A study led by Oxford researchers has identified 28 percent more cases of atrial fibrillation, a common and serious cardiac condition, in primary care data than secondary care data alone. Evidence of atrial fibrillation was also recorded an average of 1.3 years earlier.
The findings – published in Europace, a journal of the European Society of Cardiology – highlight the importance of access to comprehensive health care data, as well as communication across NHS settings, to inform our understanding of atrial fibrillation and other conditions, and so improve patient care and save lives.
The researchers at Oxford Population Health, who are supported by the NIHR Oxford Biomedical Research Centre, used data from 230,060 participants in UK Biobank who had agreed to allow access to their GP records and details of any hospital admissions to examine potential differences between people with atrial fibrillation recorded in different healthcare settings.
Of these, 7,136 had a diagnosis of atrial fibrillation recorded during the seven-year average follow-up period.
Among the key findings of the study were:
- The researchers identified 28 per cent more patients with atrial fibrillation in primary care data than in secondary care data alone;
- Atrial fibrillation was detected an average of 1.3 years earlier in primary care versus secondary care data;
- There were lower rates of anticoagulation therapy (which reduces stroke risk) and higher rates of death in patients with atrial fibrillation only recorded in hospital compared to those recorded in primary care;
- Atrial fibrillation only recorded in hospital data was associated with more established heart disease and prior medication use than that recorded in primary care.
A senior author of the study, Jemma Hopewell, Professor of Precision Medicine and Epidemiology at Oxford Population Health and NIHR Oxford BRC Theme Lead for Cardiovascular Medicine, said: “Access to electronic healthcare records has revolutionised large-scale epidemiological research, but we need to consider the richness of the data available and not rely on hospital records alone to study chronic conditions such as atrial fibrillation.
“Our findings show that data from across healthcare settings are extremely powerful for understanding patient profiles, management and consequences of atrial fibrillation. These insights can then be used to develop new strategies that will allow us to improve patient outcomes.”
Professor Hopewell added: “Our study reinforces the importance of rapid implementation of recommendations from the Sudlow Review, which called for improved access to different types of health data to accelerate our understanding of common conditions.”
Atrial fibrillation is a common condition where the upper chambers of the heart beat too quickly and irregularly; it is associated with higher risks of stroke and death.
In the UK, many chronic conditions are diagnosed in the community, with an estimated 45 percent of cases of atrial fibrillation first recorded in general practice. This means that hospital records alone may not be enough to accurately determine the relevance of different risk factors, understand disease progression or assess implementation strategies for managing the condition.
Professor Bryan Williams, Chief Scientific and Medical Officer at the British Heart Foundation, which also funded the research, said: “Atrial fibrillation is a serious heart rhythm problem that significantly increases someone’s stroke risk if left untreated. It is crucial that we can detect this condition at an early stage so that doctors can take steps to treat the condition and prevent more strokes.
“This study addresses a hugely important challenge for the modern era of wearable technologies, notably, how to integrate data from technology into NHS data systems so that clinicians can actually access and act on the data. The study shows that when this integration of the patient’s primary care and hospital records is achieved, many more cases of atrial fibrillation can be identified, allowing doctors to act to limit its consequences.
Professor Williams added: “Linking data from across different healthcare settings can unlock new understanding and better ways of treating and managing common conditions, helping us make more breakthroughs for cardiovascular patients. Helping researchers and clinicians to do this, while maintaining people’s trust in the use of this data, must be a focus for the Government.”