A study led by researchers at Oxford Population Health identified 28% more cases of atrial fibrillation, a common and serious cardiac condition, in primary care data (from general practices) than secondary care (hospital) data alone. Evidence of atrial fibrillation was also recorded an average of 1.3 years earlier.
The findings 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, in order to improve patient care and save lives. The study is published in Europace, a journal of the European Society of Cardiology.
The researchers 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 years average follow-up period.
Key findings:
- The researchers identified 28% 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.
Jemma Hopewell, Professor of Precision Medicine and Epidemiology at Oxford Population Health and senior author of the study, 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.
‘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% 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, 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.
‘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.’
This research was funded by the British Heart Foundation and the National Institute of Health and Care Research (NIHR) Oxford Biomedical Research Centre (BRC).