Real-world data on the incidence, mortality, and cost of ischaemic stroke and major bleeding events among non-valvular atrial fibrillation patients in England

Ameet Bakhai*, Hans Petri, Farnaz Vahidnia, Cyrill Wolf, Yingjie Ding, Nadia Foskett, Mark Sculpher

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Rationale, Aims, and Objectives: Several novel oral anticoagulants (NOACs) are licensed for atrial fibrillation (AF) treatment in the United Kingdom. We describe the incidence and mortality from ischaemic stroke and major bleeding in non-valvular atrial fibrillation (NVAF) patients in England, including treatment patterns before/following introduction of NOACs, healthcare resource utilization (HRU), and costs post-onset of these events. Method: Data were extracted from the UK Clinical Practice Research Datalink linked to Hospital Episode Statistics secondary care and Office for National Statistics mortality data. Results: Of 42 966 patients with a first AF record between 2011 and 2016, 9143 patients (21.3%) remained without AF (antiplatelets/antithrombotics) treatment post-index diagnosis. The proportion of patients receiving aspirin for ≥3 months post-index declined during the study (50.6%-5.5%), irrespective of CHA2DS2-VASc score, while the proportion prescribed NOACs increased (2.0%-70.1%). Rates of ischaemic stroke per 1000 patient-years (95% CI) were 9.4 (3.8-15.0) with NOACs, 10.4 (8.0-12.9) with warfarin, 20.1 (16.4-23.8) with aspirin, 21.3 (5.3-37.2) with other antiplatelets and 43.6 (39.3-47.8) in patients without AF prescription. Major bleeding occurred at a similar rate with different treatments. All-cause mortality rates were 42.8 (31.4-54.3) with NOACs, 46.3 (41.1-51.5) with warfarin, 56.5 (50.5-62.4) with aspirin, 102.2 (76.2-128.3) with other antiplatelets and 412.8 (399.6-426.0) with no AF prescription. Mean annual National Health Service healthcare costs up to 1 year post-index were lowest in patients receiving aspirin plus other antiplatelets without an event (£6152), and highest in patients with an event without AF prescriptions (£17 957). By extrapolation, national AF HRU in the United Kingdom in 2016 was estimated at £8-16 billion annually. Conclusions: These data provide temporal insights into AF treatment patterns and outcomes for NVAF patients in England and highlight the need to review higher stroke risk AF patients not receiving antiplatelet/antithrombotic prescriptions.

Original languageEnglish
Pages (from-to)119-133
Number of pages15
JournalJournal of Evaluation in Clinical Practice
Issue number1
Early online date21 Apr 2020
Publication statusPublished - 1 Feb 2021

Bibliographical note

Funding Information:
The authors acknowledge the help of Yuan‐chi Lee and Tijana Krnjeta Janicijevic. Third‐party medical writing assistance, under the direction of the authors, was provided by Fiona Fernando, PhD, contract medical writer at Gardiner‐Caldwell Communications, and was funded by Roche Diagnostics International Ltd. This study was sponsored by Roche Diagnostics International Ltd, Switzerland and Roche Real‐World Data Group, Diagnostics Information Solutions, USA.

Publisher Copyright:
© 2020 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd

Copyright 2020 Elsevier B.V., All rights reserved.


  • atrial fibrillation
  • bleeding
  • health economics
  • ischaemic stroke
  • real-world data

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