Atrial fibrillation (AF) is a common heart condition where normal heart rate is disrupted. It affects around 1.5 million people in England, and if left untreated can lead to serious complications, including stroke and heart failure.
Initially, medication is prescribed to manage the symptoms, but if this fails, a procedure called ‘ablation’ is recommended. Compared to other countries, the number of patients receiving ablation in England is lower than expected. This is concerning as symptoms can worsen over time, become more difficult to treat and reduce quality of life for patients.
This study aims to understand why ablation numbers are low, by observing:
In how many AF patients have drug treatments failed to control symptoms (so should be considered for ablation).
How many patients are referred to specialist heart doctors.
How long it takes from diagnosis of AF to receiving ablation.
If where a patient lives and their age or gender is associated with receiving ablation.
If the COVID-19 pandemic impacted waiting times for ablation.
By conducting this research, we aim to describe the current AF treatment pathway and to uncover potential barriers limiting access to ablation. We hope a publication would empower clinicians and patient groups to demand that policy makers a) prioritise AF generally and b) improve/standardise access to ablation for all patients who could benefit. With an overarching aim to improve AF symptom control, enhance the quality of life for the patient, avoid AF associated complications and reduce the overall burden of AF on the healthcare system.
AF is the most common sustained cardiac arrhythmia worldwide, with 1.5 million expected cases in England. It is a progressive disease and confers an increased risk of stroke, heart failure, cognitive decline, and death. Ablation is a procedure to treat AF which is recommended for use when drug treatment fails to control the condition. Increasing evidence is showing that early restoration of a normal heart rhythm is important for patients with AF. However, despite a 72% increase (202,333 vs. 117,880) in the number of AF diagnoses from 1998 to 2017, since 2016 the numbers of catheter ablations have remained constant. Furthermore, only 121,444 ablation procedures were administered since 2014 in England and Wales with the COVID-19 pandemic compounding these effects.
Using CPRD GOLD and Hospital Episode Statistic (HES) data, this study will explore if eligible patients are able to access ablation as per the guidelines in England. The study cohort will include patients with an AF diagnosis in the study period and at least 24 months of follow-up data. The ratio between the number of patients eligible to receive ablation compared to the number of patients who had ablation will be calculated. Potential steps in the AF care pathway were identified by reviewing guidelines (NICE, ESC and NHS). The various care pathways from AF diagnosis to the end of study period, using the pre-identified steps, will be mapped for each patient. Proportion of patients for each care pathway defined will then be summarized. Percent of patients and time between steps of the care pathways will be described. Potential disparities in access will be examined by evaluating different pre-specified subgroups of patients. This study aims to highlight areas of improvement, in turn to help the NHS, government officials and local commissioners shape AF treatment and ablation policies.
Outcome 1: Ratio of number of patients who had ablation in 24 months after first AF diagnosis, compared to those who are defined as eligible;
Outcome 2: Proportion of patients who followed each AF care pathway that has been mapped;
Outcome 3: Time between defined steps of the AF care pathway;
Outcome 4: Differences for the above outcomes based on demographic and socioeconomic factors
Karine Szwarcensztein - Chief Investigator - Johnson & Johnson Medical SAS
Cindy Tong - Corresponding Applicant - Johnson & Johnson ( JnJ - USA )
Anirban Pal - Collaborator - Mu SIgma
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient