ahsn national atrial fibrillation programme · the impact that could be made if the review work was...

AHSN National Atrial Fibrillation Programme

Faye EdwardsNational Programme Manager, Atrial Fibrillation

Helen Williams FFRPS, FRPharmSConsultant Pharmacist for CVD, South LondonClinical Advisor for Atrial Fibrillation programme

@AHSNNetwork #AHSNs

Why are the AHSNs focusing on AF?

Expected prevalence of AF in England

1.4 MillionGP registered population with AF in England 2016/17

983,300Estimated GP registered population with undiagnosed AF in England 2016/17

422,600GP registered high risk AF patients not anticoagulated

177,800

@AHSNNetwork #AHSNs

Why are the AHSNs focusing on AF?

• Across England AF is sub-optimally detected and managed, resulting in avoidable strokes

• AF-related stroke represents a significant burden to patients, carers, the NHS and Social Care.

£46,039

The average cost of an AF related stroke to the NHS and Social Care in the first 5 years

@AHSNNetwork #AHSNs

AHSN Network AF national targets 2018-2020:

• Reduce the incidence of stroke in people with known AF by 4,000 and save 1,000 lives

• Add an additional 134,000 people to the AF register to achieve 85% of expected prevalence

• Treat 100,000 more people with AF with anticoagulant therapy, increasing the proportion treated from 81% to 84%

• Deliver savings of over £84million for the NHS and over £100million for social care

@AHSNNetwork #AHSNs

Stages of an AF pathway, and opportunities for improvement

@AHSNNetwork #AHSNs

Case finding DiagnosisTherapy

TreatmentLong-term

management

DETECT PROTECT PERFECT

Local Engagement

ENGAGE

BEHAVIOUR & CULTURAL CHANGE MANAGEMENT

AF Business case model (ICHP)

Diabetes Pulse checks (NENC)

GP-upskilling / Clinical template and algoithm (East Midlands)

Jack video (Wessex)

Virtual clinics (HIN)

Pan-London AF toolkit

AF landscape tool (Greater Manchester)

AF Awareness campaign top tips (Innovation Agency)

Don’t wait to anticoagulate (West of England)

AF Cardex (NENC)

AF Quality Standards and Dashboard (UCLP)

Pop-up AF educational events (ICHP)

AF Stroke Prevention PathwayAHSN Best Practice

@AHSNNetwork #AHSNs

AF Detection Device Project

6,000 AF detection devices distributed nationally

Opportunistic case finding in a range of community and healthcare settings

AF programme team have produced guidance on distribution, information governance and integration into local care pathways

Online registration form provides centralized data collection

Project evaluation due to publish late 2019

National roll out of Unique project aims to understand the best approaches to the spread and adoption of this technology

@AHSNNetwork #AHSNs

AF detection devices – Where?• GP practices

• Community pharmacy

• Community and district nursing

• Nursing homes

• Urgent care centres

• Mental health services

• Podiatry

• Out patient clinics

• Optometry

• Fire service ‘Safe and Well’ Checks

@AHSNNetwork #AHSNs

@AHSNNetwork #AHSNs

Ischaemic strokes in patients with known AF (Charing Cross)

Imperial Stroke Database, Sentinel Stroke National Audit Programme (SSNAP) - July 2014 – January 2016

1265 ischaemic strokes

266 (21%) had known AF

prior to stroke

Anticoagulati

on11543%Aspirin

only82

31%

Nothing

6926%

115 on anticoagulation

103 on warfarin

88 had INR < 2

15 had INR > 2

12 on DOAC

In 8, evidence of suboptimal dose

or intake

96 / 115 (83%) had inadequate

anticoagulation control prior to stroke

Perfecting the Anticoagulant pathway?

@AHSNNetwork #AHSNs

AF Detection and Management

Detect – Find More!

• Pulse checks

• Device rollout

• Referral pathways to confirm the diagnosis

Protect –Treat More!

• Initiating anticoagulation therapy

•Education and training of primary care workforce

•Virtual clinics

Perfect – Treat Better!

•Optimise a/c therapy

•Patient self-testing and self monitoring

•Adherence support

@AHSNNetwork #AHSNs

Community Pharmacy AF Screening and

One-Stop AF Clinic

Possible with thanks to:

Sotiris Antoniou FFRPS, MRPharmS, Ipresc

Consultant Pharmacist and Pharmacy Lead at UCL Partners

@santon74

http://www.nellpc.org.uk/

Care City

Innovation Test Bed

Phase 1

Community Pharmacy Screening

In February 2017 we launched a pilot to screen

for AF in Community Pharmacy

Target Population: Over 65 years

Intervention: Pulse check using the Kardia Mobile

Test Site: 13 pharmacies in Waltham Forest.

Pilot Achievements:

• Community pharmacies were identified to be in

a suitable position in the pathway to support

early identification of heart rhythm problems

• Community pharmacists received a positive

response from patients across the pilot

Assessment

Result

Number of

Patients

Normal 316

Possible AF 28 (7%)

Unclassified 43 (11%)

387Patients

Screened

Time from detection to treatment for patients

diagnosed with AF can take up to 3 months

• Onward referral after screening involves:

o A GP appointment after screening

o Attending the acute trust for a 12-lead ECG

o A referral to cardiology

o An appointment at the arrhythmia clinic

o Blood tests

o An appointment to start anti-coagulation

We identified an opportunity to test a model of rapid referral of newly identified

cases of AF or actionable AF from the community

Phase 2

One Stop AF Clinic

Based on learning from the first phase we

wanted to test a new model of rapid referral

The aim of the pilot was to:

• Continue to evaluate impact of opportunistic pulse checks using Kardia Mobile on heart

rate abnormality identification in the community

• Evaluate the feasibility of the rapid referral of patients identified with atrial fibrillation in the

community, into an anticoagulation clinic for diagnosis confirmation and treatment

initiation

• Evidence the value of a “one-stop” AF clinic, for diagnostics and initiation of

appropriate anticoagulation treatment for patients with newly diagnosed AF

We launched a 6 month pilot with screening in 21 pharmacies and a One Stop AF

Clinic at Whipps Cross University Hospital in October 2017

There are three main elements to the model…

Pulse Check in Community Pharmacy: screening for heart rhythm

irregularities, specifically AF, using Kardia Mobile device.

Triage and Booking: Arrhythmia Specialist nurse reviews abnormal ECG

results, books blood test for patient and invites patient in for an appointment as

appropriate.

One Stop AF Clinic and Discharge: Same day diagnostic tests, definitive

diagnosis, risk assessment, management plan and commencement of

appropriate stroke prevention. Patient referred for ongoing management to

appropriate long term health care provider.

1

2

3

We aimed for patients to be seen at the One Stop AF Clinic within two weeks of

referral

672 patients were screened for AF using Kardia Mobile

562 65 45

Normal Unclassified Possible AF

Possible AF (7%)

Unclassified (10%)

Normal (84%)

110 Referrals

65 45

Unclassified Possible AF

Out of 110

74 triaged out

55 19


Possible AF (26%)

Unclassified (74%)

*Including 4 known AF

Appointments were offered to

35patients

10 25


Possible AF (71%)

Unclassified (29%)

* Included 2 that were found to have

known AF and were anticoagulated

so therefore did not come to clinic.

Out of 35

30 Patients attended the clinic

1Patient declined

2DNAs

2inappropriate referrals

*1 patient with known AF made it to the clinic

9 unclassified

21 possible AF

1 possible AF

1 unclassified

1 possible AF

2 known AF

➢ Underutilised resource

➢ Convenient/accessible location

➢ Potential access to hard to reach groups

➢ GP forward view advocates sharing demand across Primary Care

➢ Feedback loop for ongoing treatment management

➢ Future of pharmacy shifting from dispensing to “high street clinic”

Why was community pharmacy a good position

for screening?

Some pharmacies were innovative in recruiting using flu clinics, prescription

flagging and screening at local events or care homes

• ECG trace quality

How did we respond?

➢ We developed a Kardia placemat to try

and standardise the approach

➢ We circulated instructional videos

➢ We visited pharmacies to re-train and

understand how they carrying out the test

Findings

➢ Real time record sharing and remote ECG review allowed efficient, rapid analysis and

appointment booking

➢ Reduced unnecessary appointments by sifting out non-concerning traces

➢ Allowed for blood tests in advance of appointment so patients ready for treatment initiation

if needed

➢ Enabled us to monitor and manage the flow of referrals into the clinic and instruct

pharmacies to screen more or less

What was good about our approach to triage and booking?

One patient was on the bus home from the pharmacy when she received a call to

book into the One Stop AF clinic.

➢Multidisciplinary working -arrhythmia nurses, physiologists, clinical

pharmacists in one clinic

➢Positive patient experience

➢Sustained strong professional engagement and enthusiasm

➢Opportunity for same day diagnostics and treatment

➢Discovery of AF and other unknown conditions

What was good about our One Stop AF clinic?

Multi-disciplinary working is bringing down waiting time

“It’s great working in a multidisciplinary way – we can put them straight into the next

expert. That is really bringing down those waiting times”. (Arrhythmia Nurse)

Waltham Forest participants –

“The test brought the problem to light, it wasn’t really a concern before. Felt

heart beating first and fluctuations but just blamed it on deaths in family and

experiencing the trauma. Grieving mode but now know there is some problem

with heart and can now work towards fixing it”

Waltham Forest participants

“The test has brought me closer to the pharmacy…

sometimes it can be difficult to get an appointment with GP or even if you do

get an appointment they say come back next week to speak about the

problem. When it’s like that I may as well go to Whipps (emergency). So

to go to pharmacy saves time, I know them very well so would be happy

with going there instead or as well as”

Community Pharmacy AF

Screening and One-Stop AF Clinic

Possible with thanks to:

Sotiris Antoniou FFRPS, MRPharmS, Ipresc

Consultant Pharmacist and Pharmacy Lead at UCL Partners

@santon74

http://www.nellpc.org.uk/

Ellie Wells

Programme Manager

[email protected]

[email protected]

KSS AHSN Alliance for AF Project -

Phase 1 (General Practice)

mailto:[email protected]


• Jen Bayly Cardiovascular Lead

• Richard Blakey Clinical Lead

• Ellie Wells Programme Manager

• Justin Rocliffe Senior Analyst

• Contact us: [email protected]

Our Team


KSS AHSN Alliance for AF Project – Phase 1

• Project looking at the Known AF population and identifying patients eligible for

anticoagulation therapy

• We collaborated with 3 independent review organisations to work in 29 GP Practices across

Kent, Surrey & Sussex (KSS)

• The project ran from December 2016 to May 2018 and through this lengthy learning process,

we are now able to share complete and validated data

Headlines: Impact

• The project identified 1,390 individuals who were eligible for anticoagulation and would benefit from a change

of treatment to reduce their risk of AF-related stroke.

• By the end of May 2018, 503 individuals had had their medicines optimised by their GP Practice (equating to

around 1/3 of patients):

• 14 AF-related strokes have been avoided

• Avoiding costs to state-funded Health & Social Care of over £380,000

• The impact would be far greater if the remaining 887 individuals were optimised on anticoagulation therapy. A

further 24 AF-related strokes could be avoided in 1 year, with an additional cost saving of over £620,000 over a

5 year period.

Headlines: Opportunity

The impact that could be made if the review work was implemented at scale

• If we extrapolate the data for the KSS population of 4,739,731 based on the current impact with only around 1/3 of

the identified eligible patients being treated this could potentially save 202 strokes in 1 year, with a potential cost

saving of £5,691,911 over a 5 year period.

• If this data was extrapolated for the KSS population and scaled so all the eligible patients were treated, 559 strokes

could be saved in 1 year, with a potential cost saving of £15,729,139 over a 5 year period.

Phase 1 Dashboard

• Check/Review/Protect

• Available at GP Practice, CCG & STP level

Key findings & learning

• Reviews need to be carried out by a prescriber

• The impact of this work would be far greater if all of the eligible patients were treated

• We are working with the participating GP Practices to provide data of the patients that still

require review – hopefully picking up the remaining 2/3

• We now plan to implement a virtual clinic anticoagulation review model to support practices with the Known AF Population

Next steps…

• We will continue to work closely with STPs, CCGs, GP Practices and Alliance

members to provide Primary Care with a variety of interventions and education

• Improve the detection of patients with AF using 1 Lead ECG devices, performing

timely anticoagulation reviews and ensuring patients are receiving appropriate care

• Implement virtual clinics model following success in Lambeth CCG

• Implement a case finding/ AF audit tool on GPs electronic systems, starting with a pilot study of 4 GP Practices in KSS

Welcome to KSS AHSN’s whole

staff away day!

3 October 2018

Thank you

@HINSouthLondon

www.hin-southlondon.org

Innovative Settings

for AF Detection

Alex Lang

Stroke Prevention Programme

Health Innovation Network

@_AlexLang_

@HINSouthLondon www.hin-southlondon.org


45


So what healthcare and

non-healthcare settings

do we target? target?


• People with a SMI have a life expectancy 10-15 years less than the general pop

• Antipsychotic meds

• QT interval

• Physical health checks


• High risk population

• Familiar with irregular pulses

• Kardia

• Phone call and email trace to GP


• Student nurses

• Environment

• Timely 12 lead

• Nurse led one stop clinic


• WatchBP

• Replaced existing device

• New prisoners

• High proportion of remand prisoners


Possible AF Pulse checks

Detection rate

Detection Prevalence

Mental Health

19 611 3.1% 1 in 32

Podiatry 14 386 3.6% 1 in 27

Urgent Care 3 391 0.8% 1 in 130

Prisons 1 250 0.4% 1 in 250

@HINSouthLondon

www.hin-southlondon.org

Any questions?

Alex Lang

Stroke Prevention Programme

Health Innovation Network

@_AlexLang_

Health-system-wide approach for improvement and innovation in the management of people

with AF through medication optimisation

Dr Julia Reynolds

Associate Director

Issues in Lancashire area

• Deprived population

• High rate of AF related strokes

• Confused messages about DOACs

• Hospitals and GPs who are enthusiastic about innovation

• Commitment to improve the warfarin pathway

• Commitment to bid for funds

• Mobilising communities - AF Ambassadors – throughout our regionDetect

Geno-type guided dosing (but not in East Lancs)

Digital opportunities - integrated systemsUsing Med Tech

Protect

• Self-monitoring - patients using warfarin

• Inhealthcare and INR Star/LumeriaPerfect

AF Ambassadors

50 PeopleVariety of

backgrounds

Over 1,000 tested with 64 positive

results

2.56 strokes avoided

Costs savings over 5 years

£153,600

Self monitoring for warfarin patients

Challenge

• Over 60% of AF patients prescribed warfarin

• Needs regular monitoring

• Challenging for patients and individuals to manage

• IG and digital tools

Opportunity

• Technology is NICE approved & evidence-based

• Use of hand-held monitors

• Digitally integrated systems

• Pathway revised

• Promote self management

Findings

200 patients

Hospital Trust and GP practices in

East Lancashire

Increased time in

therapeutic range

11.3 strokes avoided

Costs savings over

5 years £123,612

What do patients say?

“It’s so simple. It’s given me peace of mind, and I know it’s there in case I don’t think things are right. If I go to the dentist or have a shoulder injection I’ve got to stop warfarin. With self-monitoring I know I can come back and test my INR, and get it back to the level. It’s just peace of mind. I would recommend it to anybody. It’s wonderful..”

Rosalee Stevenson, 66 years – patient at Pendleside Medical Practice, Lancashire.

What do GPs say?

“We were struggling with anti-coagulation clinics – they were very busy and time consuming. It seemed there was a potential to reduce the time commitment for both patients coming in ans the nurses running the clinics. Patients could spend a lot of time trying to speak to practice nurses”

“The educational aspects of the app and digital tutorials help patients to increase knowledge of their condition and medication”

Dr Lucy Astle, GP Pendleside Medical Practice, Lancashire.

Genotype Guided Dosing

To determine whether genotype guided dosing (GGD) is beneficial and feasible in clinical practice

Three clinics (n=132), three comparator clinics (n=93)

Patients commencing warfarin for AF

Three clinics used GGD approach to determine dose for first 5 days (GGD arm)

Three clinics used local standard approach to determine dose for first 5 days (control arm)

From day 6 onwards, standard clinic care

Genotype Guided Dosing

TTR

61.9% (GGD) vs 55.4% (control);

p=0.002

More controlled patients

INR ≥ 4: 2.46% (GGD) vs 7.37% (control); p=0.06

Patients viewed GGD positively; majority grading

various aspects of the approach as “Very

acceptable” or “Acceptable”

Staff largely positiveabout their experience,

with only some expressing concern

about the additional time patients waited to

know their dose

Cost effectiveness analysis underway

Mobilise More…

Our next steps• Horizon scanning

• Getting peoples attention where care happens

• System-wide approaches to regional issues

• Partnerships – cross sector working

• Useful – materials/tool-kits

• Keeping what we care and reducing strokes at the heart of what we do

31 October, 2018eahsn.org | @TheEAHSN

Screening and Optimising Stroke Prevention

in Atrial Fibrillation (SOS-AF)

Dr Amanda Buttery, Atrial Fibrillation Programme Manager, Eastern AHSN

Clinical Lecturer (Hon) King’s College London

on behalf of the SOS-AF service at Cambridge University Hospitals NHS Foundation Trust

AHSN’s Going Further and Faster to Reduce AF Stroke

Heart Rhythm Congress (HRC) Birmingham

Wednesday 10th October 2018


• Overview of the Eastern AHSN region

• Development of the SOS-AF Service at Addenbrooke’s Hospital

• Achievements in the first 7 months : Results

• Next steps

Aims of the session


Cambridge

Norwich

Stevenage

Colchester

lpswichBedford

Our region

Cambridgeshire and Peterborough, Norfolk

and Waveney, Suffolk and north east Essex,

mid and south Essex, Hertfordshire and the

eastern border of Bedfordshire

• 6.4 million people

• 46 NHS organisations

• 52 local authorities

• Life science business sector support

• Innovation, business and research centres

across Cambridge, Stevenage, Chelmsford

and Norwich

• Eastern collaboration for leadership in applied

health research and care (CLAHRC) and

Clinical Research Network


Looking east and AF prevalence

• Across England AF prevalence varies 1.0 - 3.9%

• Eastern AHSN

Estimate AF prevalence (2017) = 2.55%

• North Norfolk CCG

Estimated 3.9% = 1,751 undiagnosed cases


• Burden of AF growing rapidly in secondary care

• 15% of acute medical admissions to CUH in 2014-2015

had AF - A stark contrast to previous estimates of AF in

acute admissions: ~3-6%

• On average, at least 1 new AF/day diagnosed in our

medical inpatients: 365 per yr

• Patients admitted to hospitals: older, multiple

comorbidities, at very high risk of ischaemic stroke

(median CHA2DS2-VASc score of 4.4)

Khadjooi et al, J Royal College of Physicians of Edinburgh 2018

Developing a new service: The baseline data


• Novel multidisciplinary stroke prevention service

2 Consultants, 1 Registrar and 2 specialist nurses

• Set up in October 2017 and aims to:

• increase the number of people provided with effective

anticoagulation medicines

• improve patient care between primary and secondary care

services.

• Provides:

• in-hospital active AF screening acute medical admissions

• risk stratification and balancing benefits/risks anticoagulation

• support for challenging cases – both primary and secondary care

• includes an outpatient service.

Screening and Optimising Stroke Prevention in

Atrial Fibrillation (SOS-AF) service


SOS-AF service: Results

In the first 7 months, 8933 inpatients screened:

• 247 new AF cases identified.

• Total interventions: 346

(either starting OAC, dose change, OAC change, or advised not to start due to risks)

• 36 changes to inappropriate anticoagulant choice or dose where sub-optimal stroke

prevention therapy was identified.

• Advised medical teams and GPs not to anticoagulate 69 patients, where the risks

outweigh the benefits, with clear documentation for future guidance.


SOS-AF service: Results

• Total number initiated on appropriate stroke prevention following our advice to

medical teams, GPs or in the clinic: 237 patients.

• Total AF-related strokes prevented in 7 months: at least 9-10

• Total number of potentially devastating strokes that can be prevented in 12 months:

at least 16-17

• Based on conservative estimates in general population, 25 patients need to be

anticoagulated to prevent 1 stroke, but patients in secondary care are at much higher

risk than general population.

• Our data shows AF among acute medical admissions has risen further to 21.3%


Awareness events and next steps

• Events and in the Media

• Addenbrookes public events – rhythm checks in outpatients

• East Anglian Press coverage and Cambridge TV

• Watch the 2 minute film about the June 2018 event at

Addenbrooke’s Hospital

https://www.eahsn.org/our-work/improving-health-

and-care/atrial-fibrillation/

• Next Steps

• Expand the service into other hospital areas

• Further develop primary care interface

• Spread and adopt in other hospitals

https://www.eahsn.org/our-work/improving-health-and-care/atrial-fibrillation/


Acknowledgements and funding

https://www.eahsn.org/resources/primary-care-

talks-podcasts/

Funding: SOS-AF was initially funded by the AHSN Network’s partnership with the Alliance

Anticoagulation Foundation for stroke prevention in AF.

Acknowledgements: All the SOS-AF staff at Cambridge University Hospitals NHS Foundation

Trust and collaborators in the Department of Public Health and Primary Care at University of

Cambridge.

Listen to our AF Podcast

https://www.eahsn.org/resources/primary-care-talks-podcasts/


Thank you and please get in touch

Dr Amanda Buttery

Eastern AHSN

[email protected]

EXCELLENCE IN ANTICOAGULANT CARE

Helen Williams FFRPS, FRPharmS, IPrescConsultant Pharmacist for CV Disease, South London

Clinical Lead for CVD, Lambeth and Southwark CCGs

Clinical Director for AF, Health Innovation Network

National Clinical Adviser for AF, AHSN Network

Excellence….why?

Definition: The quality of being outstanding or extremely good.

Why perfect anticoagulant care?• High risk medicine• Implicated in high proportion of medicines related hospital admissions and

incidents• When taken appropriately reduces stroke risk by two -thirds• But poorly managed anticoagulation worse than no therapy

– Potential catastrophic consequences

• And we know adherence to long term medicines is poor• Anticoagulation: clinical AND service / organisational challenges

– Poorly defined pathways / transitions of care

Some components of an excellent anticoagulation service for AF patients

• Designated clinical lead

Services should cover:• Patient education and counselling during initiation

and maintenance of treatment• Initiation and/or monitoring of vitamin K antagonist

treatment • Initiation and/or monitoring of DOAC treatment• Prescribing of anticoagulation medication• Management of bridging treatment / perioperative

anticoagulation• Cessation of anticoagulation treatment • Regular patient and medication review relevant to

AF and anticoagulation. • Service performance monitoring

• Services should be patient centred

• Services should be able to manage all patients with AF, regardless of the complexity of their medical conditions

• ‘ll patients for whom anticoagulation is indicated for stroke prevention in AF should have access to the full range of treatment options where clinically indicated

– Warfarin with opportunity for self-testing / managing where appropriate

– DOACs

• Initiation of anticoagulation

– Use of stroke and bleed risk tools

– Discussion with patient and carers to support informed decision making

• Support for medication adherence

Some components of an excellent anticoagulation service for AF patients

• High quality safe care for patients on vitamin K antagonist anticoagulants– Documentation of TTR– Review of patients with poor control

(e.g. TTR <65%). Aim to improve anticoagulation control with VKA or consider alternative strategy (e.g. DOACs)

• Appropriate and individualised frequency of review

• Protocols and referral mechanisms / pathways in place

• Training and support for providers

• Clinical Effectiveness & Clinical governance arrangements in place

• Services should be audited and reviewed at appropriate intervals

• Service capacity should be reviewed at reviewed at appropriate intervals

DOAC Uptake across England

Medicines Optimisation Dashboard 2017https://apps.nhsbsa.nhs.uk/MOD/AtlasCCGMedsOp/atlas.html

Variation in DOAC uptake by CCGS 27% - 96%

https://apps.nhsbsa.nhs.uk/MOD/AtlasCCGMedsOp/atlas.html

New Medicine Service (NMS)

Improve adherence10%

Checklist for Excellence

EXCELLENCE IN ANTICOAGULANT CARE

Helen Williams FFRPS, FRPharmS, IPrescConsultant Pharmacist for CV Disease, South London

Clinical Lead for CVD, Lambeth and Southwark CCGs

Clinical Director for AF, Health Innovation Network

National Clinical Adviser for AF, AHSN Network

Harnessing the skills of Specialist Pharmacists

Hannah Oatley

Clinical Innovation Adoption Manager

Oxford AHSN

Oxford AHSN AF programme

Detect Protect Perfect

14,000 undetected

6000 high-risk patients not prescribed anticoagulant

Estimated 5000patients poorly controlled on warfarin or on wrong dose DOAC

Collaborative projects

3 projects:

• Excellence in AF

• Specialist anticoagulation initiation in GP

practice

• Anticoagulation optimisation

Excellence in AF

• Buckinghamshire CCG• Joint working with Bayer• Concept adopted and adapted

from ‘Don’t wait to anticoagulate’

• Interface Clinical Services Audit• Local specialist pharmacists

supporting practices to review patients

• QI support to embed sustainable changes

The project

• 7700 patient records audited• 4400 patients reviewed (face to

face or desktop)• 296 patient added to AF register• 266 patients with AF

anticoagulated, 227 of whom high risk of stroke

• 91 fewer patients have poor TTR on warfarin

• 169 patients had DOAC dose corrected

• Projected stroke incidence reduced by up to 17 strokes

Results

Pharmacist-led anticoagulation initiation in primary care

• Berkshire East and Berkshire West CCGs

• Funded by Pfizer-BMS Alliance• Secondary care Pharmacist

based in GP practices• Initiated anticoagulation in new

AF patients• Optimised anticoagulation in

existing patients• Focus on high quality

consultation and counselling (30 minute appointments)

The project

• 371 patients reviewed in first phase

• Average age 79• Average stroke risk – 9% per

annum• 121 anticoagulation naïve

patients reviewed; 82 (67%) initiated on anticoagulation

• 250 warfarin patients reviewed – 131 (53%) transitioned to a DOAC

• GP feedback excellent• Project ongoing

Results to date

Oxfordshire anticoagulation optimisation

• Oxford University Hospitals NHS Foundation Trust

• Oxfordshire CCG• Funded from Pfizer (MEGS) and

Daiichi-Sankyo• Secondary care Pharmacists

providing focused education sessions and case review in GP practices

• GP backfill provided • Focus on patients with poor TTR

on warfarin

The project

• 55/70 practices chose to engage

• 580 patients had anticoagulation optimised

• GP feedback excellent• Business case for ongoing

commissioning agreed• Next steps – anticoagulation

naïve/wrong dose DOAC

Results

Common theme – Specialist pharmacists supporting primary care

• Pharmacists understand HOW patients take their medicines

Mrs P – had refused warfarin repeatedly as husband had previously had major bleed.

Exploration of her fears around bleeding and

counselling on her own personal stroke risk (>10% per

annum) resulted in her agreeing to try a DOAC.

Mr X had experienced side effects on twice-daily DOAC. Counselling revealed he was taking his doses at 10am and

2pm.

• Counselling : longer consultations than GPs can typically offer enable a full exploration of the risks and benefits of anticoagulation.

Detect Protect Perfect

Working with the industry to improve AF care

Faye EdwardsAF Programme ManagerAHSN Network

#AHSNs @AHSNNetwork

The NHS has hugepotential to be creative and innovate, yet remains slow to adoptinnovation, research and best practice

““

AHSNs mobilise expertise and knowledge across health and care, academia and industry to identify and pull transformative innovation into the NHS quickly.

A connected ‘Network of Networks’

We are catalysts for

innovation

We connect partners

across sectors

We create the right

conditions for change

We are a collective

Saving money

Improving lives

Driving economic growth

Our continuing mission is to find, develop and support healthcare innovation

AF Programme to date Across the AHSNs a variety of innovative projects are underway with support from industry. These projects all span the AF pathway

We need to continue to work with industry to achieve our ambitious plans to save over 1000 lives and prevent over 4000 AF strokes.

We want to hear from you!

Help us ‘horizon scan’

11.00 – 12.00 in Executive Room 1

Connect with us

ahsn national atrial fibrillation programme · the impact that could be made if the review work was...

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