Atrial fibrillation

Atrial fibrillation (AF) is responsible for approximately 20 per cent of all strokes, which can leave survivors with devastating disabilities.

In the UK, one million people are known to be affected by AF and an additional 422,600 people are undiagnosed. Treating the condition costs the NHS over £2.2 billion each year.

Making sure people with AF are given the best treatment – usually blood-thinning medication to prevent clots (anticoagulants) – can more than halve their risk of having a stroke.

In 2015, the Academic Health Science Network set ambitious targets to improve the detection, diagnosis and treatment of patients with AF.

AF in the North West Coast

Here in the North West Coast, data in 2015 showed that:

• 24,210 people were estimated to have undetected AF
• 76 per cent of people with high-risk AF were treated with anticoagulation therapy

The latest Quality Outcome Framework (QOF) data for 2018 to 2020 revealed that Health Innovation North West Coast achieved a 98 per cent detection rate, making it a high performing region for this national programme and exceeding the national target.

Plus, 87 per cent of our region’s high-risk AF patients are now receiving anticoagulation therapy – an increase of 11 per cent since 2015/2016, which takes us well on the way to achieving the national target of 90 per cent which the NHS aims to achieve by 2029.

Since 2015 we have contributed to the avoidance of 715 strokes, including 179 deaths avoided and savings of £16M to health and social care. The reduction in strokes is expected to continue, as a result of actions taken to identify people at risk and prescribe life-saving medication.

QI Toolkit

An AF Quality Improvement Toolkit has been created with the purpose of spreading improvements in the diagnosis and management of AF in primary care and is aimed at GPs, practice nurses, practice managers and administrative staff. 

Actions taken

We have:

• Run public awareness campaigns about the importance of pulse testing
• Introduced portable ECG devices to a number of health and care settings including Cheshire Fire and Rescue Service who use them as part of their Safe and Well visits to vulnerable residents.
• Worked with the Strategic Clinical Network to support the development of the AF pathway and the commissioning tool-kit
• Worked with the AHSN network to produce the AF Toolkit for clinicians
• Worked with NIHR CLAHRC NWC to roll out genotype guided dosing of warfarin
• Provided patients in East Lancashire with home monitoring technology to carry out blood tests and send results via an app and digital health systems to health professionals
• Developed two North West Coast AF Collaboratives with over 120 GP practices which have been given detection devices and quality improvement support for managing their patients
• Recruited more than 70 volunteer AF Ambassadors to carry out pulse tests with families, friends, colleagues and other networks
• Developed an educational webinar
• Supported the development of the Happy Hearts website

Impacts

We have:

• Introduced technology to patients, healthcare professionals and volunteers
• Provided training and quality improvement support to GPs
• Prevented an estimated 500 strokes
• Saved a potential £3m per year in health and care costs
• Secured more than £300,000 investment from industry
• Established more than 25 new partnerships to support the programme

Plans for the future

• Expanding the AF Collaborative to include more GP practices in more CCGs
• Expanding our cohort of AF Ambassadors
• Establishing new partnerships to support our work
• Improving the uptake of technology which supports patients
• Supporting the ICS with further improvements for AF