Trends in the pharmacological management of atrial fibrillation in UK general practice 2008–2018

Abstract

ObjectiveThe 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.MethodsEleven 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.ResultsBetween 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%).ConclusionsThere 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.

Time Trends in Patient Characteristics, Anticoagulation Treatment, and Prognosis of Incident Nonvalvular Atrial Fibrillation in the Netherlands

“…Our findings are consistent with most studies that investigated anticoagulation in patients with AF, 11 , 12 , 13 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 although they generally only reported crude proportions instead of PDCs to evaluate OAC use. As PDC itself is a metric for evaluating medication adherence and the increasing PDC with time was only observed in patients with a high baseline CHA 2 DS 2 -VASc score, our results suggest that OACs were increasingly prescribed to patients for whom this was indeed indicated.…”

Treatment and prescribing trends of antihypertensive drugs in 2.7 million UK primary care patients over 31 years: a population-based cohort study

“…Although previous studies have described prescribing trends of antihypertensive drugs in UK primary care practices, these trends were reported for specific patient populations, indications, drug classes, or over short time periods 7 23–37. As such, there was a gap in the literature for a comprehensive assessment of the prescribing practices in primary care settings over time.…”

Eligibility for early rhythm control in patients with atrial fibrillation in the UK Biobank

“…However, this study was conducted to identify the number of eligible AF patients in the general population. Given that rhythm control therapy is rarely conducted in the UK, 14 our early rhythm control cohort was approximately half of the EAST-AFNET4 population and therefore underpowered for efficacy studies.…”

“…For one, we capture a part of the whole population since we focused on optimal data quality and excluded those without Additionally, a recent study using a database of primary care data in the UK from 2008 to 2018 showed that OAC use in the UK was around 43% and only recently increased to 71.6%. 14 Nevertheless, our propensity-score matched analysis provides an estimate of the of early rhythm control therapy when the rates of OAC are similarly high.…”