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Identifying unmet antithrombotic therapeutic need, and implications for stroke and systemic embolism in atrial fibrillation patients: a population-scale longitudinal study

Fatemeh Torabi Orcid Logo, Daniel Harris, Owen Bodger Orcid Logo, Ashley Akbari Orcid Logo, Ronan Lyons Orcid Logo, Michael Gravenor Orcid Logo, Julian Halcox Orcid Logo

European Heart Journal Open, Volume: 2, Issue: 6

Swansea University Authors: Fatemeh Torabi Orcid Logo, Daniel Harris, Owen Bodger Orcid Logo, Ashley Akbari Orcid Logo, Ronan Lyons Orcid Logo, Michael Gravenor Orcid Logo, Julian Halcox Orcid Logo

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DOI (Published version): 10.1093/ehjopen/oeac066

Abstract

AimsGuidelines recommend anticoagulation (AC) in atrial fibrillation (AF) to reduce stroke and systemic embolism (SSE) risk; however, implementation has been slow across many populations. This study aimed to quantify the potential impact of changing prevalence of AF, associated risk, and AC prescrib...

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Published in: European Heart Journal Open
ISSN: 2752-4191
Published: Oxford University Press (OUP) 2022
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URI: https://cronfa.swan.ac.uk/Record/cronfa62057
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fullrecord <?xml version="1.0" encoding="utf-8"?><rfc1807 xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:xsd="http://www.w3.org/2001/XMLSchema"><bib-version>v2</bib-version><id>62057</id><entry>2022-11-26</entry><title>Identifying unmet antithrombotic therapeutic need, and implications for stroke and systemic embolism in atrial fibrillation patients: a population-scale longitudinal study</title><swanseaauthors><author><sid>f569591e1bfb0e405b8091f99fec45d3</sid><ORCID>0000-0002-5853-4625</ORCID><firstname>Fatemeh</firstname><surname>Torabi</surname><name>Fatemeh Torabi</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>e60c9c73b645f0e8033ae26fa8e634b8</sid><firstname>Daniel</firstname><surname>Harris</surname><name>Daniel Harris</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>8096440ab42b60a86e6aba678fe2695a</sid><ORCID>0000-0002-4022-9964</ORCID><firstname>Owen</firstname><surname>Bodger</surname><name>Owen Bodger</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>aa1b025ec0243f708bb5eb0a93d6fb52</sid><ORCID>0000-0003-0814-0801</ORCID><firstname>Ashley</firstname><surname>Akbari</surname><name>Ashley Akbari</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>83efcf2a9dfcf8b55586999d3d152ac6</sid><ORCID>0000-0001-5225-000X</ORCID><firstname>Ronan</firstname><surname>Lyons</surname><name>Ronan Lyons</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>70a544476ce62ba78502ce463c2500d6</sid><ORCID>0000-0003-0710-0947</ORCID><firstname>Michael</firstname><surname>Gravenor</surname><name>Michael Gravenor</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>3676f695eeda169d0f8c618adf27c04b</sid><ORCID>0000-0001-6926-2947</ORCID><firstname>Julian</firstname><surname>Halcox</surname><name>Julian Halcox</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2022-11-26</date><deptcode>HDAT</deptcode><abstract>AimsGuidelines recommend anticoagulation (AC) in atrial fibrillation (AF) to reduce stroke and systemic embolism (SSE) risk; however, implementation has been slow across many populations. This study aimed to quantify the potential impact of changing prevalence of AF, associated risk, and AC prescribing on SSE hospitalizations and death.Methods and resultsWe evaluated temporal trends of AF, CHA2DS2-VASc, antithrombotic prescriptions, SSE hospitalizations, death, and their associations between 2012 and 2018 in a longitudinal cohort of AF patients in Wales UK. Multi-state Markov models were used to estimate expected SSE rates given the AC coverage, adjusting for CHA2DS2-VASc scores. SSE rates were modelled for various past and future AC scenarios. A total of 107 137 AF patients were evaluated (mean age = 74 years, 45% female). AF prevalence increased from 1.75 to 2.22% (P-value &lt;0.001). SSE hospitalizations decreased by 18% (2.34–1.92%, P-value &lt;0.001). Increased AC coverage from 50 to 70% was associated with a 37% lower SSE rate, after adjustment for individual time-dependent CHA2DS2VASc scores. The observed AC increase accounted for approximately 80 fewer SSE hospitalizations per 100 000/year. If 90% AC coverage had been achieved since 2012, an estimated 279 SSE per 100 000/year may have been prevented. Our model also predicts that improving AC coverage to 90% over the next 9 years could reduce annual SSE rates by 9%.ConclusionWe quantified the relationship between observed AC coverage, estimating the potential impact of variation in the timing of large-scale implementation. These data emphasize the importance of timely implementation and the considerable opportunity to improve clinical outcomes in the Wales-AF population.</abstract><type>Journal Article</type><journal>European Heart Journal Open</journal><volume>2</volume><journalNumber>6</journalNumber><paginationStart/><paginationEnd/><publisher>Oxford University Press (OUP)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>2752-4191</issnElectronic><keywords>Atrial fibrillation, Stroke and systemic embolism, Anticoagulation, Electronic health records</keywords><publishedDay>21</publishedDay><publishedMonth>11</publishedMonth><publishedYear>2022</publishedYear><publishedDate>2022-11-21</publishedDate><doi>10.1093/ehjopen/oeac066</doi><url/><notes>Data availability:The data sources used in this study are available in the SAIL Databank at Swansea University, Swansea, UK, but as restrictions apply, they are not publicly available. All proposals to use SAIL data are subject to review by an independent Information Governance Review Panel (IGRP). Before any data can be accessed, approval must be given by the IGRP. The IGRP considers each project to ensure proper and appropriate use of SAIL data. When access has been granted, it is gained through a privacy protecting trusted research environment and remote access system, referred to as the SAIL Gateway. SAIL has established an application process to be followed by anyone who would like to access data via SAIL at https://www.saildatabank.com/application-process.</notes><college>COLLEGE NANME</college><department>Health Data Science</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HDAT</DepartmentCode><institution>Swansea University</institution><apcterm>SU Library paid the OA fee (TA Institutional Deal)</apcterm><funders>This work was supported by Health Data Research UK [HDR-9007], which receives its funding from the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF), and the Wellcome Trust; and Administrative Data Research UK which is funded by the Economic and Social Research Council [grant ES/S007393/1].</funders><projectreference/><lastEdited>2023-09-13T15:15:52.7827217</lastEdited><Created>2022-11-26T17:50:12.9916488</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Fatemeh</firstname><surname>Torabi</surname><orcid>0000-0002-5853-4625</orcid><order>1</order></author><author><firstname>Daniel</firstname><surname>Harris</surname><order>2</order></author><author><firstname>Owen</firstname><surname>Bodger</surname><orcid>0000-0002-4022-9964</orcid><order>3</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>4</order></author><author><firstname>Ronan</firstname><surname>Lyons</surname><orcid>0000-0001-5225-000X</orcid><order>5</order></author><author><firstname>Michael</firstname><surname>Gravenor</surname><orcid>0000-0003-0710-0947</orcid><order>6</order></author><author><firstname>Julian</firstname><surname>Halcox</surname><orcid>0000-0001-6926-2947</orcid><order>7</order></author></authors><documents><document><filename>62057__26340__83e4e3cb001e4e13908e07e616b24568.pdf</filename><originalFilename>62057.pdf</originalFilename><uploaded>2023-01-19T10:38:57.7519507</uploaded><type>Output</type><contentLength>1370564</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>© The Author(s) 2022. 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spelling v2 62057 2022-11-26 Identifying unmet antithrombotic therapeutic need, and implications for stroke and systemic embolism in atrial fibrillation patients: a population-scale longitudinal study f569591e1bfb0e405b8091f99fec45d3 0000-0002-5853-4625 Fatemeh Torabi Fatemeh Torabi true false e60c9c73b645f0e8033ae26fa8e634b8 Daniel Harris Daniel Harris true false 8096440ab42b60a86e6aba678fe2695a 0000-0002-4022-9964 Owen Bodger Owen Bodger true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 83efcf2a9dfcf8b55586999d3d152ac6 0000-0001-5225-000X Ronan Lyons Ronan Lyons true false 70a544476ce62ba78502ce463c2500d6 0000-0003-0710-0947 Michael Gravenor Michael Gravenor true false 3676f695eeda169d0f8c618adf27c04b 0000-0001-6926-2947 Julian Halcox Julian Halcox true false 2022-11-26 HDAT AimsGuidelines recommend anticoagulation (AC) in atrial fibrillation (AF) to reduce stroke and systemic embolism (SSE) risk; however, implementation has been slow across many populations. This study aimed to quantify the potential impact of changing prevalence of AF, associated risk, and AC prescribing on SSE hospitalizations and death.Methods and resultsWe evaluated temporal trends of AF, CHA2DS2-VASc, antithrombotic prescriptions, SSE hospitalizations, death, and their associations between 2012 and 2018 in a longitudinal cohort of AF patients in Wales UK. Multi-state Markov models were used to estimate expected SSE rates given the AC coverage, adjusting for CHA2DS2-VASc scores. SSE rates were modelled for various past and future AC scenarios. A total of 107 137 AF patients were evaluated (mean age = 74 years, 45% female). AF prevalence increased from 1.75 to 2.22% (P-value <0.001). SSE hospitalizations decreased by 18% (2.34–1.92%, P-value <0.001). Increased AC coverage from 50 to 70% was associated with a 37% lower SSE rate, after adjustment for individual time-dependent CHA2DS2VASc scores. The observed AC increase accounted for approximately 80 fewer SSE hospitalizations per 100 000/year. If 90% AC coverage had been achieved since 2012, an estimated 279 SSE per 100 000/year may have been prevented. Our model also predicts that improving AC coverage to 90% over the next 9 years could reduce annual SSE rates by 9%.ConclusionWe quantified the relationship between observed AC coverage, estimating the potential impact of variation in the timing of large-scale implementation. These data emphasize the importance of timely implementation and the considerable opportunity to improve clinical outcomes in the Wales-AF population. Journal Article European Heart Journal Open 2 6 Oxford University Press (OUP) 2752-4191 Atrial fibrillation, Stroke and systemic embolism, Anticoagulation, Electronic health records 21 11 2022 2022-11-21 10.1093/ehjopen/oeac066 Data availability:The data sources used in this study are available in the SAIL Databank at Swansea University, Swansea, UK, but as restrictions apply, they are not publicly available. All proposals to use SAIL data are subject to review by an independent Information Governance Review Panel (IGRP). Before any data can be accessed, approval must be given by the IGRP. The IGRP considers each project to ensure proper and appropriate use of SAIL data. When access has been granted, it is gained through a privacy protecting trusted research environment and remote access system, referred to as the SAIL Gateway. SAIL has established an application process to be followed by anyone who would like to access data via SAIL at https://www.saildatabank.com/application-process. COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University SU Library paid the OA fee (TA Institutional Deal) This work was supported by Health Data Research UK [HDR-9007], which receives its funding from the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF), and the Wellcome Trust; and Administrative Data Research UK which is funded by the Economic and Social Research Council [grant ES/S007393/1]. 2023-09-13T15:15:52.7827217 2022-11-26T17:50:12.9916488 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Fatemeh Torabi 0000-0002-5853-4625 1 Daniel Harris 2 Owen Bodger 0000-0002-4022-9964 3 Ashley Akbari 0000-0003-0814-0801 4 Ronan Lyons 0000-0001-5225-000X 5 Michael Gravenor 0000-0003-0710-0947 6 Julian Halcox 0000-0001-6926-2947 7 62057__26340__83e4e3cb001e4e13908e07e616b24568.pdf 62057.pdf 2023-01-19T10:38:57.7519507 Output 1370564 application/pdf Version of Record true © The Author(s) 2022. This is an Open Access article distributed under the terms of the Creative Commons Attribution License true eng https://creativecommons.org/licenses/by/4.0/
title Identifying unmet antithrombotic therapeutic need, and implications for stroke and systemic embolism in atrial fibrillation patients: a population-scale longitudinal study
spellingShingle Identifying unmet antithrombotic therapeutic need, and implications for stroke and systemic embolism in atrial fibrillation patients: a population-scale longitudinal study
Fatemeh Torabi
Daniel Harris
Owen Bodger
Ashley Akbari
Ronan Lyons
Michael Gravenor
Julian Halcox
title_short Identifying unmet antithrombotic therapeutic need, and implications for stroke and systemic embolism in atrial fibrillation patients: a population-scale longitudinal study
title_full Identifying unmet antithrombotic therapeutic need, and implications for stroke and systemic embolism in atrial fibrillation patients: a population-scale longitudinal study
title_fullStr Identifying unmet antithrombotic therapeutic need, and implications for stroke and systemic embolism in atrial fibrillation patients: a population-scale longitudinal study
title_full_unstemmed Identifying unmet antithrombotic therapeutic need, and implications for stroke and systemic embolism in atrial fibrillation patients: a population-scale longitudinal study
title_sort Identifying unmet antithrombotic therapeutic need, and implications for stroke and systemic embolism in atrial fibrillation patients: a population-scale longitudinal study
author_id_str_mv f569591e1bfb0e405b8091f99fec45d3
e60c9c73b645f0e8033ae26fa8e634b8
8096440ab42b60a86e6aba678fe2695a
aa1b025ec0243f708bb5eb0a93d6fb52
83efcf2a9dfcf8b55586999d3d152ac6
70a544476ce62ba78502ce463c2500d6
3676f695eeda169d0f8c618adf27c04b
author_id_fullname_str_mv f569591e1bfb0e405b8091f99fec45d3_***_Fatemeh Torabi
e60c9c73b645f0e8033ae26fa8e634b8_***_Daniel Harris
8096440ab42b60a86e6aba678fe2695a_***_Owen Bodger
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
83efcf2a9dfcf8b55586999d3d152ac6_***_Ronan Lyons
70a544476ce62ba78502ce463c2500d6_***_Michael Gravenor
3676f695eeda169d0f8c618adf27c04b_***_Julian Halcox
author Fatemeh Torabi
Daniel Harris
Owen Bodger
Ashley Akbari
Ronan Lyons
Michael Gravenor
Julian Halcox
author2 Fatemeh Torabi
Daniel Harris
Owen Bodger
Ashley Akbari
Ronan Lyons
Michael Gravenor
Julian Halcox
format Journal article
container_title European Heart Journal Open
container_volume 2
container_issue 6
publishDate 2022
institution Swansea University
issn 2752-4191
doi_str_mv 10.1093/ehjopen/oeac066
publisher Oxford University Press (OUP)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description AimsGuidelines recommend anticoagulation (AC) in atrial fibrillation (AF) to reduce stroke and systemic embolism (SSE) risk; however, implementation has been slow across many populations. This study aimed to quantify the potential impact of changing prevalence of AF, associated risk, and AC prescribing on SSE hospitalizations and death.Methods and resultsWe evaluated temporal trends of AF, CHA2DS2-VASc, antithrombotic prescriptions, SSE hospitalizations, death, and their associations between 2012 and 2018 in a longitudinal cohort of AF patients in Wales UK. Multi-state Markov models were used to estimate expected SSE rates given the AC coverage, adjusting for CHA2DS2-VASc scores. SSE rates were modelled for various past and future AC scenarios. A total of 107 137 AF patients were evaluated (mean age = 74 years, 45% female). AF prevalence increased from 1.75 to 2.22% (P-value <0.001). SSE hospitalizations decreased by 18% (2.34–1.92%, P-value <0.001). Increased AC coverage from 50 to 70% was associated with a 37% lower SSE rate, after adjustment for individual time-dependent CHA2DS2VASc scores. The observed AC increase accounted for approximately 80 fewer SSE hospitalizations per 100 000/year. If 90% AC coverage had been achieved since 2012, an estimated 279 SSE per 100 000/year may have been prevented. Our model also predicts that improving AC coverage to 90% over the next 9 years could reduce annual SSE rates by 9%.ConclusionWe quantified the relationship between observed AC coverage, estimating the potential impact of variation in the timing of large-scale implementation. These data emphasize the importance of timely implementation and the considerable opportunity to improve clinical outcomes in the Wales-AF population.
published_date 2022-11-21T15:15:54Z
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score 11.013082

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