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Lifesaving stroke prevention initiative making a significant impact

An initiative to optimise care for people with atrial fibrillation by monitoring blood pressure and cholesterol – high risk factors for heart disease, stroke and dementia, has shown considerable benefit to patients in North East London.

An initiative led by Barts Health NHS Trust, Barking, Havering and Redbridge Clinical Commissioning Group, UCLPartners and the Queen Mary, University of London, Clinical Effectiveness Group has used specialist cardiovascular pharmacists to identify and optimise treatment for people with Atrial Fibrillation (AF) – an irregular heart rhythm that increases risk of stroke. At the same time, using the UCLPartners Proactive Care Frameworks1, the pharmacists optimised the treatment of other risk factors for heart attack, stroke, and dementia in these patients – high blood pressure and high cholesterol.

AF is responsible for approximately 20% of all strokes and can leave survivors with life changing consequences. The work done by UCLPartners in collaboration with healthcare services in North East London over the past few years have resulted in a significant increase in the number of people living with AF receiving anticoagulants – a blood-thinning medication to prevent clots that can more than halve the risk of having a stroke.

Impact

As of October 2021, over 800 out of approximately 1000 patients with AF had been reviewed in Barking, Havering and Redbridge. Of these 180 patients were subsequently anticoagulated, which has shown an improvement of 7% (above the London annual improvement average of 2% prior to this initiative). ‘Numbers needed to treat’ calculations show that for every 25 patients treated with an anticoagulant, 1 stroke will be prevented every 18 months2. Based upon this figure, the initiative will prevent 7 strokes every 18 months. This will provide the NHS a cost saving of roughly £175,0003.

Patient centred approach

The disruption to AF services caused by the pandemic has meant opportunities to prevent, detect and protect against AF have been missed. However, by using the UCLP Proactive Care Frameworks patients at risk have been identified, and pharmacists have worked with GPs to prescribe anticoagulants, following patient consultation. Patients at high risk of developing heart disease are also offered blood pressure and cholesterol checks and where appropriate, given advice on self management, lifestyle advice on diet and exercise and medication. This will prevent further heart attacks, strokes and cases of dementia in these patients. The programme has illustrated the tremendous value multidisciplinary groups working together and providing holistic support for people can bring.

Figure 1 below shows an example of a 79 year old male patient reviewed through this initiative, who was subsequently, also identified as having high blood pressure and cholesterol which needed treatment:

Figure 1: Patient journey

References for copy above Figure 1

1https://uclpartners.com/proactive-care/

2https://www.thennt.com/nnt/warfarin-for-atrial-fibrillation-stroke-prevention/

3https://www.nao.org.uk/wp-content/uploads/2010/02/0910291_modelling.pdf

For more information, please contact Mital Patel, Specialist Cardiac Pharmacist or Sotiris Antoniou, Consultant Pharmacist, Cardiovascular Medicine via bartshealth.afoptimisation@nhs.net.