RAISED-RISK-AF : Identifying patients at raised risk of stroke - Primary Care Unit

Title:	Identifying patients at raised risk of stroke due to paroxysmal or persistent atrial fibrillation in primary care populations
Project Description:	About 25% of strokes are associated with atrial fibrillation (AF), and about 25% of people who have a stroke that is associated with AF only have the arrhythmia diagnosed at the time of their stroke. In relative terms, AF is associated with a fivefold increase in risk of stroke, and in absolute terms, AF is going to become an even more important cause of stroke in the future. However, while there have been advances in detection and treatment of AF in recent years, the National Screening Committee currently recommends against a screening program due to insufficient evidence of patient benefit. We intend to undertake analyses to support the development of an NIHR programme grant application to determine whether screening for AF is cost effective. Our proposal is to use NSPCR funds to carry out key preliminary work using the Clinical Practice Research Datalink (CPRD) to address the following questions (which will inform the design of future studies to be included within the programme grant): 1. Is the prognosis of screen detected AF the same as clinically detected AF? 2. What proportions of people with screen detected AF are treated with anticoagulation? 3. Is anticoagulation in people with screen detected AF associated with similar reductions in stroke risk as observed in people with clinically detected AF? 4. What factors predict risk of AF in people under the age of 65? A retrospective cohort of patients will be created in CPRD; outcomes of patients with “screen detected” AF will be compared to other patients with AF (objectives 1, 2 and 3). Second, multivariate regression analysis will be used to identify factors associated with AF incidence in patients under 65 (objective 4), thus additionally supporting the development practical tool for targeting patients in future case detection or screening trials.
Project organisation
Start date:	1st April 2016
End date:	31st October 2018
Contact person:	Dr Duncan Edwards
Contact Details:	Primary Care Unit Strangeways Research Laboratory Worts Causeway Cambridge Cambs CB1 8RN UK Telephone: (01223) 330309 Fax: E-mail: dae31@medschl.cam.ac.uk
Funding information
Funding Organisation:	NIHR School for Primary Care Research
Funding Reference:	SPCR FR11
Funding Amount:	£42,170

Further Information, References and Publications
Mendonca S, Saunders CL, Lung J, Mant J, Edwards D. Temporal trends in incidence of atrial fibrillation in primary care records. BMJ Open 2020; 10(12) e042518.