Atrial fibrillation - Latest news

GRASP AF update

A new version of GRASP-AF is now available which includes the following features:

• The ability to swap between CHADS₂ and CHA₂DS₂-VASc

• The ability to look at the use of ‘AF Resolved’ codes. The data sheet can be set up to more closely reflect the practice’s QOF register

• New anticoagulants (eg Dabigatran) will be included, and counted alongside warfarin

• The number of patients with a CHADS₂ score recorded on their electronic records will be shown in graphical form, and in the data sheet – this could be used to assist with the upcoming QOF changes around atrial fibrillation patients being assessed using the CHADS₂ scoring system, and then treated depending on the score. NHS Improvement will be publishing a guide on using GRASP to help with achieving the new QOF targets soon

PRIMIS+ and NHS Improvement encourage updating to the new version as the current version will not be supported beyond Thursday 22 December. We also request you to upload your latest results to CHART Online before updating.

If you have any issues with GRASP-AF please consult the GRASP-AF help page, or contact Ian Robson.

Presentations available from GRASP-AF workshop on 16 September

NICE appraisal consultation on dabigatran etexilate for AF
A document summarising the evidence, views and draft recommendations on dabigatran etexilate has been produced by NICE and is now available for comment. The consultation closed on 8 September. To find out more, visit the NICE website.

AF included in NICE high level summary of recommendations for 2012/13 QOF indicators
NICE has published a set of new proposed indicators for the 2012/13 QOF. The 'menu', which will help target resources where they are most needed and deliver the best patient outcomes, includes two new indicators for the risk stratification and percentage of at risk patients receiving anticoagulants and the retirement and replacement of two existing indicators.

Final QOF indicators will be published by NHS Employers in winter 2011. Futher information is available on the NICE website.

Yorkshire and North Humber SHA - AF/stroke prevention guidelines
Representatives from the three Cardiovascular Networks in the Yorkshire and Humber region: West Yorkshire, North Trent and North East Yorkshire and North Lincolnshire, have developed regional guidance for atrial fibrillation and stroke prevention for healthcare professionals. Download the new guidelines.

Stroke Association and NHS Improvement join forces to improve diagnosis and management of AF - Find out more.

Anticoagulation for atrial fibrillation: A simple overview to support the commissioning of quality services
NHS Improvement has developed a simple guide to support the commissioning of quality anticoagulation services. It sets out to help commissioners develop quality anticoagulation services by emphasising evidence based practice and measurable outcomes. (April 2011)

About atrial fibrillation

Atrial fibrillation (AF) is the most common type of sustained heart rhythm disturbance, and a major predisposing factor for stroke.

It occurs as a result of rapid, disorganised, electrical activity within the heart’s upper chambers (atria) resulting in an irregular heart rhythm. The lack of proper contraction of the atria and pathological changes within the atrial walls both result in the stagnation of blood and clot formation. This predisposes to the formation of emboli and subsequent stroke.

AF increases the risk and severity of stroke and accounts for approximately 14% of all strokes. Recognition and optimal treatment of AF is of particular importance as strokes due to AF are highly preventable.

The stats:

• The prevalence of AF in primary care is estimated to be 1.2%, which equates to just over 600,000 patients in England
• 12,500 strokes per year are thought to be directly attributable to AF
• The estimated total cost of maintaining one patient on Warfarin for one year, including monitoring, is £383
• The cost per stroke due to AF is estimated to be £11,900 in the first year after stroke occurrence

The AF team believe the key to success is to develop a network of stakeholders, including cardiac and stroke networks, PCTs, GP consortia, charities and the Department of Health.

The team can provide the support, resources and tools to help deliver effective clinical practice through service improvement and redesign.

Key areas of work:

NHS Improvement has been engaged in an AF work programme since 2007 and the newly expanded team continue with the aim of reducing the number of AF related strokes by;

• Raising awareness
• Increasing the detection of AF by means of opportunistic screening
• Driving the roll-out of the GRASP-AF tool to improve the management for those diagnosed with AF
• Sharing good practice, ideas and innovations to improve detection, diagnosis and management
• Improving the quality of care for patients requiring anti-coagulation
• Addressing the need for education and training

Please use the links on the right for more information on atrial fibrillation.