Management of atrial fibrillation by different medical specialties in the UK: AF-GEN-UK study

Abstract

Abstract Background The AF-GEN-UK study is an extension of the EURObservational Research Programme (EORP) Long-term Registry on patients with atrial fibrillation (AF) in the UK (AF-GEN). The study aimed to establish a registry of the contemporary management of patients with AF by cardiologists, general practitioners, stroke, acute and emergency medicine physicians at baseline and 1-year of follow-up, to allow comparison between medical specialties. Methods Data on patients with AF diagnosed within the previous 12-months were collected using electronic case records from 101 sites, to permit comparison of patient characteristics and treatments between medical specialties. The impact of guideline-adherent oral anticoagulation (OAC) use on outcomes was assessed using Cox regression analysis. Results 1595 patients (mean (SD) age 70.5 (11.2) years; 60.1% male; 97.4% white) with ECG-documented AF were included (recruited between June 2017 and June 2018) and followed-up for 1-year. Overall OAC prescription rates were 84.2% at baseline and 87.1% at 1-year follow-up, with NOACs predominating (74.9% at baseline and 79.2% at 1-year) Figure, mainly apixaban. Prescription of VKA 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 composite endpoint of death and stroke at 1-year (adjusted hazard ratio 0.42; 95% confidence intervals 0.25–0.70). Rhythm control was evident in approximately one-quarter, with only 1.6% receiving catheter ablation. Most patients (56.6%) reported AF symptoms, but these were severe in only 17.9%. Symptomatic patients were mainly managed by cardiologists or acute/emergency medicine; among patients managed by stroke physicians, 81.5% were asymptomatic. Quality of life did not appear significantly impaired however there was a slight but significant improvement at follow-up (70.3% vs. 71.5%; p=0.044). Symptomatic patients reported poorer quality of life related to usual activities, mental health and overall quality of life. Conclusion Overall OAC use was high (>80%) with NOAC prescription predominating but rates varied by specialty, with VKA prescription significantly higher in primary care. Guideline-adherent OAC therapy at baseline was associated with significant reduction in composite outcome of death and stroke at 1-year, regardless of specialty. Rhythm control management was only evident in around one-quarter despite AF symptoms being reported in 56.6%. This registry extends the knowledge of contemporary management of AF outside of cardiology by including other specialties and demonstrates good implementation of clinical guidelines for the management of AF, particularly in relation to stroke prevention. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): This project was supported by the BMS/Pfizer European Thrombosis Investigator Initiated Research Program