Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016
ObjectiveAtrial 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 thi...
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| Veröffentlicht in: | Heart (British Cardiac Society) 2019-01, Vol.105 (1), p.27-33 |
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| creator | Adderley, Nicola Jaime Ryan, Ronan Nirantharakumar, Krishnarajah Marshall, Tom |
| description | ObjectiveAtrial 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.Methods17 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.ResultsAge–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 |
| doi_str_mv | 10.1136/heartjnl-2018-312977 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2068347190</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2154939143</sourcerecordid><originalsourceid>FETCH-LOGICAL-b487t-62e0ee662b67e926a6929082616250c8d2f1dc02ca144ff3d8aa29be6917a83f3</originalsourceid><addsrcrecordid>eNqNkE1LAzEURYMotlb_gUjAjZux-ZpMshTxCwu6sNBdyMy86JSZTM2kgv_elLYuXLl6ITn35nEQOqfkmlIupx9gQ1z6NmOEqoxTpoviAI2pkGpztThMZ57nmSS8GKGTYVgSQoRW8hiNmNaa5kSM0eI1wJdtwVeAra9xDGBjBz7i3mEbQ2Nb7JoyNG1rY9N73Hg8f8bv4CGkp1WwVWxS1oW-wyz9gGOfJpWn6MjZdoCz3Zyg-f3d2-1jNnt5eLq9mWWlUEXMJAMCICUrZQGaSSs100QxSSXLSaVq5mhdEVZZKoRzvFbWMl2C1LSwijs-QVfb3lXoP9cwRNM1QwVpXQ_9ejCMSMVFQTVJ6OUfdNmvg0_bGUZzobmmgidKbKkq9MMQwJlVaDobvg0lZmPe7M2bjXmzNZ9iF7vyddlB_Rvaq07AdAuU3fJ_lT9TzY2v</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2154939143</pqid></control><display><type>article</type><title>Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016</title><source>MEDLINE</source><source>PubMed Central</source><creator>Adderley, Nicola Jaime ; Ryan, Ronan ; Nirantharakumar, Krishnarajah ; Marshall, Tom</creator><creatorcontrib>Adderley, Nicola Jaime ; Ryan, Ronan ; Nirantharakumar, Krishnarajah ; Marshall, Tom</creatorcontrib><description>ObjectiveAtrial 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.Methods17 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.ResultsAge–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).ConclusionsFrom 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.</description><identifier>ISSN: 1355-6037</identifier><identifier>EISSN: 1468-201X</identifier><identifier>DOI: 10.1136/heartjnl-2018-312977</identifier><identifier>PMID: 29991504</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Age ; Aged ; Anticoagulants ; Anticoagulants - therapeutic use ; Atrial Fibrillation - complications ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - drug therapy ; Atrial Fibrillation - epidemiology ; Cardiac arrhythmia ; Censuses ; Cross-Sectional Studies ; Employers ; Female ; General Practice - methods ; Hemorrhage ; Humans ; Male ; Middle Aged ; Mortality ; Patients ; Prevalence ; Primary care ; Primary Health Care - statistics & numerical data ; Risk Assessment - methods ; Risk Factors ; Sensitivity analysis ; Stroke ; Stroke - epidemiology ; Stroke - etiology ; Stroke - prevention & control ; Studies ; Trends ; United Kingdom - epidemiology</subject><ispartof>Heart (British Cardiac Society), 2019-01, Vol.105 (1), p.27-33</ispartof><rights>Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.</rights><rights>2019 Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b487t-62e0ee662b67e926a6929082616250c8d2f1dc02ca144ff3d8aa29be6917a83f3</citedby><cites>FETCH-LOGICAL-b487t-62e0ee662b67e926a6929082616250c8d2f1dc02ca144ff3d8aa29be6917a83f3</cites><orcidid>0000-0003-0543-3254</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29991504$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Adderley, Nicola Jaime</creatorcontrib><creatorcontrib>Ryan, Ronan</creatorcontrib><creatorcontrib>Nirantharakumar, Krishnarajah</creatorcontrib><creatorcontrib>Marshall, Tom</creatorcontrib><title>Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016</title><title>Heart (British Cardiac Society)</title><addtitle>Heart</addtitle><description>ObjectiveAtrial 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.Methods17 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.ResultsAge–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).ConclusionsFrom 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.</description><subject>Age</subject><subject>Aged</subject><subject>Anticoagulants</subject><subject>Anticoagulants - therapeutic use</subject><subject>Atrial Fibrillation - complications</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - drug therapy</subject><subject>Atrial Fibrillation - epidemiology</subject><subject>Cardiac arrhythmia</subject><subject>Censuses</subject><subject>Cross-Sectional Studies</subject><subject>Employers</subject><subject>Female</subject><subject>General Practice - methods</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Patients</subject><subject>Prevalence</subject><subject>Primary care</subject><subject>Primary Health Care - statistics & numerical data</subject><subject>Risk Assessment - methods</subject><subject>Risk Factors</subject><subject>Sensitivity analysis</subject><subject>Stroke</subject><subject>Stroke - epidemiology</subject><subject>Stroke - etiology</subject><subject>Stroke - prevention & control</subject><subject>Studies</subject><subject>Trends</subject><subject>United Kingdom - epidemiology</subject><issn>1355-6037</issn><issn>1468-201X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkE1LAzEURYMotlb_gUjAjZux-ZpMshTxCwu6sNBdyMy86JSZTM2kgv_elLYuXLl6ITn35nEQOqfkmlIupx9gQ1z6NmOEqoxTpoviAI2pkGpztThMZ57nmSS8GKGTYVgSQoRW8hiNmNaa5kSM0eI1wJdtwVeAra9xDGBjBz7i3mEbQ2Nb7JoyNG1rY9N73Hg8f8bv4CGkp1WwVWxS1oW-wyz9gGOfJpWn6MjZdoCz3Zyg-f3d2-1jNnt5eLq9mWWlUEXMJAMCICUrZQGaSSs100QxSSXLSaVq5mhdEVZZKoRzvFbWMl2C1LSwijs-QVfb3lXoP9cwRNM1QwVpXQ_9ejCMSMVFQTVJ6OUfdNmvg0_bGUZzobmmgidKbKkq9MMQwJlVaDobvg0lZmPe7M2bjXmzNZ9iF7vyddlB_Rvaq07AdAuU3fJ_lT9TzY2v</recordid><startdate>20190101</startdate><enddate>20190101</enddate><creator>Adderley, Nicola Jaime</creator><creator>Ryan, Ronan</creator><creator>Nirantharakumar, Krishnarajah</creator><creator>Marshall, Tom</creator><general>BMJ Publishing Group LTD</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0543-3254</orcidid></search><sort><creationdate>20190101</creationdate><title>Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016</title><author>Adderley, Nicola Jaime ; Ryan, Ronan ; Nirantharakumar, Krishnarajah ; Marshall, Tom</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b487t-62e0ee662b67e926a6929082616250c8d2f1dc02ca144ff3d8aa29be6917a83f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Age</topic><topic>Aged</topic><topic>Anticoagulants</topic><topic>Anticoagulants - therapeutic use</topic><topic>Atrial Fibrillation - complications</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - drug therapy</topic><topic>Atrial Fibrillation - epidemiology</topic><topic>Cardiac arrhythmia</topic><topic>Censuses</topic><topic>Cross-Sectional Studies</topic><topic>Employers</topic><topic>Female</topic><topic>General Practice - methods</topic><topic>Hemorrhage</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Patients</topic><topic>Prevalence</topic><topic>Primary care</topic><topic>Primary Health Care - statistics & numerical data</topic><topic>Risk Assessment - methods</topic><topic>Risk Factors</topic><topic>Sensitivity analysis</topic><topic>Stroke</topic><topic>Stroke - epidemiology</topic><topic>Stroke - etiology</topic><topic>Stroke - prevention & control</topic><topic>Studies</topic><topic>Trends</topic><topic>United Kingdom - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Adderley, Nicola Jaime</creatorcontrib><creatorcontrib>Ryan, Ronan</creatorcontrib><creatorcontrib>Nirantharakumar, Krishnarajah</creatorcontrib><creatorcontrib>Marshall, Tom</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Heart (British Cardiac Society)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Adderley, Nicola Jaime</au><au>Ryan, Ronan</au><au>Nirantharakumar, Krishnarajah</au><au>Marshall, Tom</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016</atitle><jtitle>Heart (British Cardiac Society)</jtitle><addtitle>Heart</addtitle><date>2019-01-01</date><risdate>2019</risdate><volume>105</volume><issue>1</issue><spage>27</spage><epage>33</epage><pages>27-33</pages><issn>1355-6037</issn><eissn>1468-201X</eissn><abstract>ObjectiveAtrial 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.Methods17 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.ResultsAge–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).ConclusionsFrom 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.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>29991504</pmid><doi>10.1136/heartjnl-2018-312977</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-0543-3254</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Age Aged Anticoagulants Anticoagulants - therapeutic use Atrial Fibrillation - complications Atrial Fibrillation - diagnosis Atrial Fibrillation - drug therapy Atrial Fibrillation - epidemiology Cardiac arrhythmia Censuses Cross-Sectional Studies Employers Female General Practice - methods Hemorrhage Humans Male Middle Aged Mortality Patients Prevalence Primary care Primary Health Care - statistics & numerical data Risk Assessment - methods Risk Factors Sensitivity analysis Stroke Stroke - epidemiology Stroke - etiology Stroke - prevention & control Studies Trends United Kingdom - epidemiology |
| title | Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016 |
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