Patients With Paroxysmal Atrial Fibrillation Less Likely To Receive Anticoagulants Interview with:

Dr Nicola Adderley BA, MSci (Cantab), MA, MPhil, PhD Institute of Applied Health Research Research Fellow University of Birmingham

Dr. Adderley

Dr Nicola Adderley BA, MSci (Cantab), MA, MPhil, PhD
Institute of Applied Health Research
Research Fellow
University of Birmingham What is the background for this study?

Response: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major global public health problem. It is associated with a five-fold increase in risk of stroke.

There are three types of AF – paroxysmal, persistent or permanent. In paroxysmal AF, episodes come and go, and usually stop without any treatment. With persistent AF episodes can last for periods of more than seven days and are treated with medication or a medical procedure called cardioversion. In permanent AF, the irregular heartbeat is present all the time and cardioversion has failed to restore a normal heart rhythm.

All patients with AF, including paroxysmal AF, are at an increased risk of stroke. UK guidelines recommend anticoagulant treatment, such as the blood-thinning drug warfarin, for patients with all types of AF in order to reduce the risk of stroke.

Our study aimed to determine whether patients with paroxysmal AF are less likely to be treated with anticoagulants than patients with persistent or permanent AF and to investigate trends in treatment between 2000 and 2015. What are the main findings?

Response: Our team of researchers analysed the records of 14 million patients from 648 GP surgeries from across the UK, looking specifically at records covering a 15-year period between 2000 and 2015.

We found that patients with paroxysmal Atrial fibrillation were consistently less likely to be prescribed anticoagulants than those with persistent/permanent AF.

Although the proportion of AF patients prescribed anticoagulants increased considerably over the period, in 2015 fewer paroxysmal AF patients were prescribed anticoagulants – a treatment gap of 13%.

While the anticoagulant treatment gap has narrowed over the years, from 15% in 2000 to 13% in 2015, over the same period a diagnosis of paroxysmal AF became three times more common. This means that the number of paroxysmal AF patients missing out on anticoagulants is greater now than 16 years ago. What should readers take away from your report?

Response:  Underuse of anticoagulants in patients with paroxysmal AF is likely to result in preventable strokes among this group, leading to greater levels of avoidable death and disability.

Although the gap is narrowing, we need to remind ourselves that all patients with AF are at increased risk of stroke. Paroxysmal AF patients should be given the same priority for stroke prevention as other AF patients. What recommendations do you have for future research as a result of this study?

Response: Further research is needed to establish whether the difference in treatment between patients with paroxysmal AF and patients with persistent/permanent AF is the result of lower levels of treatment initiation by clinicians or whether patients with paroxysmal AF are more likely to stop their treatment, and to explore reasons why this is the case. This will facilitate the development of methods to improve guideline adherence and/or uptake of anticoagulant prophylaxis, leading to improved outcomes for patients with paroxysmal AF. Thank you for your contribution to the community.


Isaew A, Adderley NJ, Ryan R, et al. The treatment of paroxysmal atrial fibrillation in UK primary care
 Heart 2017. doi: 10.1136/heartjnl-2016-310927

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.




Last Updated on June 14, 2017 by Marie Benz MD FAAD