Stroke Prevention in Primary Care: Managing Atrial Fibrillation
Stroke Improvement Programme National Project 2009-10
Atrial Fibrillation now forms a programme of work within NHS Improvement and a new team has been established to roll this out across England.
Project objectives
Atrial fibrillation (AF) is a major predisposing factor to stroke, with 16,000 strokes annually in patients with AF, of which approximately 12,500 are thought to be directly attributable to AF. The annual risk of
stroke is five to six times greater in AF patients than in people with normal heart rhythm and is therefore
a major risk factor for stroke. Atrial fibrillation is currently under recognised and under treated.
The Stroke Improvement and Heart Improvement Programmes worked with 18 sites in the first phase of the ‘Atrial Fibrillation in Primary Care Project’, which completed in May 2009, to address the detection,
diagnosis and optimal therapy of patients with AF. Each project sought to establish a baseline to demonstrate improvements to changes in practice against:
• Numbers of new patients with AF identified, and their subsequent treatment
• Numbers of existing AF patients reviewed and, where necessary, subject to optimal therapy
• Establishment of a clear and agreed patient pathway for AF patients.
Building on this evidence base of learning and outcomes and applying the tools, resources, education and
training programmes developed to address the challenges, the Stroke Improvement Programme launched
the second phase in October 2009, working with nine sites to provide demonstrable outcomes for the
improvement of the identification, diagnosis, optimal therapy and management for patients with atrial
fibrillation to reduce risk of stroke.
Project sites
• Cardiac and Stroke Networks in Lancashire and Cumbria
• North East London Cardiovascular Network
• South East London and South West London Cardiac and Stroke Networks
• Southampton Community Healthcare
• South West Ambulance NHS Trust
• Surrey Heart and Stroke Network
• NHS Darlington
• NHS Westminster
• NHS West Kent
Anticipated outcomes
Through the appropriate treatment of atrial fibrillation we could prevent approximately 4,500 strokes per year and 3,000 deaths. Treatment of AF patients with optimal therapy is both cost effective and has overall cost benefits to health and social care through stroke prevention.
• Quality outcomes through addressing optimal therapy for AF patients
• Innovative approaches to access and management in primary care for AF patients
• Productivity through reducing inappropriate referrals to secondary care and bed days saved
• Prevention by reducing risk of stroke
National policy/strategy
• National Stroke Strategy, 2008 – Quality Marker 2
• Chapter Eight of the National Framework for Coronary Heart Disease; Arrhythmias and Sudden Cardiac Death, 2005.
• NICE 2006 The Management of Atrial Fibrillation
• NICE 2006 The Management of Atrial Fibrillation Costing Report. The report highlighted that amongst patients with recognised AF, 46% of those who would benefit from warfarin are not receiving it. Out of an estimated 355,000, only 189,000 were actually receiving warfarin.
Contact details
Julie Harries
Director, NHS Improvement
Email: julie.harries@improvement.nhs.uk
Tel: 07810 836305
Resources
Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation (GRASP-AF) Tool
This tool should be used as part of a systematic approach to the identification, diagnosis and optimal management of patients with AF to reduce their risk of stroke.
Developed collaboratively and piloted by the West Yorkshire Cardiovascular Network, the Leeds Arrhythmia team and PRIMIS+, as part of the AF in primary care national priority projects, made available nationally through NHS Improvement. Please click here to find out more and to register for the tool. A case study on the tool can be found here.
Atrial fibrillation in primary care: making an impact on stroke prevention, October 2009
This document aims to capture the final summary of their individual approach, lessons learned, improvements to practice and quality outcomes, also sharing tools and resources developed to enable other health communities to drive this agenda forward.
Commissioning for Stroke Prevention in Primary Care - The Role of Atrial Fibrillation, June 2009
Developed following a national consensus meeting of opinion leaders in the field, this document is to develop a concerted strategy towards the management of AF in primary care, in particular anticoagulant management and its significance in relation to reduction in the risk of stroke.
This document considers the evidence that a review of AF management in primary care is needed to develop more systematic strategies for the identification, diagnosis and optimal treatment of patients with AF to reduce the risk of stroke. It is aimed at cardiac and stroke networks, PCTs, commissioners, medical directors, cardiac and stroke leads, public health colleagues, GPs.
Atrial Fibrillation in Primary Care National Priority Project, April 2008.
A summary document produced in April 08 including descriptions, supporting information and key learning from the local projects that were part of the Atrial Fibrillation in Primary Care national priority project.
Atrial Fibrillation in Primary Care Resources and Learning, April 2008
This online resource is a tool produced in April 08 that captured the learning from the local project sites that worked on the Atrial Fibrillation in Primary Care national priority project. The resource provides documents, guidelines, presentations, proformas and algorithms developed and used by the local priority projects.
The resource tool is divided into the following three chapters:
1. Identifying, reviewing and managing AF patients
2. Education and training
3. Developing AF pathways and clinics
Useful links
• Heart Improvement Programme
• NHS Health Check
• Department of Health (DH)
• Stroke Care Networks
• National Institute for Clinical Excellence (NICE)
• PRIMIS+
• Heart Rhythm UK
• Atrial Fibrillation Association (AFA)
• The Stroke Association
• British Heart Foundation (BHF)
• Primary Care Cardiovascular Society (PCCS)
• The Royal College of Physicians (RCP)
• Care Quality Commission (CQC)
• Different Strokes
• Connect
• Crossroads Care