AHSN AF Programme The Results So Far Kate Mackay AF Programme Manager
Atrial Fibrillation Programme Aim To decrease the number of AF-related strokes by: Decreasing the prevalence gap and finding the missing Ensuring optimal treatment for those with detected AF
Projects CCG Engagement: Infographics tool AF Card Deck Local education event: today Opportunistic pulse checking using AliveCor Promotion of shared decision-making: training event June 2016 AF Review project in South Tees & North Yorkshire E-Learning: resource for primary care
AF Card Deck
Survey Results #1 58 responses r.r. 2.6%. GP = 81% Pharmacist =17% Area Prescribing Committee = 2%
Survey Results #2 67% had not seen the AF Card Deck. 42% who had seen the AF Card Deck used it. The best thing was clarity and easiness to read. The worst thing was its focus on NOACs. One thing to change varied in response but a few mentioned having it digitally or integrating into practice systems. http://www.ahsn-nenc.org.uk/wpcontent/uploads/2016/06/af_cards.pdf 16% of those seeing the AF Card Deck have changed their practice as a result.
Next Steps Update the AF Card Deck considering the responses received. Issue warfarin card to be included in the Deck.
Opportunistic pulse checking #1: Using AliveCor www.nice.org.uk/advice/mib35/chapter/technology-overview
Opportunistic pulse checking #1: Using AliveCor Areas participating are: DDES North Tyneside South Tyneside Northumberland Gateshead No of practices: 35
What do participating practices have to do? Attend 1.5 hours of training where they receive: FAQ Expectations sheet Protocol AliveCor Device AF Registers figures Collection of data quarterly: end of January 2017 end of April end of July end of October
Training Video https://www.ahsn-nenc.org.uk/programmes/atrialfibrillation/opportunistic-pulse-checks-alivecor/ Telephone support number Project Manager s contact details
Results to date: 11/181 detected abnormal heart rhythm i.e. 1 in 16 Interested? Please leave your name and contact details on the table
Opportunistic pulse checking #2: Diabetes Foot Check Durham and Darlington Podiatry Services (North Durham, Darlington & DDES CCG areas) ran a pilot project examining how many patients with previously unknown AF could be detected in the diabetes foot. Any patients detected with an irregular pulse were referred back to their GP for a 12-lead ECG to confirm or rule-out AF.
Opportunistic pulse checking #2: Diabetes Foot Check Results The pilot project ran for 3 months, from 1 st January 2016 31 st March 2016. The team of 45 podiatrists were trained prior to the project starting and continue to have updates. 15,873 (caveat) patients had their feet checked within the 3 month period. 10 patients were identified with previously unknown AF.
Opportunistic pulse checking #2: Diabetes Foot Check Results Extrapolating figures to 12 month indicates that 40 new patients could be identified annually across North Durham, Darlington and DDES CCGs. This would prevent 2 strokes per year a cost-saving of 46,630.
Opportunistic pulse checking #2: Diabetes Foot Check Learning Senior podiatrist to lead and drive the work. Staff felt their awareness of AF was raised and they could have a big impact on a patient s life even saving a life. Staff have their notes audited which encourages records to be completed. Spread and adopt this work through engagement with the Regional Podiatry Managers and the Northern Diabetes Footcare Network. Spread and adopt this work through engagement with other AHSN s in England.
AF Review South Tees & North Yorkshire The NHS South Tees Arrhythmia Service currently manages patients who are referred with AF by primary care. The team worked with the AHSN and industry to ensure all patients with AF are appropriately risk stratified, anti-coagulated and have a personalised package of care in line with NICE guidance. As part of the initiative the team offered to help with the review of patients currently registered as having AF. Work supported by a MEGS from Pfizer
AF Review South Tees & North Yorkshire Started in 2016. Recruited 12 practices in Wave 1 2474 patients on AF registers 427 patients had a desk-top review 174 patients reviewed by either the GP or seen in the nurse-led clinic
AF Review South Tees & North Yorkshire 28 patients anticoagulated following review 19 were taken off aspirin 29 patients were recorded to have AF with no supporting evidence. These were recommended to have further investigations such as 24 hour monitoring. Using these figures 1 stroke has already been prevented
AF Review South Tees & North Yorkshire Wave 2 7 further practices in South Tees 13 further practices in North Yorkshire
Engagement of NHS staff with other competing priorities. New technologies. Spread and adoption.
kate.mackay@ahsn-nenc.org.uk