% (95% CI 34.7% to 36.1%) to 75.5% (95% CI 75.1% to 75.8%) in those with high stroke risk (p for change over time <0.001) and from 32.8% (95% CI 30.5% to 35.2%) to 47.1% (95% CI 45.4% to 48.7%) in those with moderate stroke risk (p<0.001). In patients with low risk of stroke, the proportion decreased from 19.9% (95% CI 17.8% to 22.2%) to 9.7% (95% CI 8.4% to 11.1%) (p<0.001).

Anticoagulant prescribing performance varied between practices; in 2016, the proportion of eligible patients treated was 82.9% (95% CI 82.2% to 83.7%) and 62.0% (95% CI 61.0% to 63.0%) in the highest-performing and lowest-performing practice quintiles, respectively. There was poor agreement in individual practice performance over time from 2006 to 2016: linear-weighted κ=0.10 (95% CI 0.02 to 0.19).

Conclusions From 2000 to 2016, the prevalence of recorded AF has increased in all age groups and both sexes. Anticoagulant treatment of eligible patients with AF has more than doubled, with marked improvements since 2011, alongside a reduction in the use of anticoagulants in ineligible patients with AF.

  • atrial fibrillation
  • epidemiology
  • stroke

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Footnotes

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

  • Funding NJA and TM are funded by the NIHR Collaborations for Leadership in Applied Health Research and Care West Midlands initiative.

  • Disclaimer 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 KN has received personal fees from Sanofi and a grant from AstraZeneca outside the submitted work.

  • Patient consent Not required.

  • Ethics approval Research carried out using THIN data was approved by the NHS South-East Multicentre Research Ethics Committee (MREC) in 2003, subject to independent scientific approval. Approval for this analysis was granted by the Scientific Review Committee (for the use of THIN data), SRC reference number 15THIN021.

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

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