Atrial Fibrillation (AF) is the most common cause of an irregular heart rhythm and the cause of 20% of strokes. Despite the serious impact, many people are unaware they have the condition and Public Health England estimates that 300,000 people in England have undiagnosed AF. It occurs more often in people aged over 65 or with other long-term conditions, and it increases a person’s risk of stroke fivefold. Some people do not experience symptoms, which increases the likelihood of their AF remaining undiagnosed and places them at greatest risk of a stroke.
Strokes caused by AF are more likely to be fatal or leave a person with a severe disability, however, treating AF with anticoagulant (blood thinning) medication reduces the risk of stroke by up to two thirds. Despite this, even when diagnosed, many people with AF are not prescribed anticoagulation. In 2018/19 NHS Digital reported that there were more than 142,000 people in England with AF and at risk of stroke who were not receiving anticoagulation.
Driving the spread and adoption of AF best practice
Since 2017, the AHSN Network has been driving the spread and adoption of AF best practice across the country to improve care and outcomes for patients. This national programme of work has focussed on the three key elements of the AF pathway:
- Detect – Raising public awareness of AF and the importance of pulse rhythm testing to identify those with undiagnosed AF.
- Protect – Supporting healthcare professionals to offer optimal anticoagulation medication to all those who would benefit.
- Perfect – Supporting patients with their anticoagulation medication and supporting clinicians to review patients with AF.
Examples of our nationwide projects
Using digital technology to support AF diagnosis
In 2017, NHS England funded the AHSN Network to increase the uptake of innovative AF detection devices within the NHS, allowing us to support the detection of AF, the initiation of anticoagulation medication and develop a thorough understanding of the key elements required for a national roll out of technology.
Over the course of the project more than 6,000 AF detection devices were distributed across England to a huge variety of settings and staff groups, including GP surgeries, community pharmacies and allied health professionals. This technology detects irregular heart rhythms quickly and easily, enabling NHS staff to refer patients for the appropriate follow-up and treatment. AHSNs were on hand to deliver training, support and guidance. A full evaluation of this initiative is available here.
Increasing anticoagulant therapy – the AF Virtual Clinic Model
Based on a model developed in Lambeth and Southwark Clinical Commissioning Groups (CCGs), the AF Virtual Clinic model aims to optimise anticoagulation therapy in people with AF. It supports CCGs to deploy specialist anticoagulation pharmacists or nurses to work alongside GPs to identify and discuss treatment plans for people with high-risk AF, who are not prescribed anticoagulants. This approach provides specialist skills and expertise to the GP and enhances the communication between secondary and primary care.
This model has been widely rolled out by AHSNs. In 2019, NHS England funded a demonstrator project in 23 CCGs, supported by the AHSNs. This approach of utilising clinical specialists to support primary care is referenced in the NHS Long Term Plan.
Over the course of the national AHSN AF programme (2015/16 – 2018/19) our work has:
- Avoided 9,152 AF related strokes
- Saved 2,288 lives
- Helped 228,810 additional people to receive anticoagulation treatment.
This has saved the NHS in excess of £123 million* and resulted in cost savings of £82 million** in social care.
*Based on average £13,452 cost to the NHS in the first year following a stroke
**Based on average £8,977 social care costs in the first year following a stroke.
The AF Toolkit provides methodologies, resources and support for commissioners and clinicians working to reduce AF related strokes. The toolkit includes resources from across the AHSN Network.