The role of contraindications in prescribing anticoagulants to patients with atrial fibrillation: a cross-sectional analysis of primary care data in the UK

Adderley, Nicola J; Ryan, Ronan; Marshall, Tom

doi:10.3399/bjgp17x691685

Cited by 12 publications

(11 citation statements)

References 32 publications

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“…However, when ineligible patients include those with contraindications, the proportion of ineligible patients prescribed anticoagulants was greater and increased from 28.1% (95% CI 26.3% to 29.9%) in 2000 to 47.5% (95% CI 46.1 to 48.9) in 2016, p<0.001 (online supplementary figure 2, online supplementary table 5); this is driven by treatment of patients with AF with contraindications 23…”

Section: Resultsmentioning

confidence: 99%

Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016

Adderley

Ryan

Nirantharakumar

et al. 2018

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Section: Resultsmentioning

confidence: 99%

Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016

Adderley

Ryan

Nirantharakumar

et al. 2018

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“…Moreover, primary care physicians achieve lower anticoagulation rates compared with hospital-based physicians 28 29. While there are multiple reasons for these differences, which include differences in populations, with high percentage of (relative) contraindications (40%–65%) and care-related factors, the lack of an integral decision tool impedes informed decisions on initiating or continuing antithrombotic therapy 10 30…”

Section: Discussionmentioning

confidence: 99%

GARFIELD-AF model for prediction of stroke and major bleeding in atrial fibrillation: a Danish nationwide validation study

et al. 2019

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ObjectivesTo externally validate the accuracy of the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) model against existing risk scores for stroke and major bleeding risk in patients with non-valvular AF in a population-based cohort.DesignRetrospective cohort study.SettingDanish nationwide registries.Participants90 693 patients with newly diagnosed non-valvular AF were included between 2010 and 2016, with follow-up censored at 1 year.Primary and secondary outcome measuresExternal validation was performed using discrimination and calibration plots. C-statistics were compared with CHA2DS2VASc score for ischaemic stroke/systemic embolism (SE) and HAS-BLED score for major bleeding/haemorrhagic stroke outcomes.ResultsOf the 90 693 included, 51 180 patients received oral anticoagulants (OAC). Overall median age (Q1, Q3) were 75 (66–83) years and 48 486 (53.5%) were male. At 1-year follow-up, a total of 2094 (2.3%) strokes/SE, 2642 (2.9%) major bleedings and 10 915 (12.0%) deaths occurred. The GARFIELD-AF model was well calibrated with the predicted risk for stroke/SE and major bleeding. The discriminatory value of GARFIELD-AF risk model was superior to CHA2DS2VASc for predicting stroke in the overall cohort (C-index: 0.71, 95% CI: 0.70 to 0.72 vs C-index: 0.67, 95% CI: 0.66 to 0.68, p<0.001) as well as in low-risk patients (C-index: 0.64, 95% CI: 0.59 to 0.69 vs C-index: 0.57, 95% CI: 0.53 to 0.61, p=0.007). The GARFIELD-AF model was comparable to HAS-BLED in predicting the risk of major bleeding in patients on OAC therapy (C-index: 0.64, 95% CI: 0.63 to 0.66 vs C-index: 0.64, 95% CI: 0.63 to 0.65, p=0.60).ConclusionIn a nationwide Danish cohort with non-valvular AF, the GARFIELD-AF model adequately predicted the risk of ischaemic stroke/SE and major bleeding. Our external validation confirms that the GARFIELD-AF model was superior to CHA2DS2VASc in predicting stroke/SE and comparable with HAS-BLED for predicting major bleeding.

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“…This figure would chime with the observation from primary care’s Quality Outcomes Framework data that about 6% of the overall AF cohort in the UK are deemed to have contraindications to anticoagulation, although this was lower than the estimated 12% from the US. [ 14 , 15 ] Furthermore, the SSNAP data showed that 2,705 strokes occurred in AF patients who were already receiving anticoagulation therapy (12.3% of the total cohort).…”

Section: Demand For Left Atrial Appendage Occlusion In the Ukmentioning

confidence: 99%

Percutaneous Left Atrial Appendage Occlusion: A View From the UK

Ding¹,

Gupta²

2020

Arrhythmia &Amp; Electrophysiology Review

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AF is associated with an increased risk of thromboembolic events, which is usually managed with oral anticoagulation therapy. However, despite a broad range of anticoagulant options and improved uptake in anticoagulation over the past decade, there are some limitations to this approach. Percutaneous left atrial appendage occlusion has been shown to be an effective alternative in this setting, and population data suggest a clear demand for this procedure. Over the past decade, several important changes to the commissioning and delivery of this service have occurred in the UK. In this article, the authors describe the use of percutaneous left atrial appendage occlusion in the UK and discuss the challenges that lie ahead.

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The role of contraindications in prescribing anticoagulants to patients with atrial fibrillation: a cross-sectional analysis of primary care data in the UK

Cited by 12 publications

References 32 publications

Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016

Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016

GARFIELD-AF model for prediction of stroke and major bleeding in atrial fibrillation: a Danish nationwide validation study

Percutaneous Left Atrial Appendage Occlusion: A View From the UK

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