Increasing detection and treatment for atrial fibrillation

We are working to prevent Atrial Fibrillation (AF) related strokes and associated mortality and morbidity by supporting clinical commissioning groups (CCGs) to improve care pathways for people with AF.

AF is a common type of irregular health rhythm that can increase risk of stroke. AF affects around a 1.2 million people in the UK and is associated with one in five strokes. However, up to 25% of people with AF remain undiagnosed and there is variability in the proportion of people with AF who are prescribed anticoagulant therapy, which can help to reduce risk of stroke.

By March 2020, our AF programme aims to:

  • Improve early detection of AF. One of the ways we will do this is by supporting the roll out of NHS England funded AF detection devices, to achieve 85% of expected prevalence in all CCGs
  • Support initiation of anticoagulation in people with AF who are at risk of stroke to achieve 84% treatment in all CCGs
  • Optimise patient pathways to facilitate early diagnosis and treatment, and support improved adherence to treatment long-term

Read more about our six current work streams.


Pan London AF toolkit

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 were 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 (including CCG infographics), case studies and support for clinicians and commissioners in an electronic format.

The AF toolkit has been recognised as an excellent framework to showcase AHSN AF work across the country and is currently being being updated and configurated into a National AF Toolkit expected publication date 2020.

View the toolkit


Quality standards

Working as a member of the London CVD Prevention Partnership 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.

Pan London ambitions are by 2023 to:

  • Detect 85% of expected population with AF without exceptions
  • Protect 87% of all people with AF and a CHA2DS2Vasc score of 2 or more with anticoagulant therapy
  • Perfect anticoagulant pathways to ensure 90% of people with AF are considered for anticoagulant therapy within one week of referral

More information on the CVD Prevention Partnership can be found here


AF clinical management tools and dashboard

Below are a selection of tools and resources developed to support healthcare services to understand AF prevalence and support clinical decision making.

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.

Read more about the work of the Clinical Effectiveness Group


Primary care initiation of anticoagulation therapy for stroke prevention

We are currently developing a programme of work with CCGs in our region to support and optimise 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.

Read the ‘Guide for Primary Care Initiating anticoagulation for stroke prevention in non-valvular Atrial Fibrillation’ here.


Mobile ECG devices

UCLPartners and AHSNs across the country are supporting NHS England in their commitment to centrally fund a number of mobile ECG devices to help identify AF through mobile ECG technology. This work 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.

During 2018/2019 UCLPartners delivered 548 AliveCor Kardia mobile ECG devices to community settings. The effectiveness of these devices in helping to detect those with AF is currently being evaluated by the AHSN Network.


Virtual Clinics from NHS England

NHS England has funded a national programme to improve the uptake of anticoagulation for those with AF. The programme aims to ensure all those with AF not currently prescribed anticoagulant therapy are reviewed by a specialist in the GP Practice. The programme is being run across 23 areas of the country with the highest rates of AF, five of which are in the UCLPartners region.

The programme is being delivered from March 2019 – March 2020. A formal evaluation has been commissioned by NHS England and will be published during 2020/21.

Read more about NHS England AF demonstrator site programmes

More information on the UCLPartners Virtual Clinics work is available on the North London Partners site here

Below is a recording of the webinar held on the virtual clinics in North Central London from 12 September 2019


For more information, please contact Hawa Choudhury, Project Lead for Atrial Fibrillation, Hawa.Choudhury@uclpartners.com