What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation (n=1595). Intervention: Guideline-adherent oral anticoagulation vs. No guideline-adherent oral anticoagulation. Primary outcome: Composite of death and stroke (HR 0.41, 95% CI 0.24-0.70, p=0.001).

August 29, 2022Open Access

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

Key Result

Guideline-adherent oral anticoagulation therapy at baseline in patients with a CHA2DS2-VASc score ≥2 significantly reduced the composite risk of death and stroke at 1 year (HR 0.41).

Study Design

Type

Cohort (n=1,595)

Multicenter

Yes

Structured PICO

Does guideline-adherent oral anticoagulation reduce death and stroke at 1 year in patients with recently diagnosed atrial fibrillation?

Population

1,595 patients with recently diagnosed atrial fibrillation (≤12 months), mean age 70.5 (SD 11.2) years, 60.1% male, 97.4% white, from 101 UK sites.

Intervention

Guideline-adherent oral anticoagulation (OAC) therapy at baseline (CHA2DS2-VASc ≥2)

Outcome

Death and stroke at 1 yearhard clinical

Guideline-adherent oral anticoagulation in recently diagnosed atrial fibrillation is associated with significant reductions in 1-year mortality and stroke risk in contemporary UK practice.

Main Result

Effect estimate: HR 0.41 (95% CI 0.24-0.70)

p-value: p=0.001

Limitations

Relatively small sample size drawn from specialities other than general practice and cardiology, which may affect generalizability.
Only three specialist electrophysiology centres were included, potentially underestimating symptomatic AF and rhythm-control management.
Possibility of confounding by indication, as sicker patients may not be prescribed OAC and are more likely to have adverse events.

Abstract

AIMS: This study established a prospective registry of contemporary management of UK patients with atrial fibrillation (AF) by cardiologists, general practitioners, and 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 in 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 (CHA2DS2-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 ∼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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