Oral anticoagulant prescribing
The proportion of patients with AF and an OAC prescription recorded decreased from 39.5% (95% CI 38.6%-40.5%) in 2009 to 35.1% (95% CI 34.5-35.8%) in 2011 and then increased to 52.0% (95% CI 51.5%-52.4%) by 2018 (p <0.001; Figure 1). In all patients with AF, lone antiplatelet prescribing dropped steadily from 17.6% (95% CI 16.8%-18.3%) in 2009 to 2.9% (95% CI 2.7%-3.0%) in 2018 (p for decrease over time <0.001; Supplementary Table 1). However, these latter data are unreliable as patients can obtain aspirin without a prescription. The proportion of people who had no record of a prescription for either treatment to prevent stroke increased from 42.9% (95% CI 41.9%-43.9%) to 51.1% (95% CI 50.5%-51.7%) in 2013 and plateaued around 47.0% between 2014 and 2016, and then declined to 45.2% (95% CI 44.7%-45.7%) in 2018 (p for increase over time <0.001; Supplementary Table 1).
In high-risk patients (CHA2DS2-VASc≥2), the proportion with an OAC prescription recorded increased from 41.7% (95% CI 40.7%-42.8%) in 2009 to 55.2% (95% CI 54.7%-55.8%) in 2018 (p <0.001). In moderate stroke risk patients (CHA2DS2-VASc=1 and male), the proportion who were receiving an OAC increased from 30.9% (95% CI 27.2%-34.7%) in 2009 to 42.0% (95% CI 40.2%-43.8%) in 2018 (p<0.001). In low stroke risk patients with AF (CHA2DS2-VASc=1 and female, 0 and male), the proportion who were prescribed an OAC decreased from 14.6% (95% CI 11.8%-17.8%) in 2009-11.0% (95% CI 9.6%-12.6%) in 2013 and then increased to 16.7% (95% CI 15.3%-18.2%) in 2018 (p <0.001; Figure 1).