Are your patients aware of their risk?
There are currently over one million people with atrial fibrillation (AF) in the UK. The risk of stroke is five times greater for people with AF and the condition is currently a contributing factor to 20% of strokes in the UK.
The incidence of AF increases with age – you are approximately twice as likely to have AF for every decade after 55.
Treatment for atrial fibrillation (AF)
Aspirin monotherapy is no longer recommended by NICE as a treatment for AF.
Almost all ischaemic stroke survivors will be put on anti-platelet medication such as aspirin or clopidogrel.
Anticoagulants (such as warfarin) are a much stronger version of blood-thinners and can be given to people with AF to reduce the risk of blood clots forming. But, anticoagulants continue to be under-prescribed. In the UK, around a quarter of eligible patients with AF do not receive anticoagulation.
It is estimated that if AF were adequately treated, around 7,000 strokes would be prevented and over 2,000 lives saved every year in England alone.
Less than half of UK patients with known AF are on anticoagulant medication when they go to hospital with a stroke.
Figures taken from the Stroke Association: State of the Nation 2017.
Treating AF to reduce the risk of stroke - a professional perspective
Managing AF to reduce the risk of stroke
To reduce the risk of AF-related stroke, all patients with AF should be appropriately anticoagulated. The number of preventable/avoidable AF-related strokes would be significantly reduced by improvements in the management of anticoagulation for AF.
Anticoagulation may be with either apixaban, dabigatran, rivaroxaban or a vitamin K antagonist such as warfarin, as recommended by NICE.
It's important that all available treatment options are considered, and a decision made between the patient and doctor based on individual needs and preferences.
Patient case studies
David Derrett talks about his experience of AF and stroke:
- Our AF: what you need to know leaflet includes an ideal AF patient pathway and useful advice for identifying, treating and managing AF.
- Our AF: how can we do better reports provide detailed information about diagnosis and treatment in CCGs across England.
- Our Atrial fibrillation factsheet offers detailed information around AF symptoms, different types of treatment and where you can find out more information.
- For statistics and key information about the prevalence of AF in the UK and the link between AF and stroke, take a look at our State of the Nation 2017 report.
- Hard copies of our factsheets and leaflets for patients are available to order from our online shop.
AF Business Case Model: Public Health England and the AHSNs have collaborated to create an AF Care Pathway Business Case Model. The model assesses each management opportunity in AF to identify any potential deficits in current care, the cost impact on the local health economy, and the number of strokes that could be prevented and lives saved as a result of improvements in anticoagulation treatment patterns.
Your organisation could use this model to review a set of specific interventions to address local needs, and evaluate the most efficient focus of investment and resources in their region.
Take a look at our Doctors.net microsite for information about AF detection, investigation and management, as well as some great best practice resources and downloadable leaflets. You can access the microsite using your login details.
Best practice case studies
Our best practice professional case studies detail some examples of the great work CCGs across the UK are doing to improve AF detection and management:
- Anticoagulant Programme - East London
- Anticoagulation decision support tool - Keele
- AF dashboard - West Midlands
- Bradford Healthy Hearts - Bradford
- Improving AF diagnosis and management - East Midlands
- Know Your Pulse events - Lancashire
- Buckinghamshire's 'Excellence in AF partnerships' project
If you would like to share details of some of the work in your area, please get in touch.
Resources for your patients
The video was developed by Wessex AHSN, in partnership with Royal Pharmaceutical Society and Hampshire Hospitals NHS Foundation Trust to support practitioners in their discussions with patients about anticoagulation, but can also be used as a tool that patients can return to after discussions in clinics. Please signpost your patients to this tool should they require more information about their anticoagulation treatment.
The video explains clotting and why abnormal clots can form as people age. The different types of medicines are shown, and Jack and his son discuss common concerns, side effects and sources of support.
Our AF: reducing your risk of stroke leaflet is a great source of information for patients with AF.