Article Text

Original research
Temporal trends in incidence of atrial fibrillation in primary care records: a population-based cohort study
  1. Sílvia C Mendonça,
  2. Catherine L Saunders,
  3. Jenny Lund,
  4. Jonathan Mant,
  5. Duncan Edwards
  1. Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
  1. Correspondence to Sílvia C Mendonça; sm2061{at}medschl.cam.ac.uk

Abstract

Objectives Atrial fibrillation (AF) is a heart condition associated with a fivefold increased risk of stroke. The condition can be detected in primary care and treatment can greatly reduce the risk of stroke. In recent years, a number of policy initiatives have tried to improve diagnosis and treatment of AF, including local National Health Service schemes and the Quality and Outcomes Framework. We aimed to examine trends in the incidence of recorded AF in primary care records from English practices between 2004 and 2018.

Design Longitudinal cohort study.

Setting English primary care electronic health records linked to Index of Multiple Deprivation data.

Participants Cohort of 3.5 million patients over 40 years old registered in general practices in England, contributing 22 million person-years of observation between 2004 and 2018.

Primary and secondary outcome measures Incident AF was identified through newly recorded AF codes in the patients’ records. Yearly incidence rates were stratified by gender, age group and a measure of deprivation.

Results Incidence rates were stable before 2010 and then rose and peaked in 2015 at 5.07 (95% CI 4.94 to 5.20) cases per 1000 person-years. Incidence was higher in males (4.95 (95% CI 4.91 to 4.99) cases per 1000 person-years vs 4.12 (95% CI 4.08 to 4.16) in females) and rises markedly with age (0.58 (95% CI 0.56 to 0.59) cases per 1000 person-years in 40–54 years old vs 21.7 (95% CI 21.4 to 22.0) cases in over 85s). The increase in incidence over time was observed mainly in people over the age of 75, particularly men. There was no evidence that temporal trends in incidence were associated with deprivation.

Conclusions Changes in clinical practice and policy initiatives since 2004 have been associated with increased rates of diagnosis of AF up until 2015, but rates declined from 2015 to 2018.

  • primary care
  • epidemiology
  • health policy

Data availability statement

The study uses data from the Clinical Practice Research Datalink (CPRD). CPRD does not allow the sharing of patient-level data. The data specification for the CPRD data set is available at: https://www.cprd.com/sites/default/files/CPRD_GOLD_Full_Data_Specification_v2.0_0.pdf. Additional information on the IMD patient-level linkage data is available at: https://cprd.com/sites/default/files/Documentation_SmallAreaData_Patient_set18_v2.7.pdf. The code list used in this study is part of a set of lists made available at www.phpc.cam.ac.uk/pcu/cprd_cam/codelists/.

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

Statistics from Altmetric.com

Data availability statement

The study uses data from the Clinical Practice Research Datalink (CPRD). CPRD does not allow the sharing of patient-level data. The data specification for the CPRD data set is available at: https://www.cprd.com/sites/default/files/CPRD_GOLD_Full_Data_Specification_v2.0_0.pdf. Additional information on the IMD patient-level linkage data is available at: https://cprd.com/sites/default/files/Documentation_SmallAreaData_Patient_set18_v2.7.pdf. The code list used in this study is part of a set of lists made available at www.phpc.cam.ac.uk/pcu/cprd_cam/codelists/.

View Full Text

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

Footnotes

  • Twitter @drclsaunders, @J_C_Lund

  • Correction notice This article has been corrected since it first published. The provenance and peer review statement has been included.

  • Contributors DE and JM had the original idea for the study. DE, SCM, CLS, JL and JM designed the study. SCM undertook data extraction and performed the analysis. SCM and DE wrote the first draft of the paper, which was revised in collaboration with all authors. DE acts as the guarantor of the study.

  • Funding This report is an independent research funded by the National Institute for Health Research (NIHR School for Primary Care Research, reference FR11/290).

  • Disclaimer The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.

  • Competing interests All authors report grants from the NIHR School of Primary Care Research, during the conduct of the study. JL reports grants from the Wellcome Trust and the National Institute for Health Research, outside the submitted work. JM is on an advisory board for BMS/Pfizer on an AF screening trial, and is chief investigator of an NIHR-funded programme grant on screening for atrial fibrillation. DE is a coinvestigator on this same NIHR programme.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.