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Identifying unmet antithrombotic therapeutic need, and implications for stroke and systemic embolism in atrial fibrillation patients: a population-scale longitudinal study

Fatemeh Torabi Orcid Logo, Daniel Harris, Owen Bodger Orcid Logo, Ashley Akbari Orcid Logo, Ronan Lyons Orcid Logo, Michael Gravenor Orcid Logo, Julian Halcox Orcid Logo

European Heart Journal Open, Volume: 2, Issue: 6

Swansea University Authors: Fatemeh Torabi Orcid Logo, Daniel Harris, Owen Bodger Orcid Logo, Ashley Akbari Orcid Logo, Ronan Lyons Orcid Logo, Michael Gravenor Orcid Logo, Julian Halcox Orcid Logo

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DOI (Published version): 10.1093/ehjopen/oeac066

Abstract

AimsGuidelines recommend anticoagulation (AC) in atrial fibrillation (AF) to reduce stroke and systemic embolism (SSE) risk; however, implementation has been slow across many populations. This study aimed to quantify the potential impact of changing prevalence of AF, associated risk, and AC prescrib...

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Published in: European Heart Journal Open
ISSN: 2752-4191
Published: Oxford University Press (OUP) 2022
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URI: https://cronfa.swan.ac.uk/Record/cronfa62057
Abstract: AimsGuidelines recommend anticoagulation (AC) in atrial fibrillation (AF) to reduce stroke and systemic embolism (SSE) risk; however, implementation has been slow across many populations. This study aimed to quantify the potential impact of changing prevalence of AF, associated risk, and AC prescribing on SSE hospitalizations and death.Methods and resultsWe evaluated temporal trends of AF, CHA2DS2-VASc, antithrombotic prescriptions, SSE hospitalizations, death, and their associations between 2012 and 2018 in a longitudinal cohort of AF patients in Wales UK. Multi-state Markov models were used to estimate expected SSE rates given the AC coverage, adjusting for CHA2DS2-VASc scores. SSE rates were modelled for various past and future AC scenarios. A total of 107 137 AF patients were evaluated (mean age = 74 years, 45% female). AF prevalence increased from 1.75 to 2.22% (P-value <0.001). SSE hospitalizations decreased by 18% (2.34–1.92%, P-value <0.001). Increased AC coverage from 50 to 70% was associated with a 37% lower SSE rate, after adjustment for individual time-dependent CHA2DS2VASc scores. The observed AC increase accounted for approximately 80 fewer SSE hospitalizations per 100 000/year. If 90% AC coverage had been achieved since 2012, an estimated 279 SSE per 100 000/year may have been prevented. Our model also predicts that improving AC coverage to 90% over the next 9 years could reduce annual SSE rates by 9%.ConclusionWe quantified the relationship between observed AC coverage, estimating the potential impact of variation in the timing of large-scale implementation. These data emphasize the importance of timely implementation and the considerable opportunity to improve clinical outcomes in the Wales-AF population.
Item Description: Data availability:The data sources used in this study are available in the SAIL Databank at Swansea University, Swansea, UK, but as restrictions apply, they are not publicly available. All proposals to use SAIL data are subject to review by an independent Information Governance Review Panel (IGRP). Before any data can be accessed, approval must be given by the IGRP. The IGRP considers each project to ensure proper and appropriate use of SAIL data. When access has been granted, it is gained through a privacy protecting trusted research environment and remote access system, referred to as the SAIL Gateway. SAIL has established an application process to be followed by anyone who would like to access data via SAIL at https://www.saildatabank.com/application-process.
Keywords: Atrial fibrillation, Stroke and systemic embolism, Anticoagulation, Electronic health records
College: Faculty of Medicine, Health and Life Sciences
Funders: This work was supported by Health Data Research UK [HDR-9007], which receives its funding from the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF), and the Wellcome Trust; and Administrative Data Research UK which is funded by the Economic and Social Research Council [grant ES/S007393/1].
Issue: 6

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