Lord Ouseley – 2015 Parliamentary Question to the Department of Health
The below Parliamentary question was asked by Lord Ouseley on 2015-11-18.
To ask Her Majesty’s Government what action they are taking to increase the proportion of people with atrial fibrillation who are treated with anticoagulation therapy in order to prevent stroke.
Lord Prior of Brampton
NHS England has identified improved management of atrial fibrillation as a priority for reducing premature mortality.
NHS Improving Quality (NHS IQ) is taking action on atrial fibrillation. It is promoting the use of GRASP-AF (Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation) within GP practices in England. GRASP-AF is an audit tool developed by and trialled in the NHS, which greatly simplifies the process of identifying patients with atrial fibrillation who are not receiving the right management to help reduce their risk of stroke. NHS IQ is currently collaborating with partner organisations, including charities, to support the nationwide roll-out of GRASP-AF.
To support this work, NHS IQ recently published an analysis of the costs and benefits of using the anticoagulant drug warfarin to help prevent stroke in people with AF. A copy of this analysis is attached.
The National Institute for Health and Care Excellence (NICE) also published a Quality Standard on atrial fibrillation in July 2015, which sets out what a high quality atrial fibrillation service should look like and will help drive improvement locally. A copy is attached. The Quality and Outcomes Framework contains indicators for the management of AF which cover the use of anticoagulation therapy. This provides a further incentive for doctors to ensure AF patients receive anticoagulation where appropriate to manage their risk of stroke.
Public Health England (PHE) has recently published their Atlas of Variation which includes data on atrial fibrillation. Full data for all 216 clinical commissioning groups (CCGs) cannot be included in this reply due to its large size, but a map giving an overview of the results is attached. PHE have also collaborated with the Stroke Association to produce individualised CCG level reports on current performance in the detection and management of patients with atrial fibrillation to try and encourage poorly performing areas to improve.
The majority of the Strategic Clinical Networks (SCNs) have made atrial fibrillation management a priority, and in London the three Academic Health Science Networks and the SCN have identified atrial fibrillation as being the first area where there is a collaborative effort to improve performance.
One of the options now available for clinicians managing patients with atrial fibrillation is the novel oral anticoagulants. These drugs are useful when patients are unable or unwilling to tolerate warfarin and should result in a greater proportion of the population with atrial fibrillation being effectively treated. Additionally, NICE have now approved the use of devices to self-monitor warfarin, reducing the need for patients to attend health centres for blood testing. Again this should make anticoagulation easier and more acceptable for some patients.
