We will use a large anonymised database of patients in England which links electronic health records (e.g. GP visits, hospital visits) to answer the following five questions: (1) How does treatment adherent to the ABC pathway affect outcomes in atrial fibrillation patients? (2) How much does the risk of stroke and bleeding change over time in atrial fibrillation patients? (3) What is the best way to predict a person’s change in risk of stroke or bleeding? (4) How can the change in risk of stroke or bleeding over time best be used to help reduce someone’s overall risk? and (5) How frequently does risk need to be reassessed?
Clinicians and patients require clear information to assess the risks and benefits of medications to reduce stroke risk. We hope that the results of this study will indicate how changing risk can be best incorporated into decisions about anticoagulation therapy. The results will help to improve future care and decision making for atrial fibrillation patients
The Atrial Fibrillation Better Care (ABC) pathway is an integrated management pathway for patients with AF with three components: A - Avoid stroke with anticoagulation; B - Better symptom management and C - Cardiovascular risk management. Previous studies have shown that adherence to the ABC pathway at baseline is associated with lower risk of mortality, stroke, myocardial infarction, hospitalization and composite outcomes. We will treat adherence status as a time-dependent variable.
This project will use the Clinical Practice Research Datalink (CPRD), which is a representative sample of the primary care population in England. We will address the following four aims: 1. To compare the performance and flexibility of risk prediction models incorporating time-dependent risk factors. 2. To examine how changes in ABC pathway adherence over time impact the risk of adverse outcomes. 3. To model the trajectory of the CHA2DS2-VASc and HAS-BLED risk scores and other risk factors, and their associations with outcomes including incident stroke and major bleeding. 4. To evaluate the trajectory of the net clinical benefit of anticoagulation (the difference between the decrease in risk of a stroke on OAC and the increase in risk of a major bleed on OAC).
Deirdre Lane - Chief Investigator - University of Liverpool
David Stevens - Corresponding Applicant - University of Liverpool
Gregory Lip - Collaborator - University of Liverpool
Ruwanthi Kolamunnage-Dona - Collaborator - University of Liverpool
Stephanie Harrison - Collaborator - University of Liverpool