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Better medicines management could mitigate UK’s predicted 44% stroke increase

A study from King’s College London has predicted a 44% increase in stroke in the UK over the next 20 years. However, the UK’s leading clinical services provider, Interface Clinical Services, has said that this rise could be reduced by improved medicines management. According to the Stroke Association, there are currently more than 100,000 strokes in the UK each year . While certain lifestyle factors, such as obesity and smoking, are risk factors for stroke, there are other conditions, such as atrial fibrillation and diabetes, that are causes of stroke that can be managed more effectively with the correct medication regime. An example of this is Interface’s long-term clinical review into patients with AF which has prevented nearly 2,000 strokes.

Patients with AF are five times more likely to have a stroke, and when a stroke is related to AF there are increased levels of mortality, morbidity, disability, and longer hospital stays. Around 7,000 strokes and 2,000 deaths could be prevented every year through effective detection of AF, and treatment with the right anticoagulant drugs . Multiple audits across the UK have confirmed that anticoagulant medications used to reduce the risk of AF-related stroke are under-prescribed .

Interface’s clinical pharmacists work with primary care practices and use their expertise in pharmacology to make recommendations to GPs about the most effective medications for patients. The pharmacists are also able to use Interface’s proprietary software to interrogate primary care patient databases to conduct large-scale patient reviews.

An ongoing long-term clinical review into AF, being conducted by Interface in collaboration with over 2,000 GP practices across the UK, has so far found that more effective medicines management for AF patients has prevented 1,826 strokes. In addition, the cost benefit of this review to the NHS was estimated at over £28 million. Interface believes that continued collaboration between GPs and clinical pharmacists in reviews like this could continue to reduce the risk of stroke for AF patients, and considerably reduce the burden of increasing strokes on the NHS.

Dr John Wearne, a GP from Cheshire who took part in the review commented, “The Interface pharmacist analysed the data and identified the patients that we should review together. I found their input invaluable as we would never have had the time or resources to undertake a review of such complexity which ultimately has such a significant effect for our patients.”

Interface has also carried out multiple reviews into type-2 diabetes, a key risk factor for stroke, including a recent study published on BMJ Open . This study found that the pharmacist-led review resulted in a significant increase in the number of diabetes patients receiving all of the NICE-recommended nine key care processes. These targets are key to the effective management of type 2 diabetes and the reduction of serious complications such as heart disease and stroke. Dr Carl Deaney, a GP from Lincolnshire involved in this diabetes review commented, “If type-2 diabetes is not managed effectively then patients can suffer from major complications, like stroke. During Interface’s review we found that significantly more of our patients were receiving the NICE-recommended key care processes for type-2 diabetes, which will reduce the risk of stroke for them in the long term.”

Mike Drakard, CEO of Interface, commented on the predicted increase in stroke in the UK, “As people get older they are increasingly at risk of stroke. However, we believe that medicines management is going to be key to mitigating this risk in the future for the UK’s ageing population. Effective management of atrial fibrillation and diabetes, as well as other conditions like obesity, could significantly reduce the burden of stroke treatment and care on the NHS.”

i) “The Burden of Stroke in Europe” https://www.kcl.ac.uk/newsevents/news/newsrecords/2017/05-May/Report-predicts-growth-in-stroke-rates-for-UK.aspx ii) “State of the Nation Stroke Statistics 2017” https://www.stroke.org.uk/sites/default/files/state_of_the_nation_2017_final_1.pdf
iii) https://www.nice.org.uk/guidance/cg180/documents/thousands-of-strokes-in-people-with-common-heart-rhythm-disorder-are-avoidable-says-nice iv) National Clinical Guideline Centre. Atrial Fibrillation: the management of atrial fibrillation. Clinical guideline. Methods, evidence and recommendations. June 2014. Commissioned by the National Institute for Health and Care Excellence (full version) v) Langran T, Nanda N, Bataveljic A, et al. Supporting the management of type 2 diabetes with pharmacist-led reviews: an observational analysis. BMJ Open 2017;7: e013451. doi:10.1136/ bmjopen-2016-013451. http://bmjopen.bmj.com/content/7/3/e013451

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