PMID- 28951401
OWN - NLM
STAT- MEDLINE
DCOM- 20180601
LR  - 20190202
IS  - 2044-6055 (Electronic)
IS  - 2044-6055 (Linking)
VI  - 7
IP  - 9
DP  - 2017 Sep 25
TI  - Evolving landscape of stroke prevention in atrial fibrillation within the UK 
      between 2012 and 2016: a cross-sectional analysis study using CPRD.
PG  - e015363
LID - 10.1136/bmjopen-2016-015363 [doi]
LID - e015363
AB  - OBJECTIVE: To describe the changes in prescribing of oral anticoagulant (AC) and 
      antiplatelet (AP) agents in patients with non-valvular atrial fibrillation (NVAF) 
      in the UK and to identify the characteristics associated with deviation from 
      guideline-based recommendations. DESIGN: Five cross-sectional analyses in a large 
      retrospective population-based cohort study. SETTING: General practices 
      contributing data to the UK Clinical Practice Research Datalink. PARTICIPANTS: 
      The study included patients with a diagnosis of NVAF and eligible for 
      anticoagulation (CHA(2)DS(2)-VASc score >/=2) on 1 April of 2012, 2013, 2014, 2015 
      and 1st January 2016. RESULTS: The proportion of patients being treated with AC 
      increased at each index date, showing an absolute rise of 16.7% over the study 
      period. At the same time, the proportion of patients treated with an AP alone was 
      reduced by half, showing an absolute decrease of 16.8%. The proportion of 
      patients not receiving any antithrombotic (AT) treatment remained the same across 
      the study period. A number of predictors were identified for AP alone or no 
      treatment compared with AC treatment. CONCLUSION: Major improvements in the AT 
      management of patients with NVAF for stroke prevention in the UK were observed 
      between April 2012 and January 2016. Despite this, nearly 20% of at-risk patients 
      still received AP alone and over 15% were on no AT agents in January 2016.
CI  - (c) Article author(s) (or their employer(s) unless otherwise stated in the text of 
      the article) 2017. All rights reserved. No commercial use is permitted unless 
      otherwise expressly granted.
FAU - Lacoin, Laure
AU  - Lacoin L
AD  - UK Medical Department, Bristol-Myers Squibb, Uxbridge, UK.
FAU - Lumley, Matthew
AU  - Lumley M
AD  - Medical Department, Pfizer, Tadworth, UK.
FAU - Ridha, Essra
AU  - Ridha E
AD  - UK Medical Department, Bristol-Myers Squibb, Uxbridge, UK.
FAU - Pereira, Marta
AU  - Pereira M
AD  - Real-World Evidence, Evidera, London, UK.
FAU - McDonald, Laura
AU  - McDonald L
AD  - Real-World Evidence, Evidera, London, UK.
FAU - Ramagopalan, Sreeram
AU  - Ramagopalan S
AD  - Real-World Evidence, Evidera, London, UK.
FAU - Lefevre, Cinira
AU  - Lefevre C
AD  - Center of Observational Research and Data Sciences, Business Insights and 
      Analytics, Bristol-Myers Squibb, Rueil Malmaison, France.
AD  - Worldwide Health Economics & Outcomes Research, Bristol-Myers Squibb, Rueil 
      Malmaison, France.
FAU - Evans, David
AU  - Evans D
AD  - Worldwide Health Economics & Outcomes Research, Bristol-Myers Squibb, Rueil 
      Malmaison, France.
FAU - Halcox, Julian P
AU  - Halcox JP
AUID- ORCID: 0000-0001-6926-2947
AD  - Department of Cardiology, Swansea University, Cardiff, UK.
LA  - eng
PT  - Journal Article
DEP - 20170925
PL  - England
TA  - BMJ Open
JT  - BMJ open
JID - 101552874
RN  - 0 (Anticoagulants)
RN  - 0 (Platelet Aggregation Inhibitors)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*therapeutic use
MH  - Atrial Fibrillation/complications/*drug therapy
MH  - Cross-Sectional Studies
MH  - Databases, Factual
MH  - Drug Prescriptions/statistics & numerical data
MH  - Female
MH  - General Practice/*trends
MH  - Guideline Adherence/trends
MH  - Heart Failure/complications
MH  - Humans
MH  - Hypertension/complications
MH  - Ischemic Attack, Transient/complications
MH  - Male
MH  - Platelet Aggregation Inhibitors/*therapeutic use
MH  - Practice Guidelines as Topic
MH  - Practice Patterns, Physicians'/*trends
MH  - Retrospective Studies
MH  - Stroke/etiology/*prevention & control
MH  - United Kingdom
PMC - PMC5623501
OTO - NOTNLM
OT  - atrial fibrillation
OT  - drug therapy
OT  - electronic health records
OT  - great britain
OT  - stroke
COIS- Competing interests: MP, LM and SR were employees of Evidera and who were paid 
      consultants to Bristol-Myers Squibb (BMS) in connection with conducting this 
      study and with the development of this manuscript. JPH received consultancy fees 
      from BMS for the conduct of this study. DE, ER, CL and LL were BMS employees at 
      the time of the research. ML is a full-time employee of Pfizer.
EDAT- 2017/09/28 06:00
MHDA- 2018/06/02 06:00
PMCR- 2017/09/25
CRDT- 2017/09/28 06:00
PHST- 2017/09/28 06:00 [entrez]
PHST- 2017/09/28 06:00 [pubmed]
PHST- 2018/06/02 06:00 [medline]
PHST- 2017/09/25 00:00 [pmc-release]
AID - bmjopen-2016-015363 [pii]
AID - 10.1136/bmjopen-2016-015363 [doi]
PST - epublish
SO  - BMJ Open. 2017 Sep 25;7(9):e015363. doi: 10.1136/bmjopen-2016-015363.