title: The use of anticoagulants in the management of atrial fibrillation among general practices in England.
abstract: OBJECTIVE
  To investigate the use of oral anticoagulants (AC) and antiplatelet agents (AP) in the management of atrial fibrillation (AF) among patients in primary care in England.
  
  
  METHODS
  Epidemiological study.
  
  
  METHODS
  1857 general practices in England representing a practice population of 13.1 million registered patients.
  
  
  METHODS
  231,833 patients with a history of AF.
  
  
  METHODS
  The primary outcome was AC and AP use by CHADS2 score and age groups <30 years, 30-49 years, 50-64 years, 65-79 years and >79 years.
  
  
  RESULTS
  231,833 patients with a history of AF were identified, giving a prevalence among uploading practices of 1.76%. Prevalence of AF varied markedly between practices, related to differing practice age profiles. The total number of patients with AF in a practice was strongly predicted by the number of patients aged 65 years and over in the practice. 57.0% of the AF population had a CHADS2 score ≥2 and 83.7%≥1. 114,212 (49.3%) patients received AC therapy. AC uptake increased with increasing CHADS2 score up to a score of 3, but thereafter reached a plateau. Among 132 099 patients with a CHADS2 score ≥2, 72,211 (54.7%) received an AC, 14 987(11.3%) were recorded as having a contraindication or having declined AC therapy, leaving 44,901 (34.0%) not on AC therapy and without a recorded contraindication or recorded refusal. Among patients not prescribed an AC, 79.9% were prescribed an AP. The use of AC declined in the elderly (for CHADS2 ≥ 2, 47.4% of patients ≥80 years, compared with 64.5% for patients aged <80 years, p<0.001). By contrast, AP uptake was more prevalent among elderly patients.
  
  
  CONCLUSIONS
  Over one-third of patients with AF and known risk factors who are eligible for AC do not receive them. There is a high use of AP among patients not receiving AC. Uptake of AC is particularly poor among patients aged 80 years and over.
authors: 1NHS Improvement-Heart, Leicester, UK. Campbell.cowan@leedsth.nhs.uk
authors: Campbell
authors: C
authors: Cowan
authors: Richard
authors: R
authors: Healicon
authors: Ian
authors: I
authors: Robson
authors: W Robert
authors: WR
authors: Long
authors: James
authors: J
authors: Barrett
authors: Matthew
authors: M
authors: Fay
authors: Keith
authors: K
authors: Tyndall
authors: Chris P
authors: CP
authors: Gale
mesh_terms: D000284:Administration, Oral; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology; D011307:Drug Prescriptions; D004363:Drug Utilization / Q000639:trends; D017723:Drug Utilization Review; D004739:England / Q000453:epidemiology; D058006:General Practice / Q000639:trends*; D019983:Guideline Adherence / Q000639:trends; D006801:Humans; D016014:Linear Models; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D015995:Prevalence; D011320:Primary Health Care / Q000639:trends; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
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