Since 2014 we have been working across Wessex to improve detection and management of patients with atrial fibrillation. Our 3 areas of work are detection, protection and perfection.
The diagnosis of AF is a key step to preventing strokes.
AF can be symptomatic, or asymptomatic, and can be persistent or paroxysmal (comes and goes). Mobile ECG technology can be used for fast screening in clinics, or loaned to patients to use in their own homes. It has the capacity to improve diagnosis and therefore prevent strokes.
In 2017/18 we were part of an NHS England scheme to distribute Mobile ECG devices for detection of AF. Our Professional Advisory Group selected the Kardia AliveCor device. During the project we found that devices were most effective when used in long term condition clinics, flu clinics and with practitioners who home visited, including proactive care teams, paramedics and out of hours doctors. You can read the full evaluation report: Evaluation of a national programme to roll-out mobile ECG devices or see the Seven Lessons for Digital Roll-out in Primary Care
In Wessex we have seen the AF register increase by 24% (18,156 people) between 2015 and 2019, and 84.6% of high risk patients are receiving anticoagulation.
Once AF is detected starting patients on appropriate anticoagulation is the next key step in effective management. Our projects are aimed at understanding anticoagulation in practice and developing educational resources to support clinicians.
A Pfizer Independent Grant for Learning and Change (IGLC) has enabled us to work with practices within Dorset CCG. We have supported practices in caseload audits to identify high risk patients who are not anticoagulated. We then work with GPs and practice pharmacists to improve their knowledge and skills in the management of anticoagulation of these often complex patients. This project is due to finish in the autumn of 2020 and the report will be shared when available.
Perfecting treatment of patients with Atrial Fibrillation includes optimising anticoagulation and supporting patients' self care. Our projects in this area have highlighted the role of community pharmacists in supporting patients adherence and understanding of their medicines. We have also developed a range of resources. (see our AF Resources section here).
Take a look at our film which shows how we have worked together to improve anticoagulation in atrial fibrillation in the community: