Atrial Fibrillation

The Atrial Fibrillation (AF) Programme is a national programme mandated by NHS England.

The aim of the national programme is to reduce AF related stroke and associated mortality and morbidity by:

  1. Detecting those with undiagnosed AF
  2. Optimising treatment of those with AF.

Delivery in the North East and North Cumbria

We deliver the AF programme across the NENC with the aim to:

  1. Achieve 85% detected prevalence of AF which equates to 9,967 new diagnoses of AF
  2. Achieve 84% patients with AF and CHASD2VASc score of 2 or more, treated with anticoagulants (7,051) avoiding 282 strokes and 71 deaths.

The AHSN NENC AF Programme has been running for three years, supported by an AF Steering Group comprising of key stakeholders from across the NENC footprint. They represent primary care, secondary care, NHS England, third sector, public health and industry. The programme priorities are:

  • Raising the profile of AF with primary care practitioners within the region
  • Raising the profile of latest AF guidance, CG180, and patients to be treated according to NICE
  • Greater detection of those with undiagnosed AF in primary care
  • To understand and implement tools to ensure patients with AF are treated and audited
  • Improved treatment of those on AF Registers in primary care.

 

Past successes include:

In the first three years, the AF Programme has prevented 20 strokes and saved the NHS £280,000. If wider social care costs are factored in, then the savings equate to £921,000 (Xu et al, 2017).

  1. Publication of an AF Card Deck: a resource aimed at primary care for Anticoagulant Treatment in Atrial Fibrillation For Thromboprophylaxis. Every GP in the NENC area (2,200) received a hard copy. An electronic version of the card deck is now available to download and can be placed upon CCG intranets.
  2. Detection of irregular pulses during a diabetes foot check. Diabetes is a common condition affecting 3.4M people across England. Patients with diabetes have their pulse checked as part of their annual foot check review. All patients aged 12 and over should be offered a foot check. It is important to detect the presence or absence of a foot pulse to prevent diabetes complications. The pilot work examining pulses in patients’ feet started in County Durham and Darlington NHS Foundation and is now being spread across the NENC area as well as more widely across England. This work is supported by Anticoagulation Europe and The College of Podiatry, and won an AFA Healthcare Pioneers Award in 2018 for showcasing best practice in AF.

 

Future plans:

To achieve 85% detected prevalence of AF which equates to 9,967 new diagnoses of AF we plan to:

  • Implement irregular pulse detection using the small hand-held device, AliveCor. The AHSN NENC has already trained people within GP practices and community pharmacies along with pre-operative assessment clinics, community cardiology services and third sector organisations. We have over 100 AliveCor devices in settings across the AHSN NENC area and aim to have over 300 in total.
  • Spread the learning from the ‘detection of irregular pulses during a diabetes foot check’ pilot work to all parts of the NENC area by working with the Northern Diabetes Footcare Clinical Network.

To achieve 84% patients with AF and CHASD2VASc score of 2 or more treated with anticoagulants (7,051) avoiding 282 strokes and 71 deaths we plan to:

  • Work with GP practices and CCGs to enable optimisation of anticoagulation. Using local data, regional experts and working in partnership with a wide range of NHS organisations and commercial companies we will offer bespoke solutions to enable clinicians to feel more confident and competent in treating patients with AF. This could include:

For more information about the AHSN NENC AF Programme contact Kate Mackay.