Paroxysmal AF Management in the UK

Study Questions:

How often is the primary care management of paroxysmal atrial fibrillation (PAF) in the United Kingdom (UK) consistent with guideline recommendations?


A primary care database in the UK was analyzed to obtain information on the treatment of patients with atrial fibrillation (AF) in 2000-2015. The primary outcome was the prescription of an anticoagulant.


There were 179,343 patients with AF. Between 2000 and 2015, the proportion of AF patients who had PAF increased from 7.4% to 14%, and the proportion of patients with PAF who received a prescription for an anticoagulant increased from 16% to 50.7%. During the same years, the proportion of patients with AF other than paroxysmal increased from 33.5% to 67.1%. Among patients with a CHADS2 score ≥1, the proportion of AF patients who were prescribed an anticoagulant increased from 18.8% to 56.2% in PAF patients, and from 34.2% to 69.4% for other AF patients.


Although the proportion of patients with AF who are prescribed an anticoagulant increased between 2000 and 2015, a large proportion of eligible AF patients still are not being anticoagulated, especially when the AF is paroxysmal.


As other studies have reported, there is underutilization of anticoagulants in AF patients. This study suggests that there is the perception, either among primary care physicians or their patients, that the stroke risk from AF is lower when the AF is paroxysmal. However, most of the evidence indicates that the stroke risk in patients with AF is independent of whether the AF is paroxysmal or persistent, and this is reflected in guideline recommendations, which are the same for all types of AF.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Prevention, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Blood Coagulation, Disease Management, Physicians, Primary Care, Prescription Drugs, Primary Health Care, Secondary Prevention, Stroke, Treatment Outcome

< Back to Listings