Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016

Adderley, Nicola J; Ryan, Ronan; Nirantharakumar, Krishnarajah; Marshall, Tom

doi:10.1136/heartjnl-2018-312977

Cited by 93 publications

(90 citation statements)

References 23 publications

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“…Other examples are statins, antihypertensives and novel hypoglycaemic agents, but four new drugs in a 5-year period is extraordinary. DOACs have proven efficacy and effectiveness over VKA, and appropriate prescribing of OACs in AF has improved in the UK between 2000 and 2016 27. However, there have been variations in prescription across DOACs over time 28.…”

Section: Discussionmentioning

confidence: 99%

Adherence and persistence to direct oral anticoagulants in atrial fibrillation: a population-based study

Banerjee

Benedetto

Gichuru

et al. 2019

Heart

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background Despite simpler regimens than vitamin K antagonists (VKas) for stroke prevention in atrial fibrillation (aF), adherence (taking drugs as prescribed) and persistence (continuation of drugs) to direct oral anticoagulants are suboptimal, yet understudied in electronic health records (ehrs). Objective We investigated (1) time trends at individual and system levels, and (2) the risk factors for and associations between adherence and persistence. Methods in UK primary care ehr (The health information network 2011-2016), we investigated adherence and persistence at 1 year for oral anticoagulants (Oacs) in adults with incident aF. Baseline characteristics were analysed by Oac and adherence/persistence status. risk factors for nonadherence and non-persistence were assessed using cox and logistic regression. Patterns of adherence and persistence were analysed. results among 36 652 individuals with incident aF, cardiovascular comorbidities (median cha 2 Ds 2 Vasc[congestive heart failure, hypertension, age≥75 years, Diabetes mellitus, stroke, Vascular disease, age 65-74 years, sex category] 3) and polypharmacy (median number of drugs 6) were common. adherence was 55.2% (95% ci 54.6 to 55.7), 51.2% (95% ci 50.6 to 51.8), 66.5% (95% ci 63.7 to 69.2), 63.1% (95% ci 61.8 to 64.4) and 64.7% (95% ci 63.2 to 66.1) for all Oacs, VKa, dabigatran, rivaroxaban and apixaban.One-year persistence was 65.9% (95% ci 65.4 to 66.5), 63.4% (95% ci 62.8 to 64.0), 61.4% (95% ci 58.3 to 64.2), 72.3% (95% ci 70.9 to 73.7) and 78.7% (95% ci 77.1 to 80.1) for all Oacs, VKa, dabigatran, rivaroxaban and apixaban. risk of non-adherence and non-persistence increased over time at individual and system levels. increasing comorbidity was associated with reduced risk of non-adherence and non-persistence across all Oacs. Overall rates of 'primary non-adherence' (stopping after first prescription), 'non-adherent nonpersistence' and 'persistent adherence' were 3.5%, 26.5% and 40.2%, differing across Oacs. Conclusions adherence and persistence to Oacs are low at 1 year with heterogeneity across drugs and over time at individual and system levels. Better understanding of contributory factors will inform interventions to improve adherence and persistence across Oacs in individuals and populations.on July 10, 2020 by guest. Protected by copyright.

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Section: Discussionmentioning

confidence: 99%

Adherence and persistence to direct oral anticoagulants in atrial fibrillation: a population-based study

Banerjee

Benedetto

Gichuru

et al. 2019

Heart

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“…AF is the most common sustained arrhythmia worldwide with an estimated prevalence of 0.57% in men and 0.37% in women 1. It is more common in developed nations with an estimated prevalence of 3.29% in the UK in 2016 2 3. It primarily affects those over the age of 55 years 3 4.…”

Section: Introductionmentioning

confidence: 99%

Ergometrine-induced atrial fibrillation at caesarean section

Birch¹,

2019

BMJ Case Rep

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A 36-year-old woman with a history of one previous caesarean section presented to the birthing suite of a regional hospital with spontaneous rupture of membranes at 39+2/40 weeks. Syntocinon was administered to initiate uterine contractions in the absence of labour, as the patient desired vaginal birth. A caesarean section was subsequently indicated and ergometrine was administered for uterine atony. The patient immediately developed atrial fibrillation (AF). AF is the most common sustained arrhythmia in the general population, but is rare in the obstetric population. AF occurring in an intrapartum setting following the administration of syntocinon and ergometrine, is not documented in the literature. We suggest the initiation of paroxysmal AF was precipitated by an abrupt alteration in autonomic tone caused by administration of syntocinon followed by ergometrine.

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“…In their Heart paper, Adderley et al 4 report the results of temporal trends in age-sex standardised AF prevalence and use of stroke prevention therapy among 744 primary care practices across the UK from 2000 to 2016. Once again, this demonstrates the value of high-quality (and very large) data sets utilising data from a practice rather than a hospital level, the authors are able to characterise over 5 million individuals with AF.…”

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confidence: 99%

“…In this study, Adderley et al 4 address an important gap regarding use of stroke prevention therapy for patients with AF in primary care, a setting which will likely continue to encounter a growing AF burden. Although it is encouraging, appropriate use of antithrombotic therapy is increasing, additional simple and cost-effective strategies are needed to demonstrate an even higher use of DOAC in eligible patients, particularly those at moderate risk, minimise overtreatment and reduce practice variations that can be implemented in different healthcare systems where incentivising may not be an option.…”

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confidence: 99%

Is incentivising stroke prevention therapy in atrial fibrillation the key?

Sandhu

2018

Heart

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Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016

Cited by 93 publications

References 23 publications

Adherence and persistence to direct oral anticoagulants in atrial fibrillation: a population-based study

Adherence and persistence to direct oral anticoagulants in atrial fibrillation: a population-based study

Ergometrine-induced atrial fibrillation at caesarean section

Is incentivising stroke prevention therapy in atrial fibrillation the key?

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