By the same authors

From the same journal

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

Research output: Contribution to journalArticlepeer-review


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


Publication details

JournalJournal of Evaluation in Clinical Practice
DateAccepted/In press - 22 Mar 2020
DateE-pub ahead of print - 21 Apr 2020
DatePublished (current) - 1 Feb 2021
Issue number1
Number of pages15
Pages (from-to)119-133
Early online date21/04/20
Original languageEnglish


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.

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.

    Research areas

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

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