4.6 Article

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

Journal

EUROPACE
Volume 25, Issue 2, Pages 308-317

Publisher

OXFORD UNIV PRESS
DOI: 10.1093/europace/euac153

Keywords

Atrial fibrillation; Management; Primary care; Secondary care; Registry

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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.
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.

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