A 10 year study of hospitalized atrial fibrillation-related stroke in England and its association with uptake of oral anticoagulation

Abstract

AimsTo determine whether changing patterns of anticoagulant use in atrial fibrillation (AF) have impacted on stroke rates in England.Methods and resultsEnglish national databases, 2006–2016, were interrogated to assess stroke admissions and oral anticoagulant use. The number of patients with known AF increased linearly from 692 054 to 983 254 (prevalence 1.29% vs. 1.71%). Hospital episodes of AF-related stroke/100 000 AF patients increased from 80/week in 2006 to 98/week in 2011 and declined to 86/week in 2016 (2006–2011 difference 18.0, 95% confidence interval (CI) 17.9–18.1, 2011–2016 difference −12.0, 95% CI −12.1 to −11.9). Anticoagulant use amongst patients with CHA2DS2-VASc ≥2 increased from 48.0% to 78.6% and anti-platelet use declined from 42.9% to 16.1%; the greatest rate of change occurred in the second 5 year period (for anticoagulants 2006–2011 difference 4.8%, 95% CI 4.5–5.1%, 2011–2016 difference 25.8%, 95% CI 25.5–26.1%). After adjustment for AF prevalence, a 1% increase in anticoagulant use was associated with a 0.8% decrease in the weekly rate of AF-related stroke (incidence rate ratio 0.992, 95% CI 0.989–0.994). Had the use of anticoagulants remained at 2009 levels, 4068 (95% CI 4046–4089) more strokes would have been predicted in 2015/2016.ConclusionBetween 2006 and 2016, AF prevalence and anticoagulant use in England increased. From 2011, hospitalized AF-related stroke rates declined and were significantly associated with increased anticoagulant uptake.

Trends in anticoagulant prescribing: a review of local policies in English primary care

“…Includes pooled prescriptions of three DOACs from the set {rivaroxaban, apixaban, edoxaban, dabigatran} besides the one being considered with atrial fibrillation [7,17,[26][27][28], this study represents the first comprehensive review of local anticoagulation policies in England. Other studies use dedicated primary care databanks that contain more patient-level data, while we use national NHS prescribing data aggregated by CCG.…”

An Integrated Management Model of Patients With Atrial Fibrillation: The Experience of the Local Health Unit Tuscany North-West

“…Cowan et al [22] estimated the correlation between stroke rates and OAC use in England using data of patients with AF from 2006 to 2016. Results showed an increase in the prevalence of AF (from 1.29% to 1.71%) and in the hospitalization rate due to AF-related stroke/100,000 AF patients from 80/week in 2006 to 98/week in 2011.…”

Cost-effectiveness of targeted screening for the identification of patients with atrial fibrillation: evaluation of a machine learning risk prediction algorithm

“…The costs of treating the complications arising from asymptomatic AF place a significant economic burden on healthcare systems 11,12 . Earlier diagnosis of AF and management with preventive treatments, such as oral anticoagulants, can reduce the risk of stroke 13,14 and consequently have the potential to improve patient outcomes (e.g. quality of life and life expectancy) and decrease the economic burden placed on healthcare providers.…”