5 December, 2017eahsn.org | @TheEAHSN

Atrial Fibrillation: a priority in the stroke pathway

Dr Amanda Buttery, Atrial Fibrillation Programme Manager

East Regional Stroke Workshop

Wednesday 6th of December 2017

5 December, 2017eahsn.org | @TheEAHSN

AHSNs are driven by two imperatives:

improving health and generating economic

growth in our regions

• 15 Academic Health Science Networks across

England

• Licensed by NHS England

• Connect health and social care providers with

researchers and industry to accelerate the

spread of service and technology innovations

5 December, 2017eahsn.org | @TheEAHSN

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

5 December, 2017eahsn.org | @TheEAHSN

Our Improvement Programme

Our Atrial Fibrillation Programme fits within

our wider Improvement Programme.

• Building a Quality Improvement Infrastructure

for the Eastern region:

• Board programme

• QI Skills building

• LIFE QI platform

• Eastern Improvement Hub

• Eastern Improvement Network

• Q

• Delivering our Patient Safety Collaborative:

National Workstreams: Regional Workstreams:

• Culture

• Deterioration

• Maternity

Galvanisingpeople to advance health and wealth

Innovation and

economic growth

STP support unit

Network leadership

Improvement and Patient

Safety Collaborative

5 December, 2017eahsn.org | @TheEAHSN

• CVD Prevention – a must do for NHS sustainability

• Atrial fibrillation - 5-fold increase in stroke risk

• Anticoagulation reduces strokes by 2/3 in high risk AF

• Opportunities:

• 30% underdiagnosed

• Over half untreated or not optimally controlled

Atrial Fibrillation: A national priority

5 December, 2017eahsn.org | @TheEAHSN

5 December, 2017eahsn.org | @TheEAHSN

NHS England high value interventions in atrial fibrillation:

• Identify people with possible undiagnosed AF.

• Identify people with AF at high risk of stroke who are not anticoagulated or not maintained in the

therapeutic range.

• Undertake systematic audit in practices (GRASP-AF tool + Warfarin Patient Safety tool).

• Agree local clinical consensus and pathways for anticoagulation (including the place of direct oral

anticoagulants (DOACs)).

• Consider commissioning technologies to help detection (e.g. WatchBP, AliveCor) to support AF

detection in routine care.

So… time to talk solutions

5 December, 2017eahsn.org | @TheEAHSN

The AHSN Approach: Detect, Protect and Perfect

• Stroke caused by

AF tends to be

severe and is

associated with

significant mortality

and morbidity.– Professor Tony Rudd CBE

bit.ly/london-af

5 December, 2017eahsn.org | @TheEAHSN

The AHSN Approach: Detect, Protect and Perfect

5 December, 2017eahsn.org | @TheEAHSN

AF Care Pathway Business Case model

5 December, 2017eahsn.org | @TheEAHSN

Have you met Jack yet?

• The video shows Jack and his story of starting anticoagulant

medicines

• Great for patients and carers

• It can be viewed on the Eastern AHSN Improvement Hub

http://www.eahsn-hub.org/ or www.wessexahsn.org.uk/jack

5 December, 2017eahsn.org | @TheEAHSN

Join the Eastern Improvement Network

• Visit our website www.eahsn.org

• Please sign up to our

Improvement Newsletter

https://www.eahsn.org/resourc

es/improvement-newsletter-2/

5 December, 2017eahsn.org | @TheEAHSN

Thank you and please get in touch

Dr Amanda Buttery

Atrial Fibrillation Programme Manager

amanda.buttery@eahsn.org

5 December, 2017eahsn.org | @TheEAHSN

Useful Websites and References

• Eastern AHSN Improvement Hub. Available at: http://www.eahsn-hub.org/

• Eastern AHSN Atrial fibrillation care pathway business case model. Available at: https://www.eahsn.org/our-work/improving-health-and-care/af-care-pathway-business-case-model/

• AHSN Atrial Fibrillation Toolkit 2017. Available at: http://bit.ly/london-af

• Atrial Fibrillation Association (AFA). Available at: http://www.heartrhythmalliance.org/afa/uk

• European Society of Cardiology. Novel Oral Anticoagulants for Atrial Fibrillation -NOAC for AF Practical Guide. Available at: https://www.escardio.org/Guidelines/Recommended-Reading/Heart-Rhythm/Novel-Oral-Anticoagulants-for-Atrial-Fibrillation

• National Institute for Health and Care Excellence. Atrial fibrillation: management - Clinical guideline (CG180) - costing template. June 2014. Available at: https://www.nice.org.uk/guidance/cg180/resources/costing-template-243732205

• NHS Choices 2017. Atrial Fibrillation. Available at: https://www.nhs.uk/conditions/atrial-fibrillation/

• NHS England 2017. High value intervention in atrial fibrillation. Available at: https://www.england.nhs.uk/rightcare/products/pathways/cvd-pathway/af/

• NHS Healthcheck 2017. Size of the Prize: reducing heart attacks and strokes. Available at: http://www.healthcheck.nhs.uk/commissioners_and_providers/data/size_of_the_prize_reducing_heart_attacks_and_strokes/

• Ruff CT, Giugliano RP, Braunwald E et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin inpatients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 2014;383:955-62

• University of Nottingham GRASP-AF. Available at: http://www.nottingham.ac.uk/primis/tools-audits/tools-audits/grasp-af.aspx

• University of Edinburgh. Heart Education Awareness Resource and Training through E-learning. AF Module. https://www.heartelearning.org/