In order to prevent AF related strokes, the recommended course of action is to initiate anticoagulation therapy. It is estimated that in the UK, there are approximately 500,000 patients currently prescribed oral anticoagulant drugs, with warfarin being the most frequently prescribed oral anticoagulant in the UK. When this therapy is appropriately used and monitored, it is highly effective, lowering stroke risk by about two thirds.
Despite the clear benefits of warfarin and the presence of guidelines for its use and management in stroke prevention, current data indicates that the management of AF is still sub-optimal. The NICE 2006 costing report estimated that 46% of patients who should be on warfarin are not receiving it and those who are receiving anticoagulation are not in optimal therapeutic range.
Recent clinical trials have supported a relationship between anticoagulant control and benefit of anticoagulation, with the longer time spent in therapeutic range reducing the chance of ischaemic stroke.
Effective commissioning of anticoagulation services will ensure a high quality service is delivered by ensuring patient’s anticoagulant control is within therapeutic range for as great a proportion of the time as possible.
Key to this effectiveness is adherence to the standards available and the provision of auditable services.
It is therefore recognised that stroke prevention and AF management are priority areas for the NHS, with an estimated 6,000 strokes per year potentially avoidable through preventative work and improvement in AF management.
NHS Improvement has developed Anticoagulation for Atrial Fibrillation: a simple overview to support the commissioning of quality services .
This guide sets out to help commissioners develop quality anticoagulation services by emphasising evidence based practice and measurable outcomes. It predominantly aims to highlight that quality of anticoagulation is important, that this varies between clinics and that this variation in effectiveness will influence the outcome of stroke prevention. It also aims to provide some guidance as to the most important markers to look at in assessing quality amongst the myriad of markers in previous guidelines.