Contemporary management of atrial fibrillation in primary and secondary care in the UK: the prospective long-term AF-GEN-UK Registry

Aims This study established a prospective registry of contemporary management of UK patients with atrial fibrillation (AF) by cardiologists, general practitioners, stroke, acute, and emergency medicine physicians at baseline and 1-year follow-up. Methods and results Data on patients with recently diagnosed AF (<= 12 months) were collected from medical records from 101 UK sites to permit comparison of patient characteristics and treatments between specialities. The impact of guideline-adherent oral anticoagulation (OAC) use on outcomes was assessed using Cox regression analysis. One thousand five hundred and ninety-five AF patients [mean (standard deviation) age 70.5 (11.2) years; 60.1% male; 97.4% white] were recruited on June 2017-June 2018 and followed-up for 1 year. Overall OAC prescription rates were 84.2% at baseline and 87.1% at 1 year, with non-vitamin K antagonist oral anticoagulants (NOACs) predominating (74.9 and 79.2% at baseline and 1 year, respectively). Vitamin K antagonist prescription was significantly higher in primary care with NOAC prescription higher among stroke physicians. Guideline-adherent OAC (CHA(2)DS(2)-VASc >= 2) at baseline significantly reduced risk of death and stroke at 1 year [adjusted hazard ratio (95% confidence interval): 0.48 (0.27-0.84) and 0.11 (0.02-0.48), respectively]. Rhythm control is evident in similar to 25%, only 1.6% received catheter ablation. Conclusion High OAC use (>80%, mainly NOACs), rates varied by speciality, with VKA prescription higher in primary care. Guideline-adherent OAC therapy at baseline was associated with significant reduction in death and stroke at 1 year, regardless of speciality. Rhythm-control management is evident in only one-quarter despite AF symptoms reported in 56.6%. This registry extends the knowledge of contemporary AF management outside cardiology and demonstrates good implementation of clinical guidelines for the management of AF, particularly for stroke prevention.

Automated summary

This study established a registry to examine the management of UK patients with atrial fibrillation (AF) by different healthcare professionals. The study found that guideline-adherent oral anticoagulation significantly reduced the risk of death and stroke at 1 year, but only a quarter of patients received rhythm-control management.