According to Dr Jim Moore, a GP in Cheltenham, the condition atrial fibrillation (AF) needs to be addressed in primary care as a matter of urgency, and progress is best achieved through a balanced and honest dialogue with patients about the risk of stroke and the potential benefits of treatment. Our Don’t Wait to Anticoagulate project is helping us achieve just that.
“Atrial fibrillation (known as AF) is an arrhythmia; an abnormal heart rhythm. It affects around 1.7% of the general population and is a major cause of stroke. In any given year, 1 in 20 patients with AF will have a stroke.
“The increasing focus on this high risk population is very welcome but in my opinion long overdue, which is why I’m a keen supporter of the Don’t Wait to Anticoagulate, project.
“Thousands of strokes in the UK are avoidable with both the timely identification of patients with AF and the appropriate management of their risk with anticoagulation. Anticoagulation is the use of medication for what’s commonly called ‘thinning the blood’. In fact, it reduces certain factors in the blood associated with clotting and in doing so is very effective in reducing the risk of stroke.
“Evidence about the use of anticoagulants in the treatment of AF related stroke has been around for some time but the more recent introduction of newer anticoagulants, along with the publication of the updated NICE guidelines in 2014, has been tremendously important in increasing overall awareness of this important clinical area.
“The management of stroke risk in AF should be seen as a priority and is best achieved through a balanced and honest dialogue with patients about the risk of stroke and the potential benefits of treatment. Don’t Wait to Anticoagulate is helping us achieve just that.
“The information materials and toolkits produced as part of the project have been developed to assist both patients and clinicians in their decision-making ultimately leading to a personalised package of care. It would have been very difficult to have successfully rolled out a project of this sort without the support and expertise of the West of England AHSN.”
Don’t Wait to Anticoagulate: the lowdown
The risk of stroke is five times greater in patients with AF, and strokes suffered by patients with AF tend to be more severe. An AF related stroke means a patient is twice as likely to die, more likely to become seriously disabled, and more likely to end up bed ridden and in a nursing home.
Working with a range of industry partners, we developed the Don’t Wait to Anticoagulate project, featuring a range of toolkits for clinicians, pharmacists and patients to support shared decision making and optimise anticoagulation for patients with AF. This is supported by quality improvement (QI) methodology and clinical skills training
During phase one, we designed and tested the project with 11 GP practices. It is now being tested across the Gloucestershire CCG area, with detailed evaluation by the University of the West of England to follow from June 2016.
Phase three will see wider roll-out across other CCG areas within the West of England and in partnership with other AHSNs across the country. We are working with the University of Bath to model the impacts of Atrial Fibrillation management on health and social care systems.
In phase one (complete) and phase two (ongoing) we have seen improved patient care, increased confidence in shared decision, and improved working practices in the AF care pathways through a multidisciplinary approach.