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.

The primary purpose of our AF programme is to improve and save lives by enabling people with AF to access the most innovative, evidence-based interventions.

Our objectives are to:

  • Improve identification and management of AF in primary care
  • Address knowledge gaps around optimising adherence to anticoagulation
  • Address knowledge gaps around bleeding associated with anticoagulation

The challenge

AF affects around a million people in the UK and is associated with one in eight strokes overall, and one in three in people over 80 years of age. 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.

Currently the identified prevalence of known AF across the UCLPartners region is only 1.07% (61,764 persons according to Quality and Outcomes Framework (QOF) data 2012/13), much below the national average of 1.52%. 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

Progress to date

We are progressing the delivery of our objectives through a number of different programmes. Our progress to date is outlined below.

New AF toolkit

A London-wide partnership of the three London Academic Health Science Networks, the London Clinical Networks and AF charities is working to tackle AF issues through better detection and treatment using evidence-based interventions. This includes the creation of the Atrial Fibrillation Toolkit; an online interactive resource, which includes examples of best practice under three themes: DETECT, PROTECT and PERFECT. Containing case studies and exclusive resources, the toolkit includes:

  • An extensive review of mobile detection technology, including single lead ECGs
  • The AF improvement cycle – developed to provide clinicians and commissioners with a clear process to follow when deciding on and developing improvements in AF care
  • Clear, concise infographics for each London Clinical Commissioning Group outlining its latest performance data under the themes of DETECT, PROTECT and PERFECT
  • Nine opportunity areas for improving the detection, treatment and ongoing management of AF, supported by case studies and practical tools
  • Anticoagulation myth busters
  • Anticoagulation adherence support for patients.

You can find the toolkit at http://bit.ly/london-af.

Camden CCG AF case finding and management

Adapting work from north east London led by Queen Mary University of London (QMUL) Clinical Effectiveness Group, UCLPartners supported Camden CCG in delivering an AF case finding and management project over six months. This led to an additional 138 people with AF being put on anticoagulation between October 2013 and April 2014. This is expected in turn to prevent five strokes every year.

Consensus statement on asymptomatic screening

A consensus statement was developed and finalised 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.

Primary care education

This project helped build local relationships across primary and secondary care and respond to the demand from primary care for education sessions on CVD – including a particular focus on AF. Following the completion of this project, UCLPartners have continued develop this area by producing a core primary care CVD training package, which can be offered to CCGs in the UCLPartners region through the pan-London AHSN collaboration. 

Quality standards

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.

AF clinical management tools and dashboard

Smart clinical management tools – The 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 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.

Community of Practice

The AF community of practice meets quarterly with the aim of providing a platform for stakeholders to engage and share learning from ongoing AF interventions and approaches to optimal management.

Pan-London AF programme overview

Since August 2015, UCLPartners has been working with London and national AHSNs to develop a pan-London AF initiative to spread successful UCLPartners projects.

The objectives of the pan-London AF programme are:

  • To increase the proportion of people with known AF and at high risk of stroke who are receiving anticoagulation therapy.
  • To improve the quality of anticoagulation
  • To increase the detection of undiagnosed AF

It is expected that over five years the programme will save 350-450 lives and prevent ~1,700 strokes.

GP initiation

We are working with our partners to develop an organisational framework to support GP initiation, including educational support, governance mechanisms and the role of specialist services.

National Bleeding Registry: ORANGE study

Led by Barts Health NHS Trust this study aims to expand the national anticoagulation bleeding registry, building detailed knowledge of bleeding risks and outcomes. As of March 2016, 23 hospitals have enrolled in the ORANGE study with data on 751 major bleeds – 88% on vitamin K antagonists (VKAs) and 12% on direct oral anticoagulants (DOACs).

Working with our partners

UCLPartners AF programme is working with all national AHSNs, the Strategic Clinical Networks (SCNs), Public Health England, CCG collaboratives, the AF Association and other UK-based AF charities, pharma colleagues and acute providers.

Programme leadership

For more information on this programme contact Geraldine Long, Project Manager for AF.