Atrial fibrillation (AF) programme
Our AF programme aims to support clinical commissioning groups (CCGs) to lead local improvements to the pathway of care for AF patients, prevent AF-related strokes and associated mortality, and realise savings.
AF affects around a million people in the UK and is associated with one in eight strokes overall. More than half these strokes could be averted by oral anticoagulation, but the proportion of the population at risk who are on anticoagulant drugs has improved by only 1.5% per year over the last quarter century.
Increasing identification and delivery of evidence-based care for people with known AF in the UCLPartners region could:
- Identify a further 25,000 people with AF who could be on preventative strategies
- Prevent approximately 700 strokes annually
- Save 210 lives and avoid around £7m in costs
- Avoid the associated distress and disabilities caused by strokes
Read more about our eight current work streams.
A London-wide collaborative partnership of the three Academic Health Science Networks, the London Clinical Networks and AF charities was created in 2016 to tackle AF issues through better detection and treatment options, using evidence-based interventions.
The objectives of this work are to:
- Increase the detection of people with undiagnosed AF
- Increase the proportion of people with known AF and at high risk of stroke who are receiving anticoagulation therapy
- Improve the quality of anticoagulation services
One of the outcomes of the programme has been creation of the Atrial Fibrillation Toolkit; which brings together the latest clinical guidance, performance data, case studies and support for clinicians and commissioners in an electronic format.
The AF toolkit has been recognized as an excellent framework to showcase work across the national AF AHSN network and is currently being adapted for this by the national AF AHSN programme team.
As part of the national AF programme and UCLPartners commitment to increasing identification and delivery of evidence-based care for people with known AF, we are engaged in a range of public awareness activities.
During Heart Rhythm Week (5-11 June 2017) and Global AF Aware week (20-26 November 2017) UCLPartners ran a series of events providing free 30 second pulse checks for the general public (as part of the pan-London AF programme). Over 1,500 people within the UCLPartners geography were screened for AF using a mobile single lead ECG AliveCor Kardia device and taught how to check their own pulse manually. Ongoing events are planned in order to help identify a further 25,000 people with AF who could be on preventative strategies.
A consensus statement was developed and finalised in 2015 following feedback from peers in the Interdisciplinary group for Stroke Prevention in AF (iSPAF) hosted by NHS England, the Royal Pharmaceutical Society, the Royal College of General Practice and Public Health England.
It was developed to:
- Identify gaps in evidence and resolve these through appropriate registries and research development
- Provide guidance on opportunistic screening of intermittent AF in the over 65s through consensus of UCLPartners clinicians while additional evidence is growing.
The statement was launched in October 2015 across UCLPartners and shared with Academic Health Science Networks (AHSNs) and other stakeholders. We continue to share the statement to influence new screening guidelines.
We have co-developed AF quality standards to help measure outcomes of AF care across the whole AF pathway, from screening and detection through to ongoing monitoring and support.
Smart clinical management tools – The Queen Mary University of London (QMUL) Clinical Effectiveness Group have developed and implemented smart clinical management tools across a range of therapy areas. These tools support clinical decision making and provide key diagnostic and treatment indicators in a simple format to achieve optimal patient care.
The APL tool for AF – This tool has been implemented across five north east London Clinical Commissioning Groups (CCGs) This tool rapidly identifies high risk patients with AF who are not taking anticoagulants. It enables a priority patient list to contact for reviews. It also automatically calculates a HAS-BLED score (a score that estimates risk of major bleeding for patients on anticoagulation for AF).
The AF dashboard – This has been developed as part of the data analysis work the QMUL Clinical Effectiveness Group are undertaking for CCGs who have implemented the AF APL Tool. This data analysis is conducted to ensure a better understanding of clinical activity, patient populations and developing health trends.
The dashboards are used by GP practices, GP federations, healthcare networks/clusters, CCGs, and local authority public health departments to improve clinical services and local health quality.
During 2016-17 UCLPartners, as part of the pan-London AF programme, delivered a series of Community of Practice events, to provide a platform for stakeholder engagement, spread and adoption of best practice and optimal management of patients with AF. These pan-London collaborative events will continue to be held bi-annually to support stakeholders working in stroke prevention.
In addition to these bi-annual events UCLPartners long standing AF Community of Practice meetings will continue to be held quarterly. The aim of this event is to provide a platform for our stakeholders to engage and share learning from ongoing AF interventions and approaches to optimal management.
Contact Geraldine Long for further details
UCLParters is currently developing a program of work with its CCGs to support and optimize treatment options for patients with AF. Building on existing work being carried out with Redbridge CCG we are developing organisational frameworks to support primary care clinicians to initiate anticoagulation therapy in primary care settings. This includes development of educational support, governance mechanisms and the role of specialist services so that patients who are at risk of stroke can be more effectively detected and managed appropriately.
According to the National Cardiovascular Health Intelligence Network, the estimated number of people aged 64 and over with undiagnosed AF in the UCLPartners geography is 31,931. Left undetected and untreated, this presents a risk of around 950 AF-related strokes per year.
Early detection and monitoring can pave the way for better treatment of people with atrial fibrillation; avoidance of the illness, disability and premature death associated with AF-relates stroke and; major healthcare savings. Conservatively an AF-related stroke costs the NHS £12,228 (NICE CG 180) in the first year.
UCLPartners and Academic Health Science Networks across the country are supporting NHS England in their commitment to centrally fund a number of mobile ECG devices to help identify Atrial Fibrillation (AF) through mobile ECG technology. This is an exciting opportunity to build on work already underway across the UCLPartners geography to improve care for people with AF and reduce AF-related strokes. Furthermore, it will contribute to learning nationally on how digital technologies can be used to accelerate diagnosis, and potentially reduce the number of unnecessary, more expensive diagnostic procedures.
UCLP AHSN is delivering 670 AliveCor Kardia mobile ECG devices across the region in response to expressions of interest received earlier last year.
figure 1 – AliveCor heart monitor
How to register and use you AliveCor Kardia Mobile ECG device
Many GP practices and LPCs are implementing the AliveCor Kardia device and app as part of the NHS England AHSN Atrial Fibrillation programme. AliveCor Kardia devices are being distributed by UCLPartners with support from regional leaders and Clinical Commissioning Groups.
The device provides:
- A single-lead rhythm strip indicating whether a person has a normal or abnormal heart rhythm using 1 small piece of equipment and a smartphone or tablet.
- The flexibility to save and share a copy (pdf format) of the results by nhs.net email that can be uploaded into a patients’ electronic health record.
- Potential to increase the number of people on the quality and outcomes framework (QoF) atrial fibrillation register.
All devices need to be registered.
Resources to improve detection of AF
- Kardia training and registration video
- Kardia training and registration slide set
- AliveCor video on using Kardia mobile
- Mobile ECG project guidance document
- AHSN Network guidance flowchart explaining the recommended procedure and information governance for using AliveCor Kardia device and app
- Patient privacy notice on the use of AliveCor Kardia mobile device
- Patient screening awareness notice
- Arrhythmia Alliance ‘Know your Pulse’ video
- “Starting Anticoagulation with Jack” from Wessex AHSN Limited on Vimeo