Improving detection and treatment of atrial fibrillation in primary care

Atrial fibrillation (AF) is the most common form of arrhythmia, affecting 4 in 100 people over 65.

It affects 1 million people in the UK and is associated with 1:8 strokes (1:3 in people 80+). More than 50% could be averted by oral medicines called anticoagulants (OACs). However, the proportion of patients receiving OACs varies.

We examined the determinants of why anticoagulation varies between GPs, and implemented intervention programmes to improve medicines optimisation.

Our evaluation of primary care interventions led to:

• Implementation of pulse checks in over 65s (found to improve AF detection) across all CCGs in North East London STP;
• An AF toolkit being developed for commissioners and clinicians;
• Development of an Active Patient Link AF ‘virtual patient review’ tool to identify patients not yet anticoagulated. GPs and in-practice pharmacists in Redbridge CCG used this tool in 2018, and subsequently become second most improved of 209 CCGs in England in national Quality and Outcomes framework 2018 for AF treatment;
• An increased evidence base for the effectiveness of early detection and anticoagulation of AF patients, supporting national implementation.

Improvement in detection of AF has led to an estimated reduction of 45 strokes over three years due to anticoagulation.

Barts Health NHS Trust

Queen Mary University of London

UCLPartners

Clinical Commissioning Groups in north central, inner and outer north east London