Trends in the incidence of atrial fibrillation and the prescription of oral anticoagulants in adults with chronic obstructive pulmonary disease in UK primary care (2010–2022): a cohort study

Background Understanding the burden of atrial fibrillation (AF) and oral anticoagulant (OAC) use in patients with chronic obstructive pulmonary disease (COPD) is important for stroke prevention in this high-risk population. We assessed trends in AF incidence and OAC initiation among patients with COPD in UK primary care from 2010 to 2022. Methods We assembled a cohort of all patients at least 50 years of age who contributed data to the UK Clinical Practice Research Datalink between January 1, 2010, and December 31, 2022, who had a physician diagnosis of COPD before or during the study period. Patients were followed-up until AF diagnosis, study end date (December 2022), death, or transfer out of practice. We estimated annual incidence rates of AF and subsequent OAC initiation using Poisson regression, stratified by age, sex, ethnicity, and COPD severity. We assessed predictors of AF and OAC initiation using Cox proportional hazards regression models. Findings 444,668 patients with COPD were included (mean age 70 years, 51.8% male), contributing 2,284,799 person-years of follow-up. 37,645 (8.5%) patients were diagnosed with AF during the study period. The incidence of AF increased from 13.8 per 1000 person-years in 2010 to 19.3 in 2022 [rate ratio (RR) 1.29; 95% confidence interval (CI) 1.07–1.56], and was higher in males, White individuals, those over 80 years, and patients with severe COPD. Only 23,094 patients (66.3%) were prescribed an OAC in the year following AF diagnosis, though OAC use increased 2.9-fold during this period (RR 2.91; 95% CI 2.33–3.65). OAC initiation remained lowest among patients aged 50–59 and ≥90 years, and non-White individuals. OAC use was also up to 25.0% (adjusted hazard ratio 0.75; 95% CI 0.69, 0.81) less prevalent among those with severe COPD. Interpretation AF incidence and OAC initiation increased among patients with COPD in UK primary care over 2010–2022. However, OAC use remained suboptimal, especially among older patients, non-White individuals, and those with severe COPD. These potential treatment gaps highlight the need for further research on stroke prevention strategies in this high-risk population. Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.