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Clinical review of atrial fibrillation patients saves lives

A review of 135,000 patients with atrial fibrillation (AF) at more than a 1,000 GP practices led to over 25,000 medical interventions, which is believed to have prevented hundreds of strokes and saved the NHS millions of pounds. This extensive service was carried out by Interface Clinical Services during 2015 with help from industry sponsorship.

AF is one of the most common forms of abnormal heart rhythm and a major cause of stroke. The abnormal rhythm prevents the heart from pumping effectively allowing blood to pool in the upper chambers called the atria. This pooling can result in the formation of a clot which can break loose and cause a stroke.

Professor Mark Baker, NICE’s Director of Clinical Practice, commenting on the AF NICE guidance, said: “We know that AF increases the risk of strokes by up to five times. It’s estimated that the condition causes around 12,500 strokes each year. We also know that around 7,000 strokes and 2,000 premature deaths could be avoided every year through effective detection and protection with anticoagulant drugs that prevent blood clots forming.”[1]

Mike Drakard CEO of Interface Clinical Services, whose organisation worked with the GPs on this review service, said: “This was one of the largest projects we have undertaken and based on NICE’s figures we believe that this review has prevented more than 800 strokes and over 200 deaths. The average cost of treating a stroke, rehabilitation and community support is at least £24,855[2], therefore, conservatively we estimate a saving of over £20 million for the NHS as a whole.”

Key results of the service were:

Of the 36,327 patients who were not taking any type of oral anticoagulants - 12,516 were prescribed VKA - vitamin K antagonist - therapy and 4,189 were prescribed the new non-VKA anticoagulant drugs. Of the 89,455 patients already on oral anticoagulant medication – 8,774 moved from VKA to the new anticoagulant drugs - NOACs - and 2,743 on the new anticoagulant drugs had their dose adjusted or were taken off the drug due to clinical issues. Those patients who were not taking their drugs regularly were sent letters to encourage adherence. The review also highlighted patients who needed secondary care referrals to a haematologist.

The GP in consultation with the patient then made the decision on the best treatment for that patient going forward.

[1] https://www.nice.org.uk/guidance/cg180/documents/thousands-of-strokes-in-people-with-common-heart-rhythm-disorder-are-avoidable-says-nice

[2] National Audit Office. “Progress in improving stroke care, Report on the findings from our modelling of stroke care provision” (February 2010). NAO Report (HC 291 2009-2010). Retrieved from https://www.nao.org.uk/wp-content/uploads/2010/02/0910291_modelling.pdf

This was posted in Bdaily's Members' News section by VPR .