Inequalities in the incidence and management of non-valvular atrial fibrillation in England, 2009 to 2019: cohort study using electronic health records from general practices

Conference:

SAPC ASM 2022 - UCLan

Talk Code:

2B.7

Presenter:

Alyaa Ajabnoor

Twitter:

@alyaa_an

Co-authors:

Salwa Zghebi, Rosa Parisi, Darren Ashcroft, Martin Rutter, Tim Doran, Matthew Carr, Mamas Mamas, Evangelos Kontopantelis

Author institutions:

1. University of Manchester 2. University of York 3.Keele university

Problem

Atrial fibrillation is an important risk factor for ischaemic stroke and AF incidence is expected to increase. Guidelines recommend using oral anticoagulants (OACs) to prevent the development of stroke. However, studies have reported the frequent under-use of OACs in AF patients. The objective of this study is to describe non-valvular atrial fibrillation (NVAF) incidence in England and assess the clinical and socioeconomic factors associated with the under-prescribing OACs.

Approach

We conducted a population-based retrospective cohort study using the UK Clinical Practice Research Datalink (CPRD) database to identify patients with NVAF aged 18 years or over and registered in English general practices between 2009 and 2019. Annual incidence rate of NVAF by age, deprivation quintile, and region was estimated. OAC prescribing status was explored for patients at risk for stroke and classified into: OAC, aspirin-only, or no treatment. Factors associated with OAC under-prescribing were investigated using multinomial logistic regression models.

Findings

Overall age-adjusted incidence of NVAF per 10,000 person-years increased from 20.8 (95% CI: 20.4; 21.1) in 2009 to 25.5 (25.1; 25.9) in 2019. Higher incidence rates were observed for older ages and males. Among NVAF patients at risk of stroke, OAC prescribing increased from 59.8% (59.0; 60.6) in 2009 to 83.2% (82.9; 83.4) in 2019. Non-prescribing of OACs was associated with several conditions, including dementia [relative risk ratio (RRR) 1.76 (1.56; 1.99)], liver disease (1.73 (1.49; 2.00)), malignancy (1.42 (1.36; 1.48)), and ischaemic heart disease (1.30 (1.24; 1.37)). Compared to white ethnicity, black patients were more likely to receive no treatment (1.25 (1.05; 1.49)), and patients living in the most deprived areas were more likely to receive no treatment (1.12 (1.05; 1.20)) than patients living in the least deprived areas. Practices located in the East of England were associated with prescribing of aspirin-only compared to OAC than in practices in London region (1.14 (1.03; 1.26)).

Consequences

The incidence of NVAF increased between 2009 and 2015, before plateauing. Under-prescribing of OACs in NVAF is associated with a range of comorbidities, ethnicity and socioeconomic factors, demonstrating the need for initiatives to reduce inequalities in the care for AF patients.

Submitted by:

Alyaa Ajabnoor

Funding acknowledgement:

The first author (AA) is a PhD student at The University of Manchester, funded by a scholarship from the Saudi Arabian Cultural Bureau. The funders had no role in considering the study design or in the collection, analysis, interpretation of data, writing of the report, or decision to submit this abstract.